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Attributing Correct ICD-10 and CPT® Codes

November 1, 2019

Avoiding Lost Revenue and Maximizing Reimbursement with ICD-10 and CPT® Codes

Hospitals and ASCs experience preventable monetary losses all too often. Precise medical billing and coding is vital because the success of healthcare businesses relies on the accuracy of procedure codes.

Still, unfortunately, Medicare lost $31.6 billion to billing and coding errors in 2018.

Medical revenue cycles are drastically affected when facilities are not reimbursed properly for maneuvers completed during procedures. Yet certain mistakes are more common than others. According to healthcare media site RevCycle Intelligence, the following errors lead directly to lost revenue in the medical industry.

  • Incorrectly capturing or failing to capture relevant patient information
  • Avoiding properly informing patients about their financial responsibility for some procedures
  • Inaccurately identifying ICD-10 and CPT® codes for reimbursement
  • Manually conducting claims procedures

Combating common billing and ICD-10 and CPT® coding errors

Facilities facing loss due to claim denials and reimbursement errors should attempt to resolve the issues quickly. According to research conducted by RevCycle Intelligence, hospitals and ASCs may wish to:

Review patient information to avoid claim denials

Reimbursement delays due to incorrect patient information can leave facilities unable to receive reimbursement before the next billing cycle. All clinicians should ensure they are recording patient information correctly, from the spelling of a patient’s name to the documentation of a patient’s procedure and follow-up.

Discuss patient insurance coverage to quicken payment

Many patients are unaware of the financial costs associated with certain procedures. Discuss patient responsibilities, as well as insurance coverage, so that patients understand how much they will owe your facility.

Train clinical staff to increase reimbursement

Physicians may have vague procedure notes, illegible handwriting or improperly documented surgical maneuvers. Billing and coding specialists may mistakenly interpret physician notes incorrectly, resulting in denied claims. Worse, coding specialists may choose the wrong ICD-10 or CPT® code altogether. Combat inaccurate coding by consistently training staff members to ensure they’re up to date on the latest codes.

Employ an automated coding system to verify medical coding

Manually managing the claims process creates a burden that falls on administrative individuals. Although ICD-10 codes and CPT® codes are assigned based on procedures performed, human error is common. Perhaps your facility would want to explore a solution that automatically attributes coding based on the procedure notes.

To see how Provation® Apex automates procedure note coding, watch this quick demo.

CPT is a registered trademark of the American Medical Association.