ICD-10 CLINICAL CONCEPTS FOR FAMILY PRACTICE & CODING GUIDELINES

A family practice specialist deals with patients of all ages, making this field of medicine the most unique of all. Therefore, it requires in-depth knowledge of all the medical procedures and diagnoses involved in a family practice to deliver premium quality medical coding services.

Since family practice healthcare providers usually specialise in more than one medical field, which makes it even harder to comply with their all responsibilities and filing medical bills for their hard-earned services efficiently and accurately simultaneously.

However, well-experienced family practice medical billing and coding specialists can tune their workflow in order to pace with the busy schedule of family practitioners by adopting the following strategies.

Set Your Goal Beforehand

While generating revenue is the primary objective of family practice medical billing and coding specialists, however, they have to take some measures to reach their goal that are as follows:

• Increase clean claim rate (claims that are error-free and get reimbursed at the first attempt of submission). For this purpose, family practice medical billers and coders should deploy innovative billing solutions that can automate their workflow, prevent human errors and verify documentation before carrying out billing tasks.
• Make sure that they comply with the timelines of all inusrance payers to submit clean medical claims before the given deadline of payers. If medical claims are submitted on time then it reduces the number of claim denials/rejection which definitely improve the revenue flow across the healthcare practice.
• Deploy reliable solutions for claim denial management everytime to combat revenue related problems smartly. No matter how hard you try to verify documents, coverage plan and eliminate errors, claim denials are inevitable in family practice. Because nobody can predict when billing and coding rules, patient’s demographics and payer’s requirements can change. However, even if you have received a claim denial then it’s your responsibility to scrub the claim and appeal the insurance company on time. For this purpose, a healthcare provider should have a dedicated team of medical billing experts that are dedicated to manage claim denials and follow up with the insurance companies.
• When working for a family practice, a medical billing specialist should leave a medical claim unattended after submission. Instead, an expert medical biller follow up with all medical claims from clearing houses to insurance companies for adjudication. If a clearing house indicates the revision of claim denials then your medical billing team should adjudicate claims and resubmit to collect reimbursement without more delays.
• Lastly, family practice medical billers are the financial power house of your practice. Therefore, they should regularly remind your payers to collect your reimbursements on time. If any insurance company or patient is making delays with payments then your team should contact them anyway to inform them about their financial responsibilities. Sometimes, patients are unable to understand their billing statements, therefore, family practice medical billers should guide them and family practitioners should provide multiple payment methods to patients so they can pay their dues at their earliest convenience.

 

Stay Updated With Changes & Updates Of Medical Codes:

One of the biggest challenges for family practice coding specialists is to comply with constant changes in ICD and CPT codes. Family practice’s most revenue comes from ICD-10 and CPT codes. That’s why, family practice medical coders should verify and use accurate medical codes while preparing medical claims.

Every year, ICD codes manuals and documentation guidelines are updated for the healthcare providers. Therefore, medical coders should make sure that they use the most upgraded form of ICD codes in the way healthcare insurance companies recognize them.

For example, the industry has moved from ICD-9 to ICD-10 then ICD-10-CM codes, and those medical coders who aren’t acquaint with these updates are more likely to apply wrong medical codes in medical claims.

In such cases, when medical claims are submitted to insurance companies then they are denied or rejected. Therefore, its important to update the amendments in codes to submit error-free medical claims.

Justify Necessity Of The Service Provided:

Prior authorization or precertification is the process to ensure that service, prescription of lab test that is going to be delivered to the patient is covered by their insurance plan. Prior authorization is carried out before the services, products or medications are delivered to the patient.s that are used to deliver cardiology care and diagnostic services.

If the medical staff won’t proceed with prior authorization then they can never come to know who is the right payer of patient. It increases the chance of submitting medical claims to wrong payers. Therefore, medical billing and coding specialists should verify patient’s coverage plan and submit medical claims to the right payers.

Ensure Accuracy Of Medical Codes:

As mentioned earlier that family practice medical coding specialists should use the most latest version of medical codes (i.e. approved by the legal institutes and recognized by insurance companies).

Moreover, medical coders should represent specificity of the disease, service or medication with accurate modifiers and specifiers. For example, in case of headache, ICD-10-CM R51 is not a billable code because there are other codes that define the specificity of headache under this codes i.e. R51.0 is billable code used specifically for headache with orthostatic component.

Avoid Error In Documenting E/M services:

E/M services(Evaluation and Management) is the medical coding process to support the medical billing process and get reimbursements from Centers for Medicare and Medicaid (CMS).

ealthcare providers require E/M coding services to report their services for (that are delivered for decision making) during inpatient services, hospital visits and outpatient facility visits. The three major components of E/M coding services are as follows;

• Patient history
• Examination
• Medical Decision Making (MDM)

When family practice medical coders are using E/M codes then they should verify documents and use appropriate level of codes to avoid any ambiguity or error during family practice coding services.

Using The Accurate Modifier:

Using a modifier comes with a set of special requirements. Family practice coding specialists should understand the specificity of these requirements to use accurate modifiers. Incorrect modifiers cause claim denials that trigger delayed payments and lower reimbursements rates.

If you’re running an independent family practice or associated with a health organisation, CureCloudMD provides the most reliable and cost-effective medical billing services to all sizes of family practices. Schedule a free demo of our family practice medical billing and coding outsourcing services for an added boost of business productivity.