The Number One Billing Problem...Coding Incorrectly
According to Revcycle Intelligence in 2016, the number one offender for billing denials is coding issues. This means that a biller will miss an add-on code, modifier, or get the procedure code wrong.
When it comes to mental health billing there are only a certain amount of codes possible for counseling services. This reality helps to reduce the amount of denied claims due to coding issues. However, there can still be issues when it comes to psychological testing or evaluation and management. Follow these three tips to help reduce denials due to coding issues.
1. If You Don't Know...Ask
As a clinician you want to focus on patient care and treatment, and probably are not the greatest fan of paperwork. Why should you be?
For mental health treatment it is important to know the various codes, so that when you do paperwork you only have to do it once. If you happen to be just starting, or are starting to offer new services that are billable to insurance and don't know the codes call a biller. They have the tools and resources to look up a code for you.
You don't want to deal with denial after denial because you have the wrong code.
2. Buy a Coding Book
Another way to ensure you have the right codes for your procedures is to buy a coding book or use a website. The American Academy of Professional Coders (AAPC) has some great resources for clinicians and billers alike when it comes to coding issues.
Once you have a coding book, don't be intimidated by the size of the book, but look for the section that applies to you. This will go a long way in reducing your denials due to a wrong code.
3. Have Detailed Documentation
The last way to reduce the amount of denials due to coding issues is to have detailed documentation. The way you know a code is correct is based on the documentation from the provider. Without the appropriate level of detail provided from the documentation or verbally communicated, the biller will almost always incorrectly bill.
It is crucial to clearly communicate what the service was in great detail so the biller can bill insurance correctly.
Hopefully, claim denials are not a pervasive issue for your practice. If they are follow these simple steps to start making a difference in your claim denials. If at any point you get stuck or the problem persists give a biller or a consultant a call and they should be able to assist you with further.