New Year Resolutions for the Medical Biller

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  • 8/7/2019 New Year Resolutions for the Medical Biller


    Review Fee Schedule When was the last time you

    reviewed your fee schedule? I have asked this

    question of many practice managers, and I have

    heard answers from "annually" to "never." If you

    are not reviewing your fee schedule on an annual

    basis, there is a good chance that your practice is

    losing money. On many occasions, the amount a

    practice charges for a procedure is below the

    maximum allowed by the carrier. Not surpris-

    ingly, when this is the case, the

    carrier gladly pays the lesser

    amount. So if a carrier will pay

    $80.00 for CPT 99214 and you billonly $70.00, the carrier will pay

    you $70.00. Thus, even though

    you collected 100% of the charge,

    you just lost $10.00!

    There are many places where you

    can find helpful information when

    reviewing your fee schedule.

    Many look to the Medicare

    schedule and set their fees at a multiple of what

    Medicare pays for a particular procedure. For

    example, if Medicare pays $65.00 for a 99213,

    some practices will set their fees at twice that

    amount; in this case, $130.00.

    As the calendar has now turned to a new year, I

    am sure that many of you out there have made

    your New Year resolutions. I always like making

    resolutions, because I look at them as a way to set

    goals and apply the necessary focus toward

    achieving them. Goal setting, whether personal or

    professional, can motivate us and those around us.

    With an eye to medical billing, there are several

    resolutions that you can make as we

    head into the year ahead:

    Revise Superbill One of the mostimportant documents in your billing

    workflow is your superbill. As we all

    know, a good superbill contains the

    most commonly used CPT and ICD-9

    codes in your practice. Unfortunately,

    in many practices, superbills contain

    deleted codes. If these codes are used

    to bill for a procedure, the claim will

    be denied. By carefully reviewing all

    codes on your superbill, you are forcing yourself

    to stay current on all coding updates affecting

    your practice. I have always believed that a

    superbill is akin to the foundation of a house. If it

    is accurate and complete, it will serve as solid

    underpinning for your billing department.

    Goal setting,

    whether personal or

    professional, can

    motivate us and

    those around us.

    New Year Resolutionsfor the Medical Billerby Ronald E. Nyman, Esq.

  • 8/7/2019 New Year Resolutions for the Medical Biller



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    not had time to do it as each days work seems torun into the next. Just as Julie Andrews once said

    "Manners matter," I would say, "Coding counts."

    It is generally accepted these days that practices

    lose significant amounts of money due to

    inaccurate or incorrect coding. Coding seminars

    can help to address this problem by teaching you

    which codes to use in which situations and by

    alerting you to any new coding changes on the

    horizon. For those of you who are really

    motivated, you might decide to become a

    Certified Coder. Organizations such as the

    American Academy of Professional Coders

    (AAPC) will provide certification to those who

    can pass its rigorous exam requirements.

    I know that there are many other resolutions that

    you can make for the year but the above three are

    always tops on my list.

    May you have a Happy and Prosperous New


    Ronald E. Nyman, Esq. is founder and president

    of Medi-Claim Services, Inc.

    Others, including myself, refer to Medical FeeSchedule guides which show varying fee

    percentiles for each code. These fee percentiles

    50%, 75%, and 90% show what providers

    charge across a broad spectrum. For example, for

    99201, the 50th percentile fee is $65.00, which

    means that 50% of doctors charge above this fee

    and 50% charge below it. The 75th percentile fee

    is $75.00, which means that 25% of doctors

    charge above and 75% charge below this amount.

    For practices where the providers participate in all

    major plans, it might make sense to set your fees

    in the 75th percentile as this ensures that you will

    never bill below the maximum reimbursement

    allowed by any particular carrier. Moreover,

    having your fees in this higher range does not

    adversely affect your patients because your

    providers participate with the major plans.

    Attend Coding Classes Okay, you have beentelling yourself forever that you would attend all

    those coding classes that would help improve your

    practice reimbursement. However, you just have


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