Industry conferences generally illuminate growing trends and broad, often brilliant ideas. Distinguished presenters glide through slides and issues providing probable causes and ideal answers. One can almost feel the enthusiasm ricocheting off the walls of Ballroom A… We’re going to make it after all!
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Nokomis Health’s coding team was reviewing a client’s out of network laboratory and a batch of genetic testing claims raised some questions. The claims appeared to be legitimate – the CPT code was valid, the diagnosis code supported the charge, the NPI and TIN were correct – but the charges were very high for the code and it was unusual for the code to stand alone. We obtained records on several claims and found that the lab was simply performing a quality assurance function, they were not performing a covered service.
Continue reading “Schemes, Errors & Scams – How Uncommon Claim Review Findings Lead to Savings” »
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” »