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PRESENTED BY:

MedicalCodingCashSecrets.com

Let me cut to the chase.

The more effectively you code your medical encounters, the more money you will

make – period. I know this, not only because of the supporting data, but because

I’ve experienced this fact in my own medical practice.

In fact, a recent survey showed that more than 33% of visits involving established

patients are under-coded. What is worse is that physicians are failing to document

and code for issues unrelated to initial patient visits. The trends show that most

physicians are causing themselves to be underpaid for services they provide (as if

Medicare and insurance reimbursement cuts don’t make it hard enough).

Before I learned the key to generating outstanding revenues in my medical

practice, I was losing nearly $100,000 per year – just because I didn’t understand

how to use CPT codes the RIGHT way.

When you consider the constant reductions in our revenue stream as a result of

external factors, our ever increasing medical practice overhead, and the massive

resources allocated to handling paperwork requirements on a daily basis, it is not

difficult to see why our country is facing a severe shortage of healthcare providers.

The good news is that it does not have to be this way. You see, medical coding is

simply a process that involves assigning codes to the identification and treatments

of ailments, which dictate the level of financial reimbursement you may receive

from insurance companies and government agencies.

Unfortunately, this “simple process” is cumbersome and requires diligent

attention to the details of patient encounters if you want to receive the level of

reimbursement you deserve.

I can’t stress this enough: if you know how to properly apply CPT codes to your

diagnosis, you can make the process simple for yourself and make significantly

more money. Your success lies in having this knowledge.

INTRODUCTION

This is why I developed Medical Coding Cash Secrets – I wanted to share my

shortcut simplifying the process and maximizing revenues. The day I decided that I

would no longer be underpaid and overworked changed everything. So, I

encourage you to make the same decision for yourself.

These 10 essential strategies are the foundation upon which medical coding

success is built. If you implement these 10 essential strategies and then apply the

knowledge provided in Medical Coding Cash Secrets, I can assure you, you will be

amazed at the results.

Now, time for the 10 essentials.

If you learn to ethically code routine office visits and regular checkups

at the highest level payable for each patient you see, you will

automatically double your income. You may not believe it, but I can

assure you that you are doing this. In my consulting with physicians

one-on-one, I’ve discovered that there is a general misconception

related to the proper level coding of routine visits and regular

checkups. What you, the provider, must understand how to use

“medical decision” and “medical necessity” to determine which CPT

coding group adequately covers the office visit. If you make a point to

understand how to maximize your billing potential through the proper

usage of CPT codes, you will instantly enjoy the benefits of insurance

reimbursement at a higher level.

Not all insurance reimbursement contracts are the same, and you have

the right to negotiate the terms of your contracts. When the time

comes to renew your reimbursement contracts, review them carefully

and look for places where other carriers are providing more

competitive reimbursements. For example, you can point out where

other insurance companies reimburse for certain combinations of add-

on codes and request they match your other contract terms. Keep in

mind, many of these insurance companies are related corporately and

1. Learn to code at the highest level payable.

2. Aggressively review and negotiate your reimbursement contracts.

you can use this fact to your advantage is you find that one insurance

company related to another insurance company is trying to reimburse

differently. Under these circumstances, ask your contract

representative to explain the variance and adjust it accordingly.

As CPT and ICD codes become more specific, you need to be more

specific in the way you code individual encounters. For example, one

code for chest pain may be better suited as chest pain plus any of the

numerous associated symptoms that are related to it – this type of

evaluation will require its own individual codes that will provide you

with larger reimbursements.

Coding with specificity and precision is not just about maximizing your

reimbursements, but the right code with the right diagnosis is also

going to help you provide superior patient care while reducing your

denials and requests for medical records. Getting stuck resolving

denials and requests for medical records slows down your workflow

and cash flow as a result of delayed payments. Avoid this outcome by

coding procedures correctly the first time and you will get what you are

entitled to….your hard earned money.

Even though your patients may come in for a routine office visit, you

may be able to combine procedures for reimbursement - if you code

3. Learn to code with specificity and precision.

4. Take detailed chart notes.

them properly. Consider a situation where you routinely remove skin

lesions, moles, or tags. Instinctively, you will bill for the removals, but

what if your patient also needed prescription renewals for other health

issues? Or what if they discussed a new ailment while you conducted

the removals? Did you bill for these other matters? You should! Simply

add on a routine office visit code. To ensure that you will be paid for

both codes, document the incidents separately in the chart notes. From

there, simply add the appropriate modifier to the office visit and for

each lesion removal. It’s simple, appropriate, and an additional $15,000

in revenue each year if you do this across your patient panel.

Do you know why your insurance reimbursement claims go unpaid?

Finding out why claims are unpaid is a key component to capturing

revenue that is just waiting to be collected. There are numerous

reasons why claims do not get paid, and more often than not an input

error is to blame. For example, a claim may have been sent to the

wrong department due to an input error and is automatically denied.

This is a simple oversight that should be fixed and re-sent. Knowing why

the claim is denied is essential to getting paid when the claim is

resubmitted. Oftentimes, medical billers just resend the

reimbursement claim for a second and third time but never check to

see why the claim is not being paid. As such, your claim sits on your

aging report and you lose money because someone was too lazy to take

5. Create a system for following up with unpaid claims.

an extra step. You can prevent this by creating a system or using a

checklist for each denied claim so that they are paid upon

resubmission. Remember, there is a limited time to capture your

money from your reimbursement carrier so keep your aging reports up

to date and aggressively pursue denied claims.

