The rules and regulations regarding claims submissions changes virtually every week. Extensive and detailed CPT and ICD-10 coding expertise and understanding modifiers and medical necessity criteria play a vital role in getting the claims paid.
Even with the best team of billers and a clean claim generated by a quality Practice Management System, it cannot and frequently does not assure proper payment. So, the next step is crucial.
Getting paid for CPT codes that the provider has billed but were denied due to incorrect coding, incorrect or misuse of modifiers, and improper carrier bundling or unbundling has to be done as soon as the denial is received. It takes a knowledgeable staff to go after the money that was not paid.
Sending operative notes doesn’t help if the denial was the result of an incorrect modifier. Progress notes are ineffective if the incorrect diagnosis code was billed. Staff needs to know what battle to fight. And ours does. All of our staff are Certified Dermatology Coders. That puts our team way ahead of the “competition.”
The only way to ascertain the strength and power of your billing team is to look at the monthly reports. But who has the time to go through hundreds of pages of lengthy and confusing reports each month? Don’t you just want to know the bottom line? We now offer all of our clients monthly reports that give you the bottom line of how your practice is doing.
At a glance, the one-page summaries allow you to easily determine the productivity of each provider (e.g., gross charges, adjustments, net receipts, status of AR revenues outstanding, adjustment ratios, and percentage of claims over 90 days). You can see how each provider is doing at each location and/or the practice as a whole.
