Hospitals that own physician practices are held accountable for coding and billing mistakes by the practice, including audits by recovery audit contractors. To prevent these errors, hospital leaders should be aware of common billing and coding mistakes in physician practices. George Conomikes, president and CEO of consulting firm Conomikes Associates, shares issues that raise red flags for RACs.
Red flags
One of the most common coding and billing errors is overcoding high levels of services. Well-patient office visits have five coding levels, with each subsequent level representing increased services and therefore increased reimbursement. Mr. Conomikes says overcoding for level four and five is a red flag for RACs because it suggests the practice may be overbilling Medicare. Similarly, subsequent hospital care has three levels. A high percentage of level three codes may make physician practices vulnerable to RACs.
Another red flag for RACs are large group practices, simply because a greater number of physicians increases the likelihood of finding a coding or billing error. Being aware of large group practices' increased vulnerability can help hospital leaders prepare for RACs.
To avoid billing and coding errors, Mr. Conomikes suggests physicians and physician practices' billing staff attend coding seminars, which many healthcare associations offer. Coding education can help physicians not only avoid overbilling Medicare, but also not billing Medicare enough. "[Many physicians will] code just about everything at level three because they really don't know that some of their visits qualify for level four and five," Mr. Conomikes says. Out of a fear of being audited, physicians may be losing out on increased reimbursement. "Every physician that we have pushed to go to a coding seminar has come back and said, 'I'm coding better and making more money. And that day or two that I spent was a great investment.'"
Learn more about Conomikes Associates.
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Red flags
One of the most common coding and billing errors is overcoding high levels of services. Well-patient office visits have five coding levels, with each subsequent level representing increased services and therefore increased reimbursement. Mr. Conomikes says overcoding for level four and five is a red flag for RACs because it suggests the practice may be overbilling Medicare. Similarly, subsequent hospital care has three levels. A high percentage of level three codes may make physician practices vulnerable to RACs.
Another red flag for RACs are large group practices, simply because a greater number of physicians increases the likelihood of finding a coding or billing error. Being aware of large group practices' increased vulnerability can help hospital leaders prepare for RACs.
To avoid billing and coding errors, Mr. Conomikes suggests physicians and physician practices' billing staff attend coding seminars, which many healthcare associations offer. Coding education can help physicians not only avoid overbilling Medicare, but also not billing Medicare enough. "[Many physicians will] code just about everything at level three because they really don't know that some of their visits qualify for level four and five," Mr. Conomikes says. Out of a fear of being audited, physicians may be losing out on increased reimbursement. "Every physician that we have pushed to go to a coding seminar has come back and said, 'I'm coding better and making more money. And that day or two that I spent was a great investment.'"
Learn more about Conomikes Associates.
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Medicaid RACs Can Save Up to $10B, PRGX CEO Says