by Meghann Drella | Jun 12, 2019 | Awareness Month, Blog
June is “National Scleroderma Awareness Month”, meant to highlight the gravity of the chronic autoimmune disease scleroderma, with no known cause or cure. Sponsored by the Scleroderma Foundation (a nonprofit organization dedicated to serving the needs of the scleroderma community), the primary goal behind this campaign is to raise funds to support education and research. Scleroderma or systemic sclerosis refers to a range of disorders that involve hardening and tightening of the skin and connective tissues. The condition mostly affects women than men and commonly occurs in those in the age group of 30-50 years. While there is no known cure for this connective tissue disorder, treatment modalities are available to help ease the symptoms and improve the quality of life to a great extent. If left untreated, the condition can lead to mild or even severe complications and can affect your teeth, digestive system, fingertips, lungs, kidneys, heart and sexual function. For correct clinical documentation of this autoimmune disorder, physicians can consider utilizing outsourced medical billing and coding services.
Reports suggest that the condition affects between 75,000 and 100,000 people (2017 statistics) in the United States. It is estimated that about 1 in 3 people with this condition develop severe symptoms of the disease. Sclerodermas are of different types. In some people, the condition affects only the skin. But in others, it also harms structures beyond the skin, such as blood vessels, internal organs and the digestive tract (systemic scleroderma). Signs and symptoms vary, depending on which type of scleroderma you have. Early symptoms include changes in the fingers and hands, such as stiffness, tightness, and puffiness because of sensitivity to cold or emotional stress. There may be swelling in the hands and feet, especially in the morning. Other related symptoms include – calcium deposits in connective tissues, red spots on the face and hands, tight, thickened skin on the fingers, problems of the esophagus and narrowing of the blood vessels to the hands and feet (known as Raynaud’s disease).
The June 2019 campaign aims to spread awareness about the common causes and risk factors associated with the condition and educate people on how to provide the right support to those affected. Scleroderma results from an overproduction and accumulation of collagen (a fibrous type of protein) in body tissues. In most cases, a combination of factors including immune system problems, genetics and environmental triggers are expected to increase the potential risk of the condition.
Diagnosing scleroderma is often difficult as it can take many forms and affect different areas of the body. A thorough physical exam along with blood tests will be done to check the elevated levels of certain antibodies produced by the immune system. A small sample of the affected skin will be taken to examine in the laboratory. In addition, imaging or organ-function tests help determine whether your digestive system, heart or lungs are affected. In most cases, the skin problems associated with the condition may fade away on their own in two to five years. However, the type of scleroderma that affects internal organs usually worsens with time. Treatment modalities for this condition include medications and therapies. But a variety of medications such as steroid creams, blood pressure medications, antibiotics and over-the-counter pain relievers can help control scleroderma symptoms and prevent complications. Therapies include physical therapy or occupational therapy. Surgical options will be used as a last resort and these include amputation and lung transplants. The diagnosis and treatment procedures performed for this condition may need to be carefully documented using the correct medical codes. Medical coding services offered by reliable medical billing companies can help physicians use the correct codes for their billing purposes. ICD-10-CM codes for diagnosing Scleroderma include –
- M34 – Systemic sclerosis [scleroderma]
- M34.0 – Progressive systemic sclerosis
- M34.1 – CR (E) ST syndrome
- M34.2 – Systemic sclerosis induced by drug and chemical
- M34.8 – Other forms of systemic sclerosis
- M34.81 – Systemic sclerosis with lung involvement
- M34.82 – Systemic sclerosis with myopathy
- M34.83 – Systemic sclerosis with polyneuropathy
- M34.89 – Other systemic sclerosis
- M34.9 – Systemic sclerosis, unspecified
The Scleroderma Foundation conducts nationwide support activities that offer numerous opportunities for people to learn about the symptoms of the condition. These include educational programs (to learn more about the disease), networking with others (who are living with scleroderma), support patient education programs and fundraising activities for research. Teal custom awareness ribbons and wristbands are worn by people as an iconic symbol of hope for warriors and survivors around the world.
In the month of June, the Scleroderma Foundation and the Scleroderma Research Foundation will collaborate and work together to raise awareness with the campaign “Hard word. Harder disease.” The campaign theme touches on the difficulty of the word and the gravity of scleroderma, a rare disease with no known cause or cure. It will run across several social media platforms like Facebook and Twitter (#hardword) throughout the month of June, with visuals and copy that educate and challenge people to take a pledge to tell one person about the disease. The campaign activities will culminate on the World Scleroderma Day observed on June 29 – wherein the message will be to encourage people to learn about scleroderma and tell others about the disease.
