Coding; Billing; Reimbursement
Financial health and the very viability of any medical practice is largely a function of prompt and adequate compensation for services rendered. The comprehensive wound healing and hyperbaric medicine program is no exception. Listed below are some of many areas in which NBS has provided key guidance on behalf of client institutions.
Mis-coding: There frequently involves a disconnect between what appears to be the correct disease or procedure code and what a given payor requires to be reported in order to meet their definition of medical necessity for the very indication that the provider is managing.
Ever changing claim filing requirements: Those who purchase health care are constantly editing their reimbursement policies, sometimes in ways subtle enough to be missed by key provider personnel. For example, a reporting requirement based upon a newly added asterisk following a particular hyperbaric medicine diagnosis code continues to trip up unknowing providers. This can cause protracted insurer-provider communications and all too frequently results in providers giving up on a legitimate reimbursement claims. This is particularly the case with CMS/Medicare but does extend to almost every commercial payor.
Inadequate documentation: Many providers fail to adequately respond to insurance company requests for additional supportive information, resulting in payment denials.
If you are experiencing payment problems, or feel that an overview of your present claim filing processes would be beneficial, NBS would be pleased to discuss how we can help. You will be certain to benefit from the several decades of claims management experience and expertise our administration team has accumulated.