OPTIMIZE YOUR REVENUE: ANSWERS TO YOUR TOUGHEST CODING AND BILLING QUESTIONS

By Elizabeth W. Woodcock, MBA, FACMPE, CPC

Gaining a handle on unpredictable coding and compliance issues is vital to a healthy bottom line, not to mention both employee and patient satisfaction. Without the right tools and processes in place to manage through these constant changes, a practice’s cash flow – and standing with both patient and employees – can quickly deteriorate. Here is a look at some of the common questions practices face, along with answers that will help keep you on the right side of payer policies and, ultimately, optimize reimbursement.

QUESTION: My office manager just brought to my attention that I’m paying 6% to process credit cards. This sounds like too much! Is there anything I can do?

ANSWER: Six percent is a lot – the average is 1-3%. You’re likely to gain savings by exploring a relationship with other merchant-account providers that offer credit cards. Be sure to evaluate your fees carefully to include the terminal and related equipment (e.g., PIN pad), up-charges for non-swipe transactions (e.g., on-line or direct keying), monthly statement and maintenance fees, and perhaps a dedicated phone line.

The American Medical Association (AMA) and the Medical Group Management Association (MGMA) offer access to discounts for their members, and some retailers like Costco offer access to discounted rates. If you choose to contract with your bank for the services, share other industry rates to aid in negotiations. Be sure to keep health savings accounts in mind – get a device which allows you to process payments from patients’ accounts. Visa and MasterCard offer Patient Easy Pay, and American Express has a similar program called HealthPay Plus. With cardholders’ permission, both programs allow you to automatically debit what you’re owed upon the adjudication of the claim and the notification of the patient’s financial responsibility.

Finally, I have recently encountered several businesses that charge extra for using a credit or debit card. To do so, you’d have to tell the patient upfront and offer them other options to pay. Don’t shoot yourself in the foot, however, by letting a 70-cent extra charge on a co-payment result in the patient not paying anything.

QUESTION: I’m giving FluMist to many patients this winter. How should I code it?

ANSWER: When you provide an intranasal immunization like FluMist, you should assign 90473 (immunization by intranasal route). In addition to the 90473, be sure to report 90660 (influenza virus vaccine, live, for intranasal use) for the vaccine itself. For the diagnosis code, use V04.81 (need for prophylactic vaccination against influenza).

In addition to the vaccine administration and product code, bill for applicable evaluation and management services with a modifier -25 to indicate “significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or service.”

QUESTION: We use relative value units to measure productivity, but we’ve run into some CPT® codes that have no units associated with them. What do we do?

ANSWER: Take the average charge per relative value unit from all known services, and then divide the charge for the code with no associated RVUs by the average.

To illustrate, let’s say your average charge per RVU is $40 (for example, you charge $80 for a code worth two RVUs). If the charge for your unlisted code is $160, the estimated RVU is 4.0. This estimate holds if your charges are on a relatively consistent scale. Notably, you can also use cost accounting to develop an estimate of the units by using the same logic of computing the average of all other services. Instead of charges, however, use costs.

QUESTION: How much should I pay a coder?

ANSWER: The American Academy of Professional Coders (AAPC) recently released a report on average salaries for physician-based coders. At single specialty practices and solo practices, coders earn 30,000-$35,000. At multi-specialty practices, pay averages $35,000-$40,000. You can hire a coder to work in your practice, or consider contracting with a coding consultant and/or an Internet-based coding advisor. Some specialty societies offer these services or evaluate options available from companies offering such.

Elizabeth Woodcock is the founder and principal of Woodcock & Associates, with 15 years experience in medical group operations and revenue cycle management. A speaker, trainer and author, Ms. Woodcock has led educational sessions for the Medical Group Management Association, the American College of Obstetricians & Gynecologists and the American Medical Association, and has consulted for clients as diverse as a solo orthopedic surgeon in rural Georgia to The Mayo Clinic. She is author of Mastering Patient Flow to Increase Efficiency and Earnings, and co-author of The Physician Billing Process: Avoiding Potholes in the Road to Getting Paid and Operating Policies and Procedures Manual for Medical Practices.

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