Observe Scleroderma Awareness Month in June! Promote public awareness about this autoimmune disorder and fund medical research to help people live longer, fuller lives.
by Meghann Drella | May 28, 2019 | Blog, Medical Billing
It is getting more significant for healthcare providers to follow effective result-oriented strategies to improve their organizations’ financial health. Professional medical billing companies can help hospitals manage their revenue cycle effectively. According to a report from Data Bridge Market Research, the global revenue cycle management market that was about USD 29.5 billion in 2018 is expected to reach USD 75.69 billion by 2026, growing rapidly at a CAGR of 12.5% during 2019 to 2026.
With more and more complicating payer contracts as well as greater regulatory demands, hospitals’ revenue cycle management has been becoming more complex in recent years. A reliable RCM solution manages the patient’s bills from the time of entering the hospital to reimbursement of claims.
Managing revenue cycle involves improving the process of claims management and quality of information, accelerating explanation of benefits (EOB) reconciliation, and streamlining denial management.
Certain key factors that boost the growth of this global market include:
- decrease in reimbursement in the healthcare industry
- reduction of total healthcare costs
- initiatives undertaken by governments for implementation of revenue cycle management solutions, and
- increasing expenditure by healthcare industry especially made on IT
However, lack of training and skills in the staff as well as the lack of technical infrastructure support are factors that restrain this market growth.
The report classifies RCM market on the basis of product type, stage, function, end-user, deployment, component as well as geography. While the product types include integrated and standalone RCM, by stage the market is segmented into front office, mid office and back office.
Functions of RCM include claim & denial, medical billing and coding, payment remittance, electronic health record, clinical documentation improvement, insurance verification and other tasks such as scheduling & appointment, referral management, and contract management.
End users of this market are hospitals, general physicians, labs as well as pharmacies, emergency medical centers and others. While the market is divided into web-based, on-premise and cloud-based deployment, by component the market is divided into software and services.
Geographically, the market is segmented into North America, Europe, Asia-Pacific and Middle East & Africa.
All scripts Healthcare Solutions, Inc. (IN), athenahealth, Inc. (US), CareCloud Corporation (US), Cerner Corporation (US), Conifer Health Solutions LLC (US), eClinicalWorks (US), Epic Systems Corporation (US), Experian Information Solutions, Inc.(US), General Electric Company (US), GeBBS Healthcare Solutions (IN), McKesson Corporation (US), NXGN Management, LLC (US), nThrive, Inc. (US), Quest Diagnostics Incorporated (US), SSI Group, LLC (US).
The report also highlights certain key developments in the market -– the newest version of Quanum Enterprise Content Management Solution unveiled by Quest Diagnostics and eClinical Works Revenue Cycle Management (RCM) announced by eClinicalWorks to aid medical practices in optimizing billing.
RCM Tips for Hospitals
In its latest blog, Becker’s Hospital Review has discussed certain expert RCM tips for hospitals such as –
- Whether considering medical billing outsourcing or performing billing in-house, hospitals should carefully evaluate the pros and cons
- Revenue cycle departments of hospitals should cooperate with clinical and operational investors to improve transparency of ordered procedures and allow suitable time to secure authorizations
- Practices should track the right utilization management metrics to improve their clinical decisions, regulations/contracts and billing/finance
Boosting your hospital’s revenue cycle performance can ensure financial viability. Partnering with a reliable provider of AR management services can help practices in submitting error-free claims, better analysis of denied claims, and effective follow-up to settle outstanding claims and dues.
by Natalie Tornese | May 20, 2019 | Blog, Insurance Authorizations
Dealing with insurance companies and claim denials is a frustrating task for all dental offices. Often claims get rejected due to missing patient details, errors in submitted codes, lack of verifying patient’s dental eligibility and more.In case of any claim denial or rejection, dental practices must make sure to check the claim first and evaluate the correction to be made. If there is no error in the claim, prepare an appeal.
ADA’s Recommendations on How to Appeal a Dental Claim
A proper appeal involves sending the carrier a written request to reconsider the claim
- Include additional documentation that provides the carrier a clearer idea of why the treatment is recommended
- Provide the dentist consultant as much information as possible, as they will only be checking the dental claim form
- Follow specific instructions provided by the particular carrier including the submission of the appeal in writing within the time allowed by the carrier.
