Description
Ensuring Proper Payment for the Medical Office
In the majority of healthcare cases poor reimbursement, improper coding, and documentation is the culprit.
Debra Mitchell – Insurance Coding and Billing for the Medical Office: 2019
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!!
Handouts
Manual – Insurance Coding and Billing for the Medical Office (5.89 MB) 158 Pages Available after Purchase
Outline
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 offâ€
Understanding the importance of physician profiling
News from the CMS front that may impact your billing
Faculty
Debra Mitchell, MSPH, CPC-HDebra Mitchell, MSPH, CPC-H, is a coding and compliance consultant and auditor, drawing from 30 years of experience in the field. She also shares her expertise through nationally presented continuing education events to benefit those working in various coding and billing roles. Debra has contributed to the development of a coding certification program and supervised a statewide Medicaid “peer review†program. Her commitment to the specialty is reflected as Debra maintains active membership in the American Academy of Professional Coders and is certified in hospital coding.
Speaker Disclosures:
Financial: Debra Mitchell receives a speaking honorarium from PESI, Inc.
Non-financial: Debra Mitchell is a member of the American Academy of Professional Coders.
