Studies show that more doctor’s offices and clinics are hiring healthcare and hospital consultants to help them ensure clinical coding optimization and compliance for medical billing services. Not only will non-compliance mean more denied or rejected claims, resulting in a loss of revenue, but it can also lead to severe penalties. ENT account management must include ensuring that staff gets proper training and that the right software, systems, and processes are in place to ensure that all coding resources are current and up-to-date. The healthcare industry is continually changing and expanding, which means that staying on top of coding compliance and optimization is now more important than ever.

Increased Enforcement Initiatives

In addition to all of the changes made to billing and coding through the use of ICD-10, healthcare providers are bound by increased initiatives to enforce compliance. Just some of the governing bodies include the United States Department of Justice (USDOJ), the Office of the Inspector General (OIG), and the Centers for Medicare & Medicaid Services (CMS). There are also many different national and state accreditation bodies that clinical coding compliance for medical billing services and ENT account management fall under in the United States.

Practice and hospital consultants are working overtime to ensure that their clients are fully compliant. If small issues aren’t caught early before they become big problems, it can mean lots of fines, penalties, and costs associated with resolving the issues to prevent them from happening again in the future. It is important to have your current system for medical billing and coding reviewed by a professional consultant who specializes in working with your field. Implementing a compliance program can help to prevent issues from occurring, but it will need to be reviewed, updated, and renewed occasionally. Your medical billing team will also need training and to be kept current on the best coding practices.

Common Medical Coding Issues

It is important to know how to identify red flags when you see them that are indicative of common medical coding issues. These can help you realize when it is time to hire practice or hospital consultants to assist with clinical coding optimization. Whether you submit your staff to training, provide support, or decide to outsource your medical billing services until you can get them under control, just make sure you do something.

Some of the signs associated with coding issues include:

  • undercoding – results in lost revenues and can also be a red flag for an audit
  • upcoding – occurs when a coder can’t find a specific code for a procedure; however, instead of using the wrong code, the coder should report that the missing code and provide appropriate documentation
  • unbundling – breaking down common procedure codes into individual codes
  • undocumented – submitting bills that were not checked against the clinical documentation or that do not have the proper documentation for reimbursement
  • understanding – it is important that coders understand payer guidelines and submit the right codes where the diagnosis justifies the test, procedure, or treatment that is provided to prevent reporting multiple services that should not be billed together

What You Can Do

The first thing you need to do is to evaluate your risk for an audit. In particular, specialty group practices, including Otolaryngology, need to review the coding patterns of all physicians to ensure that they meet all of the national and state standards for the specialty. This is why it is important to work with practice and hospital consultants who can provide evaluations, audits, reviews, and training for medical billing services that also specialize in your specialty. MD Pro Solutions has over 45 years of working with ENT account management specifically, so we really know the ins and outs of clinical coding optimization for Otolaryngology practices and clinics.

If you do your medical billing and coding in-house, your staff needs an update on a regular basis. Continuing education is critical to the success of your practice, so it should be provided to your billing department and front office staff to ensure that everyone understands and is up-to-date on compliance rules and regulations. If you outsource your medical billing and coding, make sure to review your associate agreements with the service to ensure that the company is providing you with quality services for optimal ENT account management and reliable medical billing services. Call MD Pro Solutions today at 508-946-1665 to schedule an evaluation or to learn more about the services we provide.