- Send your appeal letter to the specified department of the carrier and it must be in the form the carrier requires
- Include the word “appeal” in the title and the text of the document and in any cover letter that accompanies the appeal document
Four Major Dental Claim Rejections and How to Respond
1. Patient ineligible for the procedure
Patient eligibility verification is a key factor in preventing claim denials. As insurance policies and plans change constantly at the insured level as well as for the insurer, it is important for the provider to verify eligibility each and every time services are provided.
For new patients, all insurance information including patient’s name and date of birth, name of the primary insured, social security number of primary insured, insurance carrier, ID number, preauthorization and group number should be collected and verified before their visit. Outsourcing dental insurance verification tasks helps hospital staff to focus on their core task and practices can also save time and money.
2. Coverage on periodontal scaling and root planing (SRP)
Frequencies for denial are more with certain procedures such as periodontal scaling and root planing (SRP) than other procedures or requests.
- D4341 periodontal scaling and root planing – four or more teeth per quadrant
- D4342 periodontal scaling and root planing – one to three teeth per quadrant
Both patients and dentists must be clear that while SRP may be necessary, the plan will only provide benefit when its particular clinical indicators are present. Insurance carriers failing to release specific payment guidelines or processing policies for specific procedure codes is a major factor that creates confusion in actual benefits.
In cases where the claim has not been properly adjudicated, you can appeal the benefit decision. For SRP claims, try including documentation of radiographic evidence of bone loss, periodontal charting and a narrative description of procedures.
3. Limited benefits for periodontal maintenance
This procedure performed following periodontal therapy and at varying intervals is frequently denied because many carriers have limited benefits for this procedure.
- D4910 Periodontal maintenance
Carriers have different policies or limitations for this procedure. While some payers have limited this procedure to be paid as a benefit only within 2 to 12 months of SRP, other payers have qualified periodontal maintenance by denying benefits for this procedure unless two or more quadrants have received prior therapy. For this procedure, dentists must make their patients aware that all procedures are not covered by some plans, for extended periods of time. While appealing for periodontal maintenance claim denials, include details on radiographs, periodontal charting and a description of the treatment.
4. Core buildup procedure
Core buildup procedure performed prior to restoring a tooth with a crown is often reported to be denied for its lack of benefits.
- D2950 core buildup, including any pins when required
Making patients understand the limitations of their plan prior to treatment may help dentists avoid problems. Dentists are also confused about the policies of bundling these procedures and the total fee for the procedures. ADA recommends including radiographic evidence of the need for a buildup, while appealing for this procedure.
Other Tips to Prevent and Resolve Such Claim Errors
Use the right CDT codes without errors
Use the correct, current code set to identify the diagnosis, services rendered, and procedures performed. HIPAA recommends using the version of the CDT Code in effect on the date of service, no matter when the claim is submitted. Review the denied claims to check whether the procedure codes reported are correct. If there is a coding error, prepare and submit a corrected claim.
Provide a clear narrative
Narrative description in the document should include the clinical condition of the oral cavity, description of the procedure performed, reasons why extra time or material was needed, how new technology enabled the procedure to be delivered as well as any specific information required under a participating provider agreement.
Determine the date of service
While assigning a single code for a procedure that requires multiple appointments, ADA encourages third party payers to use the date of impression as the date of service. However, some state laws and third party carrier processing policies and contract provisions specify the completion date as the date of service.
Dental billing services provided by experienced medical billing companies can help dental practices meet their medical billing and claim submission requirements. Such companies will provide the services of skilled AAPC-certified coders and expert billing specialists who can ensure that your practice has only fewer accounts receivable and unresolved dental claims.
by Julie Clements | May 17, 2019 | Blog, ICD 10 Coding
With the summer season fast approaching, most people are getting ready for beach trips, outdoor recreations, and other similar activities. However, a number of diseases/ ailments could make life unpleasant and spoil the joy and merriment of summer holidays. This is a period when healthcare providers are often pre-occupied with ailing patients. Reports suggest that the number of conditions treated in the emergency department nearly doubles during the summer in the United States. Physicians’ practices dealing with a large number of patients with summer ailments/diseases need to know the ICD-10 codes to report these conditions correctly. Medical billing services from a reputable medical billing company helps in accurate and timely claim filing for appropriate reimbursement.
