Do you know how much power there is in a single two-digit number? Most payors and health plans don’t realize the impact that the 59 modifier can have on claim costs. Adding this simple modifier to a CPT code allows that code to bypass several code edits, resulting in erroneous and often incorrect payments. Providers have learned that the way to avoid denials is to append a 59 modifier to many codes. The problem is that in many instances, the modifier is not appropriate.
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INTERVIEW WITH FOUNDER RICH HENRIKSEN
How did you get started in the claims field? What was your career path prior to Nokomis Health?
I graduated from Luther College in Decorah, Iowa with a biology degree and then received my master’s degree in hospital administration from The University of Iowa. Scott Anderson, the CEO of North Memorial Medical Center in Robbinsdale, Minnesota, was an alumnus of my graduate program and each year he took on an administrative fellow from my program. He selected me to come to his hospital, so I moved to Minneapolis and ended up staying at North Memorial for 7 years. I was originally deployed to the Finance department, where I automated the hospital’s budget process. I stayed in Finance for my entire tenure at North, ultimately becoming the director of managed care. It was at this time that I really learned about coding, reimbursement, contracting, contract modeling, and data analysis. Pat Boran, the CFO, was a super boss and mentor. I learned a great deal from him.
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Q&A WITH NOKOMIS HEALTH DIRECTOR OF CODING ANNE KARL
What are CPT Codes?
As you may know, every procedure code on a claim is tied into a dollar amount. So if a coder miscodes something, the provider could be paid for a code that isn’t supported by the documentation or the clinic may be losing reimbursement that is rightly due to them. Miscoding is typically a result of coders lacking education and not knowing how to code properly or they may be trying to game the system. That’s why insurance companies need a claim review partner. We can look for trends that we see in the claims and set an edit to manually review those claims or automatically deny them. Just because there is a CPT code doesn’t mean that you can use that code for reimbursement or use it for reimbursement in combination with other codes.
Continue reading “Medical Coding 101 – Insights, Challenges and Standard Practices” »
INTERVIEW WITH DIRECTOR OF CODING ANNE KARL
How did you get into coding?
My father was a family practice physician and I’ve always been drawn to that world. When I came out of school the traditional job for an RHIA (Registered Health Information Administrator) was to be the Director of Medical Records in a hospital setting, but that didn’t really interest me. The physician setting is much more fast-paced and I’ve spent a majority of my career in that area. I always had my heart in it – making sure the providers were paid fairly for their services. Payment starts with the documentation of the provider and the codes assigned. Poor documentation and/or coding can really hurt the reimbursement to a provider. After working in some very non-traditional jobs, I found that coding was really my passion.
Continue reading “How Do You Become an Expert Medical Coder?” »