Frustrated With Health Care

With a ”Coding and Documentation” seminar you kinda know going in that you may not want to hear some of the stuff that will be presented.  This is exactly how I felt a couple of weeks ago when I went to one of these seminars in my area.  

Don’t get me wrong, it’s always good to learn about great codes I can use to bill for services I’m already providing.  HOWEVER, it is always disheartening to learn all the rules and the precautions.  It takes all the fun out when in the next breath we’re told to be very careful to use the right code, and the correct modifier.  AND, be extra careful to be sure that you are documenting everything in your notes so you can safely bill those fancy codes.  For the privilege of spending an extra 15 minutes with your patient, you get to bill, and possibly “chase”, the carrier for $17, maybe!  Is it really worth it?

In my book, it hardly is worth it.  I mean, you have to be sure that, according to that particular insurance company’s rules, using a particular code is justified for the patient, and that you do not overuse it for this particular condition.  All this is a headache I do not wish to get involved with!

Why do I chose not to get involved?!  Because I chose to care for my patients based on what THEY need, NOT what the insurance company thinks I should give them based on a code.  If I want to give advice on ADL I would rather do a little on each visit, which might add up to 2 or 3 minutes each time.  But wait a minute, I need to spend 15 minutes in order to bill the carrier!  I know, I’ll just spend my 2 to 3 minutes and when it adds up to 15 minutes that’s when I will bill the carrier.

Let me tell you about the second part of this seminar; the part where we learn about post-payment audits.  Just as it sounds, based on a review of records an insurance carrier can request a refund because of what they consider inaccurate or improper coding and documentation, and the “fun” part is they can go back 6 years!  Based on this, I’m not so sure that I want to play games by billing for 15 minutes of ADL after spending 3 minutes 5 times.  The carrier could contact the patient who would only know that you didn’t spend 15 minutes with them on a single visit, ever.

I know, how often do insurance companies check this stuff and what are the chances you’d get caught in this scenario?  You’re right, slim to none!  I just chose not to get involved.  I chose not to worry about all the little neuances about billing these nuisance codes.  In actual fact, I believe I can make up for any “lost revenue” as a result of not billing for these services by seeing more patients for their regular office visit, which I know I can bill for without raising any red flags.

A cash practice with a “non-barrier fee” will keep you going strong. 

Until next time at www.FrustratedWithHealthcare.com.