Let’s take a look at the ICD-10 codes for some common health problems that occur when the temperature increases –
Sunburn – Sunburn is the term for swollen and painful skin caused due to over exposure to ultraviolet (UV) rays from the sun. A serious risk factor for skin cancer, the extent of sun burn can vary from mild to severe and may depend on the skin type and the amount of exposure to the sun. Common symptoms include – redness and tenderness, blistering, pain, fever, chills and nausea and vomiting. After the sun exposure, the skin may turn red in as little as 30 minutes, but most often it takes 2-6 hours. Treatment for this condition includes – over-the-counter (OTC) pain relief medications such as ibuprofen or other non-steroidal anti-inflammatory medications (NSAIDs) and applying hydrocortisone cream. Applying a sun screen lotion on the exposed areas of the body 20 minutes before heading out in the sun would provide protection from sunburn. The ICD-10 codes for sunburns are –
- L55 – Sunburn
- L55.0 – Sunburn of first degree
- L55.1 – Sunburn of second degree
- L55.2 – Sunburn of third degree
- L55.9 – Sunburn, unspecified
Heat stroke and Heat cramps – Another common summer disease, heat stroke is caused by the body’s failure to regulate body temperature when exposed to excessively high temperatures. Heat cramps on the other hand, refer to the painful and involuntary muscle spasms that occur due to exposure to hot environments. Typical symptoms include difficulty in breathing, rapid pulse, high body temperature and confusion. Drinking adequate liquids and staying in cooler areas would help avoid these heat conditions. Related ICD-10 codes are –
- T67.0 – Heatstroke and sunstroke
- T67.0XXA – Heatstroke and sunstroke, initial encounter
- T67.0XXD – Heatstroke and sunstroke, subsequent encounter
- T67.0XXS – Heatstroke and sunstroke, sequela
- T67.2 – Heat cramp
- T67.2XXA – Heat cramp, initial encounter
- T67.2XXD – Heat cramp, subsequent encounter
- T67.2XXS – Heat cramp, sequela
Prickly heat rashes – A common skin problem among children and adults, prickly heat rashes cause the skin to turn red, along with a warm, stinging, or prickly sensation. The rash may also cause small, raised bumps and blisters. Also called miliaria rubra, these rashes commonly occur in the face, shoulders, and chest. Tiny red bumps and itching on the area of skin that has been exposed to heat and sweat for a long time are common signs of prickly heat. ICD-10 codes for miliaria rubra –
- L74 – Eccrine sweat disorders
- L74.0 – Miliaria rubra
- L74.1 – Miliaria crystallina
- L74.2 – Miliaria profunda
- L74.3 – Miliaria, unspecified
- L74.4 – Anhidrosis
Food Poisoning – Reports from the United States Department of Agriculture (USDA, 2017) found that rates of foodborne illness peak during the summer, when it is between 90 and 110 degrees Fahrenheit. Warm weather encourages bacteria to multiply. Food that is prepared in advance and allowed to stand in the heat creates the perfect conditions for contamination and food poisoning. Therefore, pre-prepared food should be handled hygienically, stored safely and kept cool if possible. Make sure, especially in hot weather, to refrigerate any food that can possibly spoil right away. Common symptoms of food poisoning include vomiting, abdominal pain, diarrhea, fever, and headaches. Most cases of food poisoning can be easily treated at home. However, if symptoms are severe, patients need to be admitted to hospital for a few days and will be given intravenous hydration. ICD-10 codes related to food poisoning include –
- A05 – Other bacterial foodborne intoxications, not elsewhere classified
- A05.0 – Foodborne staphylococcal intoxication
- A05.1 – Botulism food poisoning
- A05.2 – Foodborne Clostridium perfringens [Clostridium welchii] intoxication
- A05.3 – Foodborne Vibrio parahaemolyticus intoxication
- A05.4 – Foodborne Bacillus cereus intoxication
- A05.5 – Foodborne Vibrio vulnificus intoxication
- A05.8 – Other specified bacterial foodborne intoxications
- A05.9 – Bacterial foodborne intoxication, unspecified
Lyme disease – Regarded as the most common insect-borne disease in the US, Lyme disease peaks during the summer months when people are exposed to ticks in yards and woods. Lyme disease is caused by the bacterium “Borrelia burgdorferi” and is transmitted to humans through the bite of infected blacklegged ticks. Typical symptoms include – fever, headache, fatigue, and a characteristic skin rash called erythema migrans. For reimbursement purposes, report the following codes –
-
- A69.2 – Lyme disease
- A69.20 – Lyme disease, unspecified
- A69.21 – Meningitis due to Lyme disease
- A69.22 – Other neurologic disorders in Lyme disease
- A69.23 – Arthritis due to Lyme disease
- A69.29 – Other conditions associated with Lyme disease
One of the primary reasons behind the outbreak of these diseases during summer is the presence of favorable weather conditions for bacteria and other viruses to breed. Therefore, it is important to keep your premises clean. People who happen to spend a lot of time outdoors are at more risk of summer ailments and hence should take adequate preventative measures. The best and simplest way to avoid these diseases is to stop activities outside the home during peak sun hours and avoid exposure to direct sunlight. Other ways to be sun-safe are to – increase the intake of water or liquid to prevent dehydration, use sunscreen with a higher SPF to prevent skin damage, avoid roadside food or contaminated water and wear light-colored, loose, cotton clothing.