Insurance companies love to give you the responsibility of educating

yourself on their reimbursement rates. It’s no coincidence that fee

schedules are rarely attached to your contract and must be “requested”

or “downloaded online.” Today it is not uncommon for insurance

companies to use Medicare as a reimbursement guide (this is where

everything has shifted to their advantage), so contracts often read

“reimbursements are at 90% or prevailing Medicare fee schedule,” or

similar language.

No matter how many times you’ve seen these contracts, always have

your healthcare attorney or someone who understands contracts

review the clauses in your reimbursement contract with you. And

always, always closely review the reimbursement schedule or fee

schedule for all CPT codes that you provide in your office. Make sure

these reimbursement rates are reasonable to you and your practice;

you have the right to refuse inadequate compensation. Do not get

6. Don’t sign a reimbursement contract without seeing the fee schedule first.

caught working harder for less money. Instead, work smarter for more

revenue.

As a doctor, your main focus is to provide excellent care to your

patients. Nevertheless, your practice must always obey the

fundamental laws of good business. Finance, marketing, and operations

are critical elements to your success. Regardless of whether you have a

medical billing and coding specialist in your office or one working on

your account a remote location, your practice will suffer if you do not

actively manage these areas of your practice. Remind yourself, you own

a medical practice AND a business.

“Medical necessity” is a somewhat nebulous concept and is described

in less detail than some of the other coding definitions. Despite this

fact, you must get familiar with the concept and develop a concrete

understanding of “medical necessity” to avoid the pitfalls of denied

claims and delays in payment. The Medicare Claims Processing Manual

says “medical necessity is the overarching criterion for payment in

addition to the individual requirements of a CPT code. It would not be

medically necessary or appropriate to bill a higher level of evaluation

and management service when a lower level of service is warranted.

7. You must think like a business owner, not just as a doctor.

8. Understand the concept of “medical necessity”.

The volume of documentation should not be the primary influence

upon which a specific level of service is billed. Documentation should

support the level of service reported.” This puts adequate

reimbursement on your shoulders. Are you fully documenting your

service? Do you know how to fully document for higher level

evaluations? You could be losing revenue daily because of it.

Many times, physicians encounter patients who bring up new problems

during the routine office visits. These new problems may range from a

slight headache the night before to a tiny lump on their forehead.

Sometimes patients reveal something more serious, for example,

symptoms indicating the earliest manifestations of osteoarthritis. In

these situations, most physicians fail to recognize the instant

justification for billing at a higher and more precise level.

As the only person able to assess the level of a patient encounter you

must become vigilant about identifying opportunities to increase the

billable level of an office visit. You a given the opportunity to increase

revenue daily.

I consistently see physicians fail to identify the shift from a “casual” low

complexity 99213 office visit to a moderate complexity 99214 office

visit. Don’t do this to yourself. You owe it to yourself to properly

9. Recognize the need to increase the billable level of an office visit.

document and code complexity with accuracy and maximize the

revenue you’re entitled to receive.

If you have unresolved claims 25 days or older, you’ve failed to

implement a system for denied claims. Claims 25 days or older should

be revisited on a monthly basis. This will help you identify claims that

may not have been received, as well as enable you to start the appeals

process on claims that have been denied. If you have a fairly large

practice, you may benefit by setting aside one day a month where

everyone on your staff works on claim follow-up projects.

Once you identify claims that need to be reprocessed, you should break

them down into categories of difficulty. As a general rule of thumb, you

will find that claims denied for coordination of benefit, or other patient

issues will be hardest to resolve. It can also be difficult to get patients

to comply with demands for additional information if you do not see

them on a regular basis. Under these circumstances, you should adopt

a billing policy that will enable you to send bills and correspondence to

the patient as reminders.

10. Don’t allow claims to go unresolved for more than 25 days.

I know that you will see great improvements in your medical practice by applying these 10 essential strategies, and it is my hope that you will do it. I have a passion for helping my colleagues succeed because I know what it is like to work so hard and see so little in return. Our privilege to help and serve others is incredibly rewarding, but sometimes it is not enough in light of all the obstacles we face on a daily basis.

I hope that you will be encouraged to learn more about Medical Coding Cash Secrets (and take advantage of our current special offer), because even though your clinical intuition and medical experience will guide you through the daily patient encounter, effective and strategic coding will dictate your level reimbursement.

REMEMBER: Your documentation and coding must reflect the intensity of service that you render! Once you learn to accurately code in the most detailed yet efficient way, you will begin to be highly paid for the work that you do. Unfortunately, this is not intuitive. Think about it; in the course of learning and practicing medicine, who took the time to teach and train us on the billing and coding of our medical claims? NO ONE!

You must take the time to develop this skill. Don’t you think earning an additional $100,000 per year is worth the time and minor investment?

I guarantee you that it is.

Best of luck to you and your future success,

Dr. Adam Alpers, DO

P.S. If you are ready to start learning the keys to coding and reimbursement success today, simply fill out the form below and fax it to: 352-368-6027 or visit medicalcodingcashsecrets.com today!

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