How to Put More Money in Your Pocket

Correct Coding is the Secret to Accurate Provider Payments
February 2012

Correct Coding is the Secret to Accurate Provider Payments

Can you really afford to leave money on the table instead of in your pocket? Submitting claims with accurate, complete and timely billing codes can favorably impact your bottom line.

Billing codes are a primary source of information about the delivery of services provided to L.A. Care members. The data is also used for reporting to various state and federal regulatory agencies and can affect capitation rates and plan ratings. For example, the new CMS Star Ratings program will influence incentive payments in the near future.

Here are L.A. Care’s top four billing code mistakes that can delay reimbursements and shortchange a practice:

• Using expired CPT codes. Make sure you have an up-to-date CPT code directory for your staff to use.

• Forgetting to code a procedure. Check patient charts to make sure all work is documented for billing.

• Using a generic vs. specific code (e.g., using a General Office Visit Code in place of a Well Care Visit Code). Undercoding is not the way to avoid an audit; truthful and accurate coding with documentation is the best policy.

• Not getting preauthorization. When necessary, be sure to get preauthorization for those medical services that require it. This way, you will receive timely payments for the services you provide.

Although most coding errors are usually minor oversights, they can lead to big dollars in unbilled revenue. The easiest solution is to check with billing staff to see if recurring but fixable errors are happening. Overall, correct coding results in faster payments, potential financial incentives and more money in your pocket.