Diagnosis Codes & Procedure codes/Editing of invoices

[jamiepec]

Who does the coding in your office? Is it the doctor, tech, or billing coordinator? 
If Doc, how do you handle corrections of codes? Who does this? 
Does this have an affect on correcting invoices that were posted at sign out? 

[friscoeyeassociates]

The doc codes at the end of examination and those codes transfer to the bill via the routing slip. Our Insurance Coordinator files all claims and will correct coding issues as they present themselves, with the input from the doctor if needed. For example we may want to bill a patient's contact lenses as medically necessary, but that requires certain medical conditions be present in order to be reimbursed. If a doc forgets to put a proper diag code in for this type of reimbursement she will go to that doctor and inquire as to which diag code they intend to use for medically necessary.

At this time I don't believe Crystal permanently connects the Diag codes in the bill to the encounter so if you do change diag codes after the fact you will need to change them in both the bill AND the medical record.

Correcting codes on a particular invoice does not affect the validity of the invoice as a whole, even if that invoice is from a previous day..

In my opinion, this is one of the larger responsibilities of the "billing" or "insurance" coordinator.. And it is another reason that person should probably be one of the most knowledgeable and better paid employees of your practice. Depending on the size of the office, this may be all that this person does. We are lucky to have one of the best around I think, and she does a fantastic job of staying on top of what can and cannot be billed and getting us the maximum reimbursement for our services. But to more directly answer your question, she handles ALL of the corrections made to diag codes on invoices and she does these corrections post check out almost 100% of the time as we typically collect payment at time of service.

[jamiepec]

Great feedback....Thank you!
I am having difficulty because as it is now, we do not invoice patients while they are in the office, at sign out. We post payments to a blank invoice, and once our billing coordinator corrects any diagnosis or procedure codes that were made in error, and then edits the invoice (blank, with only a payment applied to it) to complete the visit.

We are new to Crystal, and in our old system it HAD to be done this way, but trying to show her that you can still do all of that and allow the front desk to turn a route slip (even if the coding needs fixing) into an invoice and post the charges to that invoice has presented a challenge.

I would love to see how other offices do this, from check in to check out.

[vaderkty]

THE NEW UP ARROWS TO LUMP THE MED AND ROUTINE CODES IS A GREAT NEW FEATURE. MY DR HAS A "QUICK LIST" I SET UP OF "THE USUAL SUSPECTS" AND EITHER PERSON BILLING OUT OR INSURANCE BILLER (ME) ADJUSTS ACCORDING TO CLAIM TYPE. THIS IS WHERE THE "ON HOLD" AND NOTES IN THE ACTUAL ECLAIMS COMES IN VERY HANDY FOR MY OPTICIANS AND FRONT DESK TO CHECK OVER ANYTHING ON HOLD, IN THEIR FREE TIME.

I ALSO SET UP THE 1 CLICK PROCEDURE CODES SO A COMPLEX CONTACT HAS EVERYTHING IN ONE CLICK AND A PREVIOUS EYE EXAM HAS IT'S OWN SET. MAKES FOR QUICK BILLING ON A 72 YEAR OLD, COMPUTER CHALLENGED, TO STILL WORK SYSTEM LIKE A PRO.

[jerry]

Hi, folks.....Just dipping my toe in the water and trying EMR. First question is, on the A&E page, the entire list of diagnoses on the right side: Is there any rhyme or reason as to the order of the buttons? And some of the abbreviations make no sense at all to me (the doc). Any way to memorize or rearrange them? TIA.....Jerry

[jamiepec]

Hi Jerry -
YES, you can change the names, abbreviations, order, color, etc. I would call Erica and have her assist you! You need to get into the EDIT TEMPLATE mode and it can be very overwhelming until you figure out how to use it!

[jamiepec]

Sept 14, 2016 14:28:29 GMT -6 friscoeyeassociates said:

The doc codes at the end of examination and those codes transfer to the bill via the routing slip. Our Insurance Coordinator files all claims and will correct coding issues as they present themselves, with the input from the doctor if needed. For example we may want to bill a patient's contact lenses as medically necessary, but that requires certain medical conditions be present in order to be reimbursed. If a doc forgets to put a proper diag code in for this type of reimbursement she will go to that doctor and inquire as to which diag code they intend to use for medically necessary.

At this time I don't believe Crystal permanently connects the Diag codes in the bill to the encounter so if you do change diag codes after the fact you will need to change them in both the bill AND the medical record.

Correcting codes on a particular invoice does not affect the validity of the invoice as a whole, even if that invoice is from a previous day..

In my opinion, this is one of the larger responsibilities of the "billing" or "insurance" coordinator.. And it is another reason that person should probably be one of the most knowledgeable and better paid employees of your practice. Depending on the size of the office, this may be all that this person does. We are lucky to have one of the best around I think, and she does a fantastic job of staying on top of what can and cannot be billed and getting us the maximum reimbursement for our services. But to more directly answer your question, she handles ALL of the corrections made to diag codes on invoices and she does these corrections post check out almost 100% of the time as we typically collect payment at time of service.