Summer is a beautiful time to enjoy vacations and spend time with family and friends. All that you need to do is to stay healthy, become aware about the outbreak of these diseases and take extra precautions to enjoy the good times.
Healthcare providers must know the highly specific ICD-10 codes related to documenting common summer ailments. Medical billing companies can provide the necessary medical coding and billing support physicians are looking for, and ensure accurate and timely claim submissions.
by Rajeev Rajagopal | May 14, 2019 | Appointment Scheduling, Blog
One of the many services that medical billing and coding companies offer, patient appointment scheduling aims to create a more efficient patient experience and ease workflow for physicians.
Patient scheduling is not an easy task: the main challenge is how to schedule the number of patient appointments using special time slots based on fluctuations in patients and patient treatment times. If too few patients are allotted to a time slot, medical resources will remain unused. On the other hand, if too many patients are assigned to a time slot, some patients will be forced to wait. Thus, lack of proper coordination affects both providers and patients. Optimizing a practice’s appointment schedule is necessary to improve provider productivity and revenue, and boost patient satisfaction. Here are some tips to improve patient scheduling:
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- Track data to detect trends: Medical scheduling software allows you to track patients from arrival to departure and receive real-time updates on co-pays and cancellations. Studying trends will provide a better idea of specific scheduling and patient flow problems. Physicians Practice recommends analyzing two weeks of data to identify trends and key reasons for scheduling and patient-flow problems that affect practice workflow. Examining scheduling patterns will reveal the time each patient spent in the office vs. length of the appointment, how many patients were booked within a day before their visit, how many were double-booked, and where the physician fell behind schedule and the reasons for this.
- Fix a baseline: Practices need to fix a baseline as to what they consider “on schedule”. Patient wait time is an important indicator of whether things are going according to schedule – whether work flow is efficient, space utilization is optimal, or patient service is affected.
- Schedule appointments consecutively: Experts recommend scheduling morning appointments from noon backward and afternoon appointments from noon forward. This can help minimize the number of empty appointment slots over the day. If morning or afternoon slots are vacant, these can be used for some other productive activity as holding staff meetings.
- Prioritize appointments: Not all patient issues require face-to-face time with a provider and can be addressed via a phone consultation or email. Prioritizing appointments will ensure that only patients who need the highest level of care can schedule same-day appointments if needed. Some longer slots can be reserved for patients with multiple care issues. This strategy will also increase the number of appointments that drive revenue.
- Send out reminders: Appointment reminders can help minimize no-shows. In fact, good communication promotes patient satisfaction and prevents empty slots in practice schedules. Options to send out reminders include automated reminder systems, text messages or email. Automated systems for confirmation enable patients to cancel or make a request to reschedule. Patients also need to be made aware of the practice’s cancellation policy and fee for missed appointments, if any.
- Extend office hours: Extending office hours to accommodate more appointment time slots. Factors to consider include:
- The method used to schedule patients
- The type of patients who will be seen during extended hours – new or just established patients
- Whether some appointment slots will be left open to ensure same-day access
- Whether there is sufficient support staff to facilitate the additional hours and the additional costs involved
- Double booking: Double booking must be handled carefully. Adding just a few patients a day is acceptable and manageable. But if it gets out of hand, this strategy can lead to heavy backlogs at the end of the day. Better utilizing other members of the care team can help physicians see more patients. For instance, nurses can be trained to take on more clinical-support responsibilities.
The patient appointment scheduling solutions offered by experienced medical billing companies enhance the patient experience, decrease no-show rates, and improve practices’ return on investment. Efficient appointment scheduling also improves care coordination and convenience for the patient and provider, minimizes waiting times, reduces non-compliance, and improves patient retention.
