Resolutions -Be Ready For Changes (Codes, Insurance Plans, Etc)

Anyone who is successful in healthcare knows that learning never stops in this industry.  Things are always changing-new surgical procedures, new diseases, new billing rules, etc.  How well are you and your staff at keeping up with the changes?

Codes used for billing update throughout the year, but the biggest changes and additions occur with the new year.  The new ICD-10-CM codebooks become effective October 1st of each year.

CPT codes, our procedure codes, have update and become effective for use on Jan 1st of each year. Make sure you have a new CPT book and/or CPT computer software for looking up codes. Check with your billing software and clearinghouse to ensure the codes get updated automatically, or if your office needs to manually update the new codes.  Charge slips, forms, and letters used by your office that include codes may need updates as well.  Check with staff and make sure everyone is aware of the code changes.  A good time to discuss the new changes would be during an office meeting.  The medical association for your specialty probably offers a coding update book. This is a great way to get practice specific information to share with staff.

Many insurance companies update their fee schedules at the start of a new year, however some may update at other times of the year.  Check your contracts to determine when fee schedules are updated.  Many insurance companies also mail information stating fee schedule update information and changes to billing policies.  Even though this looks like “junk mail” make sure someone is perusing the mail before just throwing it all away. If you are unable to verify the dates of fee schedule updates, and the new prices, contact your provider representative for the insurance company.  If you are a contracted provider, they must give you the fee schedule that corresponds with your contact and specialty.  Once you get the fee schedule check your current prices against the new charges.  If you are “undercharging,” increase your fees.  Your biller or payment poster should be catching undercharges when posting payments with the EOB already.  But by being proactive, you can save your practice lots of money.  If you wait until the EOB arrives to review and update charges, the undercharged amount is lost on each claim that goes out until your updates are made.  If your billing software allows you to upload insurance fee schedules, do that also. 

A new year can mean new insurance plans, or changes to existing plans.  Many insurance plans are based off a calendar year.  While patients should be asked about insurance at each visit and required to show their insurance card and identification, any plans that run on a calendar year should have a benefit investigation completed on them too.  Copays as well as deductibles and coinsurance amounts change frequently, and the patient may not even be aware of the changes to their plan.  Patient responsibility for medical bills has been steadily increasing the last few years.  Medical practices are having a harder time keeping up with increased patient AR.  Collecting from patients can be difficult.  Ensure the patient understands their responsibility for the new plan year, and if needed get a new payment plan set up with the patient.

Does your office have a policy and procedure manual? If so, check for the frequency of needing the patient to sign new HIPAA forms as well as other medical release documents.  If the manual states that your practice updates these forms with the patient once per year, then plan on having patients review and sign the forms again.  If you do not have a policy manual, it is imperative that you do implement one. From helping train new staff, to having proof your office follows legal protocols, a policy manual is very important.  Contact your attorney or legal counsel for advice on HIPAA and release documents if you have concerns.

The New Year’s holiday commonly makes people think of ways to improve or update themselves.  We know that if we don’t strive for being the best we can be, we are stagnant in our lives.  Your medical practice follows the same idea.  There are many changes that take place in the new calendar year; coding changes, billing policy rules, insurance coverage, etc.  It is imperative to make sure you, your office and staff are ready for changes for the next year.