I was just reviewing feedback on here and came up with another question. How does your front desk handle patient check-out and collecting the appropriate fees? 
How do you handle collecting fees when the exam is being billed to medical insurance but the receptionist doesnt know that and she accidentally collects, and posts the invoice, thinking that we are billing routine?
We are just going  "live" with patient check-out and trying to figure out all the issues before they arise. 
From what I understand, the front desk will enter the patients insurance info, and plug in their co-payments on the patient tab. Then once they create an invoice, all they have to do is select which insurance is being billed and that co-payment will populate?
Also - is there a way to automatically set up discounts for, lets say, Medicare patients who pay the refraction out-of-pocket? OR do we need to go in and add discount to the line every time discounts are necessary?
Thanks again for the feedback!!

[friscoeyeassociates]

At our office it is the responsibility of the technician or doctor that is dropping the patient off at the front desk post exam to let the front desk associate know if we intend to bill an exam to medical insurance. But We also train our front desk staff to be aware of what may cause an exam to be billed medically as opposed to routine in case the tech or doc forgets to let them know. It is pretty straight forward because in terms of services, vision insurances basically only pay for routine annual health visits and a refraction. As soon as someone at the front desk sees anything other than those two types of services on a bill it should be an automatic red flag that they need to possibly look further into how to check this patient out. Due to our training, it is automatically a red flag to our staff if medical line items and routine vision line items make it onto the same bill. For instance, if a patient makes it to the front desk and the staff member sees a bill with 4 different line items on it: Comprehensive Exam, Refraction, Visual Field, OCT, then that staff member knows immediately that patient had more than routine vision services today. Often they will go to the insurance coordinators office in these situations just to quickly make sure medical benefits were pulled for that service date and everything is in order and that we are billing services in such a way that the patient is getting their best value. In the example mentioned previously, maybe the patient was diabetic and we would bill to patient's medical insurance for Routine exam, OCT, and VF and they would pay refraction out of pocket ($30 at our office). I dont believe you can bill both vision and medical insurance for the same encounter, so in some instances it may be less expensive for the patient to split up the testing into two different encounters, especially if they have a medical plan that makes them pay a percentage of usual and customary charges. Come in, have routine visit, pay your vision insurance copay. Then come back a week later and do your OCT/VF and bill those to medical. Many clinicians prefer that second option anyways because it allows you to bill for 2 separate encounters and potentially get more reimbursement, but we always give our patients the option of doing it same day if they want. Sometimes the time is more valuable to them. Coming back for a second visit is a hassle. So, it is nuanced, and it takes time for staff to wrap their heads around it, but the basics are not difficult.

To answer the other question of co payments auto populating once entered into patient insurance tab.. This is the case BUT in my honest opinion I don't think it is wise to ever be complacent or satisfied with staff relying on the software to do it for them.. Also, it is really only useful for Vision Insurances that have exam co-pays. Sure, sometimes a medical plan will be easy and just be a copay for whatever a patient needs done. More often than not though medical insurance coverage is much more variable. There are deductibles that need to be met before certain benefits kick in, sometimes plans don't have copays at all and patients owe a percentage of usual and customary charges. It is really all over the map. One of the techniques I use in my training is to teach staff "Closing Moves". This is a technique for learning complicated games like chess that can be applied to many different things. If you try to train and go over every little nuance of each insurance company and the way they bill, staff will probably be overwhelmed or miss a lot of it. However, if you begin training by only going over the "Closing Moves" first then your staff can more naturally branch off that foundation because their knowledge of the end game is well ingrained. The analogy with chess would be to take most of the other pawns off the board and practice just defending your king in end game situations, and get a really good idea of what is and is not a good position for your king to be in, this way you will see those positions coming in advance while playing and will hopefully be able to make adjustments as you learn and get better. I usually start by showing staff a multitude of bills with different scenarios that have been done incorrectly before I ever show them anything being done correctly.. This instills in them a watchful eye, and forces them to approach each bill with the "is there anything out of place here" mentality. Over time, with that mentality, staff can build a really robust understanding. We are also particularly lucky to have a very knowledgeable and dedicated insurance coordinator on staff that the front desk can consult if they get to a "Closing Move" and don't know what to do.

For the last question- You should have 2 different line items for each exam that you are billing to insurance, whether its medical or vision. You should always have one Comprehensive Exam line item (92004, or 92014) and one refraction line item (92015). In the case of a Medicare patient you would bill the Exam line to Medicare, and the refraction line would be out of pocket. The only time we combine the exam charge and refraction charge is if a patient is Self Pay and not using insurance of any kind. In these cases we use the single codes S0621 for established patients and S0620 for New Patients, and bill it all in one lump sum.

[nick]

Jan 10, 2017 12:47:05 GMT -6 jamiepec said:

Also - is there a way to automatically set up discounts for, lets say, Medicare patients who pay the refraction out-of-pocket? OR do we need to go in and add discount to the line every time discounts are necessary?
Thanks again for the feedback!!

You can set up fee schedules for each insurance individually on the admin->insurance->fee schedule tab. I've got my 15% off type discount plans set up that way and it works well. As far as I know you cannot use a percentage discount on individual billing codes, but you can set a specific fee.