5 Coding Compliance Questions for Medical Billing Companies

Here are the top coding compliance and education questions for medical billing companies

Coding education and compliance go hand in hand. That’s why it’s essential to team up with a leading medical billing company with deep expertise and up-to-date coding knowledge. Accurate coding means that your practice or department is equipped to remain compliant and ensure that all money due is collected. Here are five education and compliance related questions to see if your current coding solution is effective. Be sure to dig and look below the surface: when it comes to medical coding, what you don’t know can hurt your bottom line! Compliance Questions for Medical Billing Companies

     1. Does the billing company have the resources to provide quality coding input and feedback on an ongoing basis? 

Most companies say they do. But financial pressures have caused many companies to cut resources in this area. Ask your company for the percentage of staff who are certified coders. At AdvantEdge, over 20% of staff are certified coders, which enables clients the opportunity to secure feedback as needed and on a timely basis. This includes feedback on the accuracy of documentation and suggestions for improvement, all very important to ensure the practice is not perpetuating systemic errors or missing procedures that should be billed. 

In addition, if coders are unable to code a service due to documentation that is insufficient or reveals a conflict, the provider is immediately made aware of this finding so there is as little delay as possible in processing and submitting the claim. For example: A pathology order or cover sheet indicates five stains, but only four are documented in the report. AdvantEdge promptly notifies the provider to explain that the provider needs to create an addendum to add the fifth stain – or delete it on the bill. The same process applies in other specialties. For example, a radiology report that indicates a CT without contrast where the order indicates with and without. 

     2. How often does the billing company provide audits and quality feedback?

Coding reviews and audits take even more resources and skills than the feedback described above. Ask how often documentation is reviewed and audits performed. Does the company have certified auditors (CPMA) on staff? Every AdvantEdge coder is certified, and several have the  CPMA auditor credential as well. These auditors review charts from every provider and offer a scored documentation analysis, including justification and abstracting of their findings. For example: Was the reason for a less-than-optimal score due to insufficient documentation or because a procedure wasn’t properly indicated in the report? Another example is bundled services (especially common in orthopedics), where many services are rolled into the primary procedure. If a provider performed shoulder surgery, for example, he or she can’t normally submit a separate code for the debridement because it’s already part of the primary procedure. If AdvantEdge notices trends of coding errors or other inconsistencies, a root cause analysis is completed and followed up with a comprehensive action and provider education plan. 

     3. How does the billing company stay abreast of coding changes – and do they promptly share this information with their clients?

ICD-10 and CPT codes are updated annually and when needed, as with COVID-19 related updates. How does your billing company keep up? How do they train their coders? Does the medical billing company have enough resources to participate in industry seminars and association meetings covering all your specialties? After attending such events, AdvantEdge prepares comprehensive documentation for each specialty to keep healthcare providers current. In most cases, this documentation is sufficient for providers. However, AdvantEdge is available to providers who want more personalized training sessions to go over changes in further detail and to address additional questions. 

AdvantEdge also has certified coding trainers on staff to assure that all coders are up to date. You should ensure your billing or coding company provides that same level of service.

     4. Does the billing company offer customized support to clients introducing new services and procedures into their practice?

Partnering with a company that can help providers introduce new services and procedures is extremely valuable. Does the company offer clients documentation outlining the procedure, including coding guidelines? In instances involving difficult, challenging or experimental procedures/cases, does the company help providers with coding requirements to enable them to be properly reimbursed? Your billing or coding company should be  equipped, as AdvantEdge is, with the necessary coding expertise and technology to help clients incorporate new services and procedures into their practices. AdvantEdge conducts research and compiles a comprehensive report for providers outlining the details, along with coding documentation requirements.

     5. Does the billing company offer new clients assistance with prior coding concerns? 

It’s helpful for a medical billing company to be available to review a provider’s coding history once he or she is a client. During the implementation process the company should be reviewing past coding practices and workflows to identify any weaknesses or risks that could negatively impact revenue or create coding related compliance concerns. This should be specifically documented in the implementation plan and onboarding process.

We all know how important coding education and compliance are. But the only way to be sure your practice or department is getting proper support is to ask detailed questions, like the ones suggested above. Please contact us so that we can answer your specific questions: info@ahsrcmstg.wpengine.com or 855-501-1611. 

There you have it – our top 5 coding compliance questions for medical billing companies. Keep up to date on AdvantEdge and its medical billing initiatives by visiting our LinkedIn page.