Question

If you were the manager of a medical - office, how would you help the physician in getting maximum reimbursement for the Services provided.

Answer 1

Reimbursement is actually paid based on the patient diagnostic codes or the patient abstract which contains CPT codes for that particular encounter visit.

Both ICD 10 codes and CPT i.e. Current Procedure Terminology codes are utmost important for the reimbursement process.

As a manager of a Medical office I must be aware of the process. The process is in certain steps.

1. When I assigned a particular auditor to check every step of reimbursement, my initial step is TO CHECK DOCUMENTATION

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Rationale : All ICD 10 codes and CPT codes are coded in the coding abstract of the patient records based on the clinical documentation made by the physician. So there is a need to check all the documents to find any sources of conditions which can be claimed high and those should be added to the existing documentation and modify the ICD 10 codes in the abstract session by contraction CDS personnel i.e. Clinical Documentation Specialist.

E.g. If patient was coded as Sepsis unspecified organ in A41.9

there is a chance of less pay, and if we find the source of organ dysfunction , along with SIRS this can be coded as Severe Sepsis R65 where reimbursement would be highly paid.

Next step is timely submission of claims with in 15 days.

If payment was done well and good if not then go and revise all CPT and ICD Codes, then think about the modifiers.

After making minor changes , will submit it again

Above all the mentioned attempts can help my physician to reimburse more amount.

Hope it's useful