Communication image/ Improving Healthcare Profitability for Providers

Improving healthcare profitability for providers can make a world of difference for an organization.

The first two blog posts on improving profitability were about reducing no shows and collection at point of service.  Today’s post will be on the importance of corect coding.  We will use the example of outpatient psychiatric services but the concept holds true for any situation.  You as providers need to make sure the services that are being delivered are coded accurately and correctly thus maximizing reimbursement for services rendered. Letr’s discuss our latest piece: Improving Healthcare Profitability for Providers Part 3: Optimizing Coding.

Challenges Providers May Experience With Incorrect Coding

For healthcare providers, accurate coding is pivotal for seamless operations. When providers grapple with incorrect coding, a series of challenges unfold, impacting their efficiency. Billing errors, stemming from coding inaccuracies, lead to claim rejections and payment delays, demanding additional time and resources for rectification.

Beyond operational disruptions, inaccurate coding exposes providers to compliance risks and potential legal consequences, accompanied by financial penalties. Providers find themselves dedicating more time to documentation reviews and coding audits, diverting attention from core patient care.

Ultimately, the repercussions extend to the financial realm. Revenue loss isn’t solely a result of denied or delayed claims but also stems from the resources invested in correcting these errors. To support providers in maintaining operational smoothness and financial stability, prioritizing accurate coding is crucial. Robust systems and continuous training become indispensable to navigate the challenges associated with incorrect coding effectively.

Improving Healthcare Profitability for Providers

All E/M and psychiatry codes are currently included in Category I. Nearly 1/3 of all services reported by physicians are E/M services. The CPT codes reported on the health insurance claim form or billing statement should be supported by the documentation in the medical record.  Three similar CPT codes:  90862, 90805, 99214. All three have different requirements and significantly different reimbursement rates.  In fact if your practices is billing $100,000 per year in  90862 but are actually delivering a more comprehensive service ( as most of our clients do) than by correctly coding the practice can bill an addition $67,000 by correctly coding and documenting services delivered.  That is a 67 percent increase.

The exact codes are determined by the combination of different levels of history taking, examination, and medical decision-making performed by a physician or certain face to face time.The following components are used to determine the level of E/M service: History, Examination, Medical decision making, Counseling, Coordination of care, Nature of presenting problem, Time.

Correct documentation is critical and cannot be addressed here.  For correct E&M coding either time or complexity of patient encounter is the critical factor.  Please contact us for more information on how your healthcare entity can improve it’s bottom line.

 different requirements and significantly different payments