Insurance Coding and Billing for the Medical Office: 2019 – Debra Mitchell

Ensuring Proper Payment for the Medical Office

In the majority of healthcare cases poor reimbursement, improper coding, and documentation is the culprit. While it is important to be paid for the services rendered by our providers, it is also important for the claims to be accurately coded. If we recognize that claims are a reflection of the patient, as well as the provider office, then the services and the diagnoses billed must be those which are documented in the medical record. Dealing with denied and rejected claims can be costly and frustrating! Not to mention ever-changing healthcare guidelines, laws, and codes.

This recording is designed to help you understand the claims process and avoid unnecessary back-end work, achieving optimal reimbursement, THE FIRST TIME, and success for your medical office. Develop a better understanding of how to effectively utilize CPT, ICD-10-CM, HCPCS II, and modifier codes to ensure proper payment. This course is a MUST for anyone who is involved in coding, billing, or reimbursement for the physician practice—including the physicians themselves!!

1. Maximize your reimbursement by emphasizing proper coding
2. Outline the 2019 changes to ICD-10-CM and CPT codes and how they affect your practice
3. Identify when to use attachments
4. Explain how to treat medical necessity denials
5. Assess what ICD-10-CM denials are most popular common
6. Discuss tips and techniques to obtain optimal and timely reimbursement
7. Examine bundling and how or when to unbundle codes
8. Illustrate proper submission of incident-to claims
9. Recognize what downcoding is and how to fight it and avoid it

FIRST LOOK AT 2019

• The coding process
• What to expect for 2019
• The OIG Work Plan
• Proper use of prolonged time codes – how this can help your practice, immediately

THE CODING PROCESS IN THE CHANGING HEALTHCARE ENVIRONMENT

• 2019 ICD-10-CM codes—a closer look
• OIG work plan issues for physician billing
• An overview of CPT changes
• Modifiers and which ones can enhance reimbursement
• Unraveling the complexities of Medicare, Medicaid, and Third Party Insurance

NAVIGATING THE INS AND OUTS OF THE CLAIMS SUBMISSION PROCESS

• Know when documentation must be submitted with the claim
• The elements of an incident-to claim
• Recognize CCI edits (bundling) and understand how and when to unbundle

DOCUMENTATION, DOCUMENTATION

• What to do if you have been downcoded
• How to analyze and solve difficult billing problems
• What to look for with a denial for medical necessity
• Understand what to use from the documentation for an appeal or correction

EFFECTIVE TECHNIQUES FOR BETTER BILLING

• How to avoid the most common errors
• Know when to appeal and when to “write it off”
• Understanding the importance of physician profiling
• News from the CMS front that may impact your billing