March 27, 2018–Did you receive BCBS’ August 2017 newsletter announcing their code-editing process? Then you probably have already felt the impact of the implementation of this process. The code-edit was designed to focus on use of modifiers -25 and -59. If you are receiving denials, more than likely the code-edit is not to blame. The code-edit just ‘catches’ claims that are billed incorrectly. But in some cases, the coding edit has ‘trapped’ perfectly correct claims being adjudicated against the wrong edit.
Unfortunately, it appears that providers may be rendering the services and documenting them correctly, but all of this is lost when they submit the claim. It often dependent on two factors: incorrect data entry or practice management software that is faulty when it comes to generating data in the correct fields. Appealing these improperly denied claims is a must not only for your office but for the overarching correction of the faulty edit.
How can you make sure that all your hard work is not being destroyed by faulty billing? If you find that you are making coding mistakes, what can you do to resolve them? And, what if after researching your billing process you find that you have billed correctly, how can you manage the appeals process? For answers to these questions and information on taking a pro-active approach, visit KMC University here: https://www.kmcuniversity.com/overwhelmed-therapy-denials-bcbs
Source: KMC University