It Takes a Billing Class to Train Some Geniuses

PR Henriksen, the character

You might not know this but here at Genius Solutions the vast majority of our software support staff and all of our trainers have worked in various healthcare settings:  offices, hospitals, support staff, billers, office managers, multiple office managers, and more.  Basically our Genius support is made up of practical medical office specialists, software geeks, and hardware tech specialists who are hardware, networking, and software geeks.  There is a lot, and quite a variety, of expert knowledge on call, for your calls.

Me? I started at Genius in support, as part of the software geek zone (with some generally nerdy hardware tendencies).
I worked in data conversions for a few years also.  I have also written and produced almost all of the newsletters and blog articles over the last ten years, I get to work on the web sites and the social media sites, I get to work on the advertising you get to see from Genius, and I’ve been lucky to be out at most of the Genius Seminars for the last 5 + years to speak with you and have fun.  Well, they’ve finally decided that I need to be a more well-rounded person, so they’ve sent me to billing class for the next couple of months to make sure I really have your perspective and can use all of the highly technical terms you use, when I’m with you (apparently the ever popular “thing-a-ma-bob” isn’t techie enough for you :D)

Being the multi-purpose geek that I am, I thought it would be good to post some articles on the process or of some of the cool things that I learn, or those nuggets that just stand out to me.  It might help you in your process.  It might inspire you to try some more classes, or it might share some insight with you providers about how valuable training can be for your billers and office staff.

Week 1:  Procedure codes, modifiers, a touch of ICD-10, and how to speak doctor-ease (i.e. introduction to medical language and word parts)

Coders and Billers have to translate doctor-speak into the language of getting paid.  EHRs are helping them because they can now read and ask questions about what the providers are doing/have done.  But they need to learn the doctors’ language to be able to work their magic.  This skill will be even more vital as ICD-10 is implemented over the next year.  Better, more legible record keeping, as well as an increase in sheer volume of records leads to a greater need for billers to read, understand, and interpret your provider notes into more specific ICD-10 codes to get you paid and paid correctly.

Golden Nugget #1:  An EHR cannot replace a good biller or coder.

There is getting the information down.  Then there is having it translated into billing-coding language (what I call “getting paid” language), and then there is arranging it in the best way to not only tell the story of your patient encounters, but to get you the maximum possible payment for those encounters.

I’m guessing that most providers think – “I put all the of the information down all the biller has to do ask me a question if they need to and then send out the codes the EHR made sure I filled in correctly.  All the information you want is in the file, pay me, thanks.”  I probably would think just that same thing myself…. BUT here is what I learned in class this week:

When using a modifier code like “51” which is for “multiple procedure codes” (we won’t even mention the possibilities of using this code incorrectly), the order your procedure codes are billed out matters.  It doesn’t matter to the insurance company so much, maybe, they got their information and they are paying like you asked, right?  But, if you have a sharp biller, who knows what the rules are and what the insurance companies are looking for, you can go from getting paid, to getting paid the maximum possible reimbursement. 

Order matters! 

In the example we saw in class, the modifier 51 was used for “multiple procedure codes” as mentioned, but the reimbursement was different depending on the order you put the procedure codes in.  In the case shown the first procure line posted under the 51 modifier would be reimbursed at 100% while the next line would be reimbursed at 50%.  Two procedure codes:  code A=$153 fee, code B=$47 fee.  So, modifier 51+A+B = $176.50 reimbursement, while coding it as modifier 51+B+A=$123.50 reimbursement.  This is a difference of $53.  Multiply that difference x10/a day ($530) X 5 days a week ($2650) X 52 weeks (a year) = $137,800/ yr for just that one job you might be doing.  Imagine more codes, more costly codes, and maybe even more times a day!  

Neither your EHR, nor your practice management system can tell you the best way to code and bill out your data for reimbursement.  However, a well trained awesome biller / coder can give your office an instant pay raise.  Take time to make sure your staff gets training and updates that training regularly.  The difference to your cash flow can easily be awe inspiring (for good or bad).

***Editor’s Note:  The opinions and information expressed here are on the News Editor, PR Henriksen. As you can see, she always advocates getting some good training.