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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