July 2008

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Introduction to Neuromechanical Instrument Adjusting: Impulse Adjusting Technique

Better reimbursements, fewer audits

All healthcare providers were required to begin using a National Provider Identifier (NPI) in May 2008.

Available through the National Plan and Provider Enumeration System (NPPES), the NPI’s stated objective is “to improve the efficiency and effectiveness of the electronic transmission of health information.”

Part of that “efficiency and effectiveness” is easier monitoring of claims. Your NPI will enable Medicare and other third-party payer’s greater access to your clinic by way of profiling. If red flags pop up during this process, you can expect a probe audit to be ordered with a post-payment audit on the way.

Red flags are caused by incorrect coding. Proper training in coding is the only way to minimize the risk of audits and facilitate reimbursements from insurance companies.

Currently many billing clerks receive most of their training in two ways — from vendor-sponsored seminars or other employees (on-the-job training). Neither of these training methods is a good option because neither assures correct information.

• Vendor training. Despite good intentions, some vendors provide incorrect billing and coding information that could lead to a post-payment audit and result in large amounts of money being returned.

• On-the-job training. Your insurance clerk may process claims fast and have a good collection rate, but how do you know he or she is applying all of the correct codes?

If your clerk received on-the-job training, bad information may have been passed on. Your practice could be losing unclaimed revenues or it could be the target for a post-payment audit, if coding is incorrect.

Additionally, if your clerk does not have a way to keep up with the ever-changing world of compliant billing and coding, your practice can be losing revenue.

CERTIFICATION: THE REAL SOLUTION

Healthcare is changing; insurance-reimbursement is changing. To remain compliant, the only good solution is to have staff who are trained and certified in coding — a certified professional coder (CPC).

The American Academy of Professional Coders (AAPC) define a CPC as an individual who

• Determining correct coding for diagnoses, procedures, and services performed by physicians;

• Staying current with compliance issues, such as correct coding and medical necessity concepts;

• Performing internal audits on billing, coding, and documentation practices;

• Training doctors and other staff members on billing, coding, and compliance-related topics;

• Periodically providing you with up-to-date coding information from reliable sources, such as specific payers, the American Medical Association (AMA), and Centers for Medicare and Medicaid Services (CMS);

• Implementing new coding guidelines within your practice;

• Updating your clinic’s fee schedule based on annual relative value unit (RVU) updates and based on additions or deletions of procedure codes;

• Preparing and submitting completed CMS-1500 forms for services performed; and

• Evaluating explanations of benefits (EOBs) and filing appeals for denied claims.

The certification process is a 150- question multiple-choice test given in a five-hour period. It is administered through the AAPC.

After initial certification, a CPC must earn 18 continuing-education certification credits each year to remain certified.

Let your insurance staff do what they do best, but give them the tools to do their job. Give them appropriate training in coding and billing.

Medical practitioners have employed CPCs for a long time. Although chiropractic uses fewer codes, compliance is becoming more difficult as healthcare changes. It is time for the chiropractic profession to step up to another professional level. Having compliant billing, coding, and documentation will be paramount in maintaining or even maximizing your current level of income.

Ted A. Arkfeld, DC, MS, CICE, CPC, is the president of Advanced Compliance Technologies PLLC, a consulting firm specializing in compliance programs, billing, coding, and proper documentation. He can be reached at 989-614-0261, tarkfeld@arkfelcompliance.com, or through www.arkfeldcompliance.com.

For more information on coding certification and the American Academy of Professional Coders (AAPC), call 800-626-2633 or go to www.aapc.com.

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