Medical Billing Challenges In Geriatrics - PowerPoint PPT Presentation

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Medical Billing Challenges In Geriatrics

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Compliant and accurate coding backed by comprehensive clinical documentation is crucial for ensuring physicians receive the highest level of reimbursement to which they are entitled. Inaccurate coding can delay payments, negatively impacting cash flow as insurance carriers withhold reimbursement until claims are corrected or appropriate supporting documents are received. – PowerPoint PPT presentation

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Title: Medical Billing Challenges In Geriatrics


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Medical Billing Challenges In Geriatrics
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Medical Billing Challenges In Geriatrics
  • Compliant and accurate coding backed by
    comprehensive clinical documentation is crucial
    for ensuring physicians receive the highest level
    of reimbursement to which they are entitled.
    Inaccurate coding can delay payments, negatively
    impacting cash flow as insurance carriers
    withhold reimbursement until claims are corrected
    or appropriate supporting documents are received.
    For providers who primarily provide care for
    older patients, the process is even more complex
    due to stringent Medicare regulations and
    idiosyncrasies specific to each care environment
    that impact the coding and documentation required
    for reimbursement. Caring for older patients
    typically involves managing multiple complex
    diagnoses that must be evaluated at each visit.
    During those same visits, physicians often need
    to address additional issues ranging from basic
    considerations such as flu shots to more complex
    chronic conditions such as renal disease or
    diabetes. This can lead to a number of coding
    issues, including failure to use appropriate code
    combinations and lack of specificity in the code
    ultimately selected. In this article, we have
    listed medical billing challenges in Geriatrics
    with respect to various place of service.
  • Ambulatory Setting
  • Many tests or procedures may be performed in the
    clinic, and Medicare is likely to bundle and
    reduce payment unless medical necessity is met.
    Coders must utilize documentation guidelines for
    coding and meet typical auditing standards.
  • In many cases, failure to use the correct bundle
    can result in denial of payment. In other
    instances, using individual rather than bundled
    codes can reduce reimbursement rates, as the
    latter typically reflects higher severity. More
    often than not, these coding issues can be
    resolved with improved clinical documentation.

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Medical Billing Challenges In Geriatrics
  • When a coder seeks additional information to
    determine whether a higher-level code is
    warranted, it delays billing and slows the
    overall revenue cycle. Conversely, if
    documentation is insufficient to support a
    higher-severity code, the claim is likely to be
    denied or care billed at a lower reimbursement
    level. It can also impact whether or not the
    payer considers the care medically necessary.
  • Things gets more challenging for those practices
    and facilities that have not yet made the leap to
    electronic documentation and coding systems.
    Paper-based documentation and coding systems are
    highly prone to human error that can wreak havoc
    on the bottom line.
  • Home Healthcare
  • Human error and incomplete or insufficient
    documentation are the primary culprits behind
    coding and billing problems within the home
    health sector. That standardized data-gathering
    tool drives the plan of care for the patient, the
    coding and sequencing, and thus the
    reimbursement. The challenge is the skill of each
    clinician, which can impact the assessment of the
    environment, severity of illness, ability to
    communicate.
  • The first is a requirement for documentation of a
    face-to-face encounter with a physician or a
    nurse practitioner prior to admission of a
    Medicare beneficiary to home care. This applies
    to patients referred by hospitalists as well as
    by physicians from all inpatient settings, such
    as rehab facilities and skilled nursing
    facilities (SNFs). The real issue is documenting
    the encounter, the date, and the reason for the
    visit.

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Medical Billing Challenges In Geriatrics
  • Another challenge is, physicians to personally
    sign and date all orders for a patients care
    before a claim can be filed with Medicare for
    reimbursement. In the past, when undated
    documents were received from physicians,
    intermediaries had been permitted to date stamp
    them to show when they were received by the home
    health provider. This will cause additional
    workflow for physicians because we must return
    paperwork back to their office for dating.
  • SNFs, ALFs, and Hospice
  • Related to documentation issues, another
    challenge for many physician practices is
    accurately coding for place of service. The
    challenge has assumed new prominence as patients
    are moved more quickly from higher-cost inpatient
    settings to specialty settings, including
    rehabilitation facilities, SNFs, and assisted
    living facilities (ALFs).
  • The most significant challenge in these settings
    lies in understanding how Medicare reimburses for
    care provided. Like ambulatory care, which codes
    and bills based on diagnosis and treatment, there
    are edits for SNFs that establish limitations on
    services based on a diagnosis in combination with
    a procedure or a service code.
  • Those limitations can be for daily services,
    across a month, or a limitation or guideline
    thats recommended for a certain type of service,
    such as physical therapy or occupational therapy,
    for an annual benefit period. So, understanding
    the benefits their patients can receive is
    important.
  • Attempting to bill for services that fall outside
    the established limitations or guidelines will
    result in denial or delayed payment while the
    claim is corrected. What makes coding and billing
    for care in this setting even more challenging is
    that those delays impact not only the physician
    submitting the claim, but can also impact any
    other physician or provider who is part of that
    patients care team.

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Medical Billing Challenges In Geriatrics
  • Physician services rendered to hospice patients
    produce yet another challenge in terms of coding
    and billing. Expenses for most services provided
    for hospice care are bundled and paid under a
    consolidated billing system. Hospice enrollment
    requires a physician to certify that a patient
    has a terminal condition supported by a medically
    appropriate and necessary plan for palliative
    care. The problem is that not all conditions or
    services are related to the hospice care plan
    therefore, in these situations, a physician
    deserves additional reimbursement. Physicians and
    support staff need to have solid working
    relationships with the (hospice agency and/or
    ALF) as well as have coders expert enough to
    recognize this is a hospice situation and apply
    the appropriate modifier.
  • Medical billing for Geriatrics is a challenging
    task requiring experts at all stages of revenue
    cycle management. Hiring such billing and coding
    experts for your practice may not be financially
    feasible due to unavailability of Geriatrics
    coders and billers. Medisys Data Solutions can
    assist you in Geriatrics billing for your
    practice. Our Geriatrics billers and coders will
    submit your claims accurately and assist you in
    receiving accurate insurance reimbursements. To
    know more about our Geriatrics billing and coding
    services, contact us at info_at_medisysdata.com/
    302-261-9187

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