Reduce Cardiology Denials with Proper Documentation

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(No Transcript)
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Reduce Cardiology Denials with Proper
Documentation
Importance of Proper Documentation in Cardiology
Billing A lot of cardiology claims got denied
due to improper and incomplete documentation.
Its really frustrating not to receive insurance
reimbursement for the delivered services, though
you completed all steps in cardiology medical
billing. While focussing on billing and coding
guidelines, sometimes cardiologists might not
maintain proper documentation. Proper
documentation is not only critical in justifying
medical necessity and selection of codes but
primarily it ensures accurate payments. Proper
documentation tells the story of a patient visit
by recording pertinent facts, findings, and
observations. Insurance carriers will refer
attached documents to verify coding choices, site
of service, medical necessity, appropriateness,
and accurate reporting of furnished services.
Lets see, how we can reduce cardiology denials
with proper documentation. Reduce Cardiology
Denials with Proper Documentation Avoiding
Identical Documentation One of the items that
the insurance carriers are looking into is
multiple office notes that seem to be cloned or
identical.  There are many pitfalls that you
can fall into using copy-and-paste option on
your electronic
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Reduce Cardiology Denials with Proper
Documentation

• health record (EHR). Medicare contractors have
  noted an increased frequency of medical records
  with identical documentation across services. By
  copying and pasting documentation from previous
  notes, cardiologists may document more complexity
  in a visit than necessary. You might even be
  surprised to see your own health assessment
  copied and pasted on another physicians note.
• Since the volume of documentation doesnt always
  determine the code, make sure the medical
  necessity warrants the appropriate code you have
  chosen for each visit.
• Some of the proper documentation tips for EHR are
  as follows
• Make sure that your review of systems is
  pertinent to the patients chief complaint
• Dont forget the prime rule, If its not
  documented it wasnt done
• Ensure that all EHR documentation authorship is
  accurately recorded
• Check that the automated code generated is
  associated with your documentation and correct
  based on your medical decision making
• Beware of fields that have automatically
  populated answers
• The EHR must still follow the same guidelines for
  documenting as when you documented in paper charts

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Reduce Cardiology Denials with Proper
Documentation

• Just because the information is found somewhere
  in the EHR, it will not be counted towards your
  documentation unless you note the date of service
  as a reference in your documentation
• Your note has to stand alone, applicable to
  complete EHR documentation
• Avoid Documentation Denials for E/M Coding
• In addition to the components of an evaluation
  and management (E/M) service, there are several
  principles of proper documentation that must be
  considered
• The medical record should be complete and legible
• If not documented, the rationale for ordering
  diagnostic and other ancillary services should be
  able to be inferred easily
• Past and present diagnoses should be accessible
  to the treating and/or consulting physician
• Appropriate health risk factors should be
  identified
• The patients progress, response to treatment,
  changes in treatment, and revision of diagnosis
  should be documented

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Reduce Cardiology Denials with Proper
Documentation

• The CPT and ICD-10-CM codes reported on the claim
  form or billing statement should be supported by
  the documentation in the medical record
• Insurance carriers will request medical records
  to compare billing (your choice of CPT
  and ICD-10 codes) with documentation. They will
  check for the site of service errors, the medical
  necessity, appropriateness of the diagnostic
  and/or therapeutic services provided, and an
  accurate reporting of services provided.
• Using Accurate POS Codes
• If your claims are being denied, it is important
  to make sure the information on your claims is
  correct. One of the billing issues identified by
  the government as problematic has to do with
  coding for the location where services have been
  provided. Recently, the Centers for Medicare and
  Medicaid Services (CMS) revised instructions for
  what Place of Service (POS) codes to use for your
  claims. These instructions, issued as a result of
  a report published by the Office of Inspector
  General (OIG) on improper coding practices by
  clinicians, are designed to reduce errors in POS
  coding. Specifically, they help cardiologists
  determine how to assign POS codes when
  interpreting diagnostic tests outside of the
  office setting. You can refer to the CMS webpage
  on the Place of Service (POS) code set for
  the complete list.

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Reduce Cardiology Denials with Proper
Documentation
POS codes must be assigned based on the setting
in which the beneficiary receives the
face-to-face service. Because most services
include a face-to-face component, this rule
applies to the overwhelming majority of services.
Where there is no face-to-face requirement, such
as where an interpretation of a diagnostic test
is performed remotely, you should use the POS
code for the setting in which the beneficiary
received the test (also referred to as the
technical component (TC)) of the test. This
determination is generally made easily when
distinguishing between a hospital and a
physicians office. However, it becomes much more
complex when services are provided in the
hospital because a determination will still need
to be made as to whether the patient is being
treated as an inpatient or an outpatient. When
reporting POS, CMS instructs providers to pay
more attention to the patients general inpatient
or outpatient hospital status, rather than the
precise inpatient or outpatient code. That said,
if you know that a determination has been made
regarding inpatient or outpatient status that is
what should be reported. We referred to
information available on CMS and the American
College of Cardiology websites to discuss, how to
reduce cardiology denials with proper
documentation. Medical Billers and Coders
(MBC) is a leading medical billing company
providing complete medical billing and coding
services.
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Reduce Cardiology Denials with Proper
Documentation
We can assist you in cardiology billing to get
accurate insurance reimbursement from private and
government insurance carriers. To know more about
our cardiology billing and coding services,
contact us at 888-357-3226 or drop an email
at info_at_medicalbillersandcoders.com.