This article is written by Barbara Cataletto, MBA, CPC, Chief Executive Officer, Business Dynamics Limited. 
So now we are months into the new CPT code changes for spine for 2012. If you were able to get this far without losing your mind or quitting your job, then you must be a real trooper! There have been so many issues surrounding the implementation of these codes in all sectors of the industry. Practices need to adjust op notes, authorizations and coding programs. Carriers need to adjust their coverage policies and edits. Both need to address the contractual reimbursement rates which can be quite exhausting.
Our business has had to do quite a bit this year to keep our practices and carriers in check. The most difficult task is to educate those that don't want to learn! This involves both sides of the industry. Practices are frustrated with the continued costly updates, training and decreased reimbursements. Carriers are having difficulty with the add-on and additional level procedures and denials are rampant. How does the practice deal with these issues with the least amount of risk and cost? Well, if you have not implemented a strategy by now, you are losing both money and productivity. So here is short checklist of items to run through to help you get a handle on this pronto!
1. Coding Updates: Train the staff and surgeons! This is key to the process. Understanding the coding applications and how they apply to the preauthorization and reimbursement process will put all involved on the same page. No one should be excluded because "they don't need to know". Hold weekly meetings to identify those cases that have authorization or reimbursement difficulties and develop a plan to resolve open items.
2. Contract Discussions: Reach out to the carriers that have specific contract rates by code, as the contracts that are paid at a percentage of the Medicare rate will just fall into place. The contracts with code carve outs, or those that were independently formulated, will certainly have reimbursement issues surrounding the rates for the new codes. Generally these new rates are extremely low when compared to last years' coding applications. Pushing to have these new codes moved into the carved out mix is a must-do. And don't accept their first rate offer as they may be much lower than expected the first time around.
3. Reimbursement Denials: Several carriers have not adapted well to the new codes and practices and are flooded with denials. These denials bring about several obvious issues; low reimbursement, frustrated staff and increased concerns about cash flow. Some of the reasons for these denials are due to the fact that CMS did not implement the proper edits as they apply to the add-on and additional level codes. And with that the commercial carriers followed suit and have denied so many claims. This can result in overwhelming the reimbursement staff with so many denials leaving them with limited resources to respond and appeal the cases, and little time to collect on other current Accounts Receivables. It is imperative that the practice put together a team of specialized staff members, including surgeons and high level administrators, that can tackle these denials in a reasonably quick and comprehensive manner. This is to insure proper reimbursement in the quickest timeframe possible, while the AR team can focus on daily revenue cycle management.
These past few months have been extremely stressful on all involved in the business of spine. Looking to lighten the burden will take teamwork and planning. It's not too late to get started if you haven't done so yet. Take the time now to look to correct the situations that may have developed before it has a devastating impact on the bottom line.
For a quick reference of the coding changes, click here. Please feel free to contact us for further updates!
Barbara Cataletto, MBA, CPC is CEO and Founder of Business Dynamics Limited, CaseCoder™ and the Business of Spine. All three companies provide reimbursement services and/or education to the entire spine industry. She is considered the subject matter expert in the field and sits on the ISASS Coding Task Force, Adelphi University’s Robert B Willumstad School of Business Board of Advisors and was most recently named one of the 50 Most Influential Women in Business on Long island, New York.
So now we are months into the new CPT code changes for spine for 2012. If you were able to get this far without losing your mind or quitting your job, then you must be a real trooper! There have been so many issues surrounding the implementation of these codes in all sectors of the industry. Practices need to adjust op notes, authorizations and coding programs. Carriers need to adjust their coverage policies and edits. Both need to address the contractual reimbursement rates which can be quite exhausting.Our business has had to do quite a bit this year to keep our practices and carriers in check. The most difficult task is to educate those that don't want to learn! This involves both sides of the industry. Practices are frustrated with the continued costly updates, training and decreased reimbursements. Carriers are having difficulty with the add-on and additional level procedures and denials are rampant. How does the practice deal with these issues with the least amount of risk and cost? Well, if you have not implemented a strategy by now, you are losing both money and productivity. So here is short checklist of items to run through to help you get a handle on this pronto!
1. Coding Updates: Train the staff and surgeons! This is key to the process. Understanding the coding applications and how they apply to the preauthorization and reimbursement process will put all involved on the same page. No one should be excluded because "they don't need to know". Hold weekly meetings to identify those cases that have authorization or reimbursement difficulties and develop a plan to resolve open items.
2. Contract Discussions: Reach out to the carriers that have specific contract rates by code, as the contracts that are paid at a percentage of the Medicare rate will just fall into place. The contracts with code carve outs, or those that were independently formulated, will certainly have reimbursement issues surrounding the rates for the new codes. Generally these new rates are extremely low when compared to last years' coding applications. Pushing to have these new codes moved into the carved out mix is a must-do. And don't accept their first rate offer as they may be much lower than expected the first time around.
3. Reimbursement Denials: Several carriers have not adapted well to the new codes and practices and are flooded with denials. These denials bring about several obvious issues; low reimbursement, frustrated staff and increased concerns about cash flow. Some of the reasons for these denials are due to the fact that CMS did not implement the proper edits as they apply to the add-on and additional level codes. And with that the commercial carriers followed suit and have denied so many claims. This can result in overwhelming the reimbursement staff with so many denials leaving them with limited resources to respond and appeal the cases, and little time to collect on other current Accounts Receivables. It is imperative that the practice put together a team of specialized staff members, including surgeons and high level administrators, that can tackle these denials in a reasonably quick and comprehensive manner. This is to insure proper reimbursement in the quickest timeframe possible, while the AR team can focus on daily revenue cycle management.
These past few months have been extremely stressful on all involved in the business of spine. Looking to lighten the burden will take teamwork and planning. It's not too late to get started if you haven't done so yet. Take the time now to look to correct the situations that may have developed before it has a devastating impact on the bottom line.
For a quick reference of the coding changes, click here. Please feel free to contact us for further updates!
Barbara Cataletto, MBA, CPC is CEO and Founder of Business Dynamics Limited, CaseCoder™ and the Business of Spine. All three companies provide reimbursement services and/or education to the entire spine industry. She is considered the subject matter expert in the field and sits on the ISASS Coding Task Force, Adelphi University’s Robert B Willumstad School of Business Board of Advisors and was most recently named one of the 50 Most Influential Women in Business on Long island, New York.