You know, sometimes, as coders and auditors, we’re the last ones to know about new things that come into the office, but sometimes we should be the first.
This past week I got an e-mail from a friend (who is also a client and NAMAS member) who said their office received a new type of intervention; a patch that can be dispensed to their patients. This client is a podiatrist, and the drug rep told them to use a particular modality code for this type of patch, which is actually a physical therapy code. This is a 15-minute code that requires the provider (a physical therapist) be in attendance during the code. So, my obvious refute was no, no, no-no, no, you cannot fill that code, especially if you’re dispensing a patch for the patient to take home.
We should help everyone in the office be aware that when new fundamentals and interventions, and techniques come into the office, maybe we should be some of the first to know instead of the last to know. The sales reps have the best of intentions when they’re giving out any type of sample, and they are there at the benefit of who sent them giving out that coding advice, but we always need to do our due diligence and check. We need to be involved when new interventions are provided in any practice to make sure that the advice given by the sales rep (or any rep). We must step up and remind our providers, our practice managers, and the individual practice locations -those that have “boots on the ground” that before there is a new practice in place or a new service line, let us look at the codes they are going to use. We don’t want to bill for any services until we check those codes out.
While we don’t think we would ever want to commit fraud (of course, nobody ever wants to commit fraud), however, it is still abuse if we bill those codes and we didn’t intend to do it, but we still did it. We collect revenue for things not knowing they were the wrong codes to use, and we then must go back, correct the reimbursement, and submit the claim for corrected billing.
It’s always best to create a standard of how to implement anything new. So, like our organization is currently doing, go through your processes and create standards detailing how you go about this, like a policy. From now on, before you implement a new form of service, send it to a coder/auditor and have them review it. Look at the coding, look at the billing, find out the policies, see if Medicare has a reimbursement policy for that, maybe look at your top five carriers, and see if they also have a reimbursement policy associated for that service as well. Look at which providers can order it, see if there are any type of service restrictions there, and what providers can render the service as well.
I hope this tip is useful for you. If you ever have any questions, don’t forget that NAMAS is here to provide that support to you!
(Watch Shannon discuss this topic on the NAMAS YouTube channel