Welcome to this McVey Seminars presentations on Coding & Billing for your specialty. As reimbursement rates go down it becomes crucial to code and maximize your resources, and efficiency. We wish to first share an overall “position” from our experiences with thousands of participants over the past 38 years.
Reminder: there are no "secret codes" for better payment. However, it seems as if there are interdependent steps that can be taken to ensure proper coding and obtain rightful reimbursement.
One of our goals is to share the insights of successful Physician reimbursement. For instance, some attendees assume one coding approach works for all insurance carriers / administrators. Others feel that if they are aligned with the Medicare Carrier it should work for all others. Still, others seem to believe that there are guidelines for all carriers and hope that “right-will-out,” and that they will be vindicated against the carrier. We ask your willingness to suspend such positions until the seminar is over.
Our experience dictates several “points of information” to recall for successful coding & reimbursement.
1. There is contract insurance (HMO, PPO, EPO, etc....) private indemnity (no contract) insurance, and Medicare (CMS/Medicaid). When you accept a contract patient, you must be knowledgable in the contract rules or suffer the inevitable consequences of down-coding, lower & non-payments or, even worse, penalties. You must also continue to stay updated in Medicare Coverage Policies & Decisions (LCD's).
2. Private indemnity insurance only has a contract with the patient, unless you are the "participating physician" in that plan or accept assignment. If so, the physician has chosen to join the “loop” and is responsible for knowing the business rules of that carrier.
3. There are thousands of insurance plans each having administrators. Therefore, there seem to be just as many philosophies for interpreting your coding approach.
4. There is also the patient out of pocket obligation that must be included in your collection efforts.
No one technique or approach works all the time. Success comes from trying different approaches and using what's best. Being willing to change or modify your approach every 6 to 12 months, or fight for your rights with administrative review, is the real world of insurance reimbursements.
We are here to share our experiences in what does and does not work. Please accept our invitation in adding to the shared knowledge at our specialty seminars.
Sincerely,
Laura Petersen
McVey Seminars
