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    It's time to declare war on costly billing mistakes

    Here are the mistakes seen most frequently—and how you can eradicate them from your practice


    Common points of failure

    Here are just a few examples of areas and actions that we see as common points of failure during the billing process.

    Pre-service: Incorrect demographic data, inaccurate insurance/coverage information, prior authorization. Solution:

    • Attention to detail by practice staff, including collecting all required information, scanning documents, and entering data correctly and in the correct fields.
    • Leverage all available tools: Understand your practice management system, upgrade when required, conduct routine training, find external tools and plug-ins to address deficiencies, analyze performance, and provide feedback to your team.
    • Collect before or at the time of service any co-payments, co-insurance, and past due balances. Setting proper expectations is half the battle. Communicate with your patients and provide accurate and complete information.
    • Be patient and be diligent, but move forward.

    Encounter: Failure to report all services provided, incomplete documentation, inadequate communication from provider to billing department, and inaccurate coding, including the wrong level of evaluation and management service provided. Solution:

    • Proper and consistent communication, including feedback among clinical and administration, is required.
    • Double checks in the protocol are a must. Do not rely solely on your EMR code (E/M) calculator. Review coding—both manual and automated—regularly, with a focus on accuracy. Both upcoding and downcoding should be addressed through training.
    • Understanding of service coding is beneficial for both data input accuracy and output accuracy. Lead by example; a physician who does not care about coding accuracy may be perceived as not caring about billing accuracy. Your staff will follow your lead. Online video and in-person seminars targeted to physicians are available from the AUA, Physician Reimbursement Services Network, and other sources; use them all.
    • Continuous training of billing staff and clinical staff, including quick reference material, such as the “Pocket Card” and auacodingtoday.com, are invaluable. Use multiple sources and assess both learned and retained information.

    Billing: Improper modifier use. Two specific examples follow.

    Example 1: Modifier –25 is both overused and underused due to a lack of understanding of how it should be used. Solution:

    • Updated, accurate, practice-wide policies and training to promote consistent application and understanding of proper use are essential for both data input (chart documentation) and output (coding and billing).
    • Understand payer-specific requirements for use of this modifier relative to diagnosis and service combinations.

    Example 2: Modifier –59 and the “X” modifiers. The problem here is overuse and misuse. Solution:

    • Practice-wide policies and training to promote consistent documentation for services that may require use of modifier –59 or –X (E, S, P, U) modifiers should be implemented.
    • Billing staff, including certified professional coders, will need to continue educational updates and obtain practical experience with payers for each practice.
    • Consistent communication pathways among clinical and administrative staff should be developed to include messaging and meetings with specific, targeted agendas.

    Next: Follow-up

    Ray Painter, MD
    Urologist Ray Painter, MD, is president of Physician Reimbursement Systems, Inc., in Denver, and is also publisher of Urology Coding and ...
    Mark Painter
    Mark Painter is CEO of PRS Urology SC in Denver.


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