It's Complicated

Question: Is Your Practice Under-Coding Insurance Claims?

You’re providing the highest possible quality care to your patients. But are you getting paid accurately for it? That’s the question all physicians occasionally ask themselves, and the answer is often “no.” Your practice is busy and claims go out to insurances every day, but cash flow is a problem, and your bottom line is just barely in the black.

But who’s to blame? Doctors are providing top-notch care. Coders are grinding away assigning ICD-10 codes. The billing manager is making sure the right modifiers are attached to the right CPT codes and that payer guidelines are met.

The answer is that getting paid by insurance companies these days can be extremely complicated.

Afraid of audits and repayments, physicians may lean toward under coding. But having a team of reimbursement specialist who can ensure every visit and procedure is coded accurately and to the highest level of specificity means you’ll be paid more accurately. And it’s why the best billing services won’t back down from a denied claim. They’re willing to fight for every dollar because they know that you did your job right, and they know how to do theirs at a high level of proficiency.

For example, instead of using S22009 (unspecified fracture of unspecified thoracic vertebra), a specialist would search the encounter for more information (or ping the physician) in order to enter S22009A (closed fracture), S22009B (open fracture), S22009D (with routine healing), S22009G (with delayed healing), S22009K (with nonunion), or S22009S (sequela).

Without first-class practice management software and a team of billing specialists to help your practice code to the highest level of specificity, all or many of your claims may be under-coded, and although it may seem like a safe route, it’s not as good as getting every penny you deserve—with confidence.

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