ED Coding & Reimbursement Alert - 2007 Issue 33
CODING: Harvest 'Low-Hanging Fruit' To Boost Your Profits
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Article Overview
This article is aimed at medical coders, billing staff, and practice managers who want to understand why reimbursement may be changing and where missed revenue may exist. It focuses on broad billing and documentation issues in physician practices, including evaluation and management activity, procedure-related add-ons, claim backlogs, enrollment delays, and practice workflow factors that can affect collections. The discussion is framed around general coding and reimbursement improvement strategies rather than specialty-specific clinical guidance.
Why This Topic Matters
Understanding common billing and documentation gaps can help practices identify whether revenue changes are tied to coding patterns, claim processing, staffing, or payer-related issues. The article is relevant for readers looking to assess potential underbilling and operational causes of reimbursement decline.
Article Sections
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Avoid this common E/M trap
This section discusses broad evaluation and management billing patterns, comparison of current and prior billing activity, and the role of modifier use when procedures and visits occur on the same date. It also touches on how practice mix can affect reimbursement trends.
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Don't Overlook Basic Add-Ons
This section covers common areas where practices may miss billing opportunities tied to procedure-related services, documentation, claim backlogs, and enrollment delays. It also references broader revenue issues related to imaging and collections processes.
What You Will Learn
- How to evaluate whether reimbursement changes are related to billing patterns
- Why evaluation and management activity may affect practice revenue
- How missed add-on services and documentation gaps can impact collections
- What operational factors can contribute to claim delays and revenue declines
- How to review practice billing trends across services and payers
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Revenue cycle teams
- Physician office administrators
Codes Discussed
Modifiers Discussed
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