Managing a healthcare practice comes with a long list of complex challenges that need to be solved on a daily basis. Anyone who is involved in the operational aspects of a medical integrated office or healthcare facility understands that there are many situations that require making educated and rule-based decisions based on a variety of factors.

Dr. Dahan, COA’s senior consultant, has established over 1256 integrated medical centers in 45 states for the last 26 years and therefore has an unprecedented advantage over any competition. Since 1994, he has designed a comprehensive database of codes and billing methods for each state. Reports show that many clinics fail miserably to successfully collect on the services they perform because they are simply not trained properly. These clinics are performing the services, but they are not getting paid the full fees they deserve.

Here is a brief overview of critical protocols which require careful attention:

Diagnosis:

Doctors need to know how to choose the most relevant diagnosis which must not only reflect the correct code describing the patient’s condition but will also be accepted and reimbursed by the payor. The applicable diagnosis must also be listed in a precise order to demonstrate relevancy; this process done incorrectly will not only delay payment but could most likely deny full treatment approval.

Fee schedule and codes bundling:

Another common mistake is not knowing how to choose a legitimate fee schedule which must be precisely selected to support a reasonable percentile according to each local demographic. All codes must be skillfully organized and or bundled. However, although code bundling can be beneficial in many instances, there is potential for issues to occur when a patient requires a service that doesn’t fall into a set of codes that can be bundled. This again, can put a provider at risk for not being reimbursed for the additional services. In this situation, there is also unfortunately the potential for a healthcare provider to avoid performing a particular service or procedure, or to bill the patient more than they should, in order to ensure they receive full payment for all procedures provided. This tactic of over-billing is referred to as upcoding, and is an illegal medical practice.

CPT Modifiers:

In cases where procedures are altered from the norm, or additional services are added, code modifiers are used to reflect the changes for billing and reimbursement purposes. In some cases, a healthcare billing professional may forget to include the correct modifiers with their CPT codes, which again prevents the provider from receiving the full reimbursement for the services performed. Or, on the other hand, the payer may overlook a CPT modifier and therefore reimburse less than what is due to the provider.

When done correctly, CPT code bundling and using modifiers does improve the billing and collecting process for healthcare practices.

Reading the few comments listed above, one can easily realize why it is very important for all professionals to be properly trained and to understand how to use the different types of medical codes and modifiers correctly when considering medical integration.

The Nation’s #1 Medical Integration Program

COA’s Medical Integration is USA’s most trusted and reputable program. Dr. Dahan, America’s most recognized leading expert authority on Medical Integration has guided thousands of doctors reach their ultimate potentials. Dr. Dahan owned and managed his two clinics for twelve years in Southern California before he became a consultant. His direct and simple approach as well as his ability to take very complex business and life issues and translate them into real life lessons, has been the hallmark of his success. In the fall of 2019, Dr. Dahan was exclusively chosen to host the Doctors Daily Live Radio Show, addressing physicians’ issues while influencing doctors to reach higher potentials. With brilliant marketing strategies, unmatched healthcare consulting experience and clinic integration expertise, Dr. Dahan has so much to offer. A gifted speaker and accomplished writer, Dr. Dahan shares his advice in his unique, informative manner. His Wisdom Podcasts are downloaded by 52,000 global listeners daily. Dr. Dahan also writes blogs for the VJ Posts and has appeared on the Charlie Harary Radio Show. 

https://www.medirevv.com/blog/6-actionable-tips-to-improve-medical-coding-operations

https://www.lightspeedinc.com/five-rules-to-improve-coding-efficiency-throughput-and-accuracy/

https://www.physicianspractice.com/coding/five-ways-improve-coding-your-medical-practice

https://www.m-scribe.com/blog/improved-medical-coding-efficiency-improves-your-bottom-line