Practice Management

Every year, the CPT coding system is updated, and every year this results in confusion and panic in physician office billing departments. But do not despair. Instead, make it a habit to carefully review both the new and established codes, learn to correctly code for the services you provide, and reevaluate your methods of capturing charges.

The Most Important Change

CPT coding requirements and use are becoming more complex with each passing year, and 2002 is no exception. The American Medical Association, which has responsibility for developing and updating CPT codes, has introduced changes that acknowledge a number of new procedures and emerging technologies -- and these will no doubt prove helpful to physicians.

However, although procedures are becoming more technically difficult, requiring greater skill, most physicians will be reimbursed less for them in 2002 than they were in 2001, from Medicare and carriers that establish their reimbursements based on the Resource Base Relative Value System (RBRVS) methodology. Internal medicine was fortunate this year -- it received a 1%increase in RBRVS reimbursement rates. In contrast, rheumatology will now be paid 6% less overall for the procedures specific to its areas of specialization.

The most controversial change in 2002 is the decrease in the Medicare Conversion Factor used in calculating the payment per Relative Value Unit (RVU) for services. The Medicare Conversion Factor for 2001 was $38.2581, whereas for 2002 it is $36.1992. Because of this decrease, taken as a whole, the medical profession will suffer a 5.4% cut in reimbursements.

What to Do

In light of the CPT code changes and the decrease in the Medicare Conversion Factor for 2002, physician offices will benefit more than ever before from adopting these recommendations:

• Review annually the codes related to your practice, because CPT codes change every year.
• Be sure that you and your staff are up-to-date with the most current billing and coding guidelines. Medicare Part B bulletins published by the federal government and fiscal intermediaries give the most current Medicare policies, which may affect your coding habits and help you to properly bill Medicare for services provided (available at www.partbnews.com). The AMA offers another publication that fully summarizes the changes for 2002 entitled CPT^® Changes 2002: An Insider's View -- this is a must-have and is available at www.ama-assn.org/ama/pub/category/5173.html.
• Be sure you are correctly documenting and coding for the services you provide.
• Believe it or not, in many practices staff and even physicians are completely confounded with coding. Many others have coding pretty well in hand but still have much room for improvement.
• Coding and billing must be based on accurate medical record documentation, which also achieves continuing quality care for the patient. Appropriate documentation of diagnosis and treatment plan is necessary to both determine and prove appropriate medical treatment and coding and billing determinations.

Reevaluate Your Methods of Capturing Charges

Charge capture is an often overlooked aspect of coding. To avoid common reporting problems, make sure that every service you deliver and every procedure you perform is reported from the physician to the billing office. For example, if you perform an injection but don't accurately report the number of units, the billing office will not appropriately bill the insurance company for the injectable.

HIV practices are experiencing extensive financial difficulties associated with inadequate reimbursement for services provided and excessive delays in insurance carrier payment. Therefore, the Academy has introduced the Reimbursement Hotline. This hotline can help members improve billing operations and reimbursement by helping you ensure that you appropriately and accuratelycapture your services. The Reimbursement Hotline regularly answers questions (including backup documentation) on such issues as:

• Appropriate CPT codes/ICD-9 codes for Procrit^®/EPO injections
• Appropriate billing for flu shots and pneumonia vaccinations
• Appropriate use of modifiers, such as modifier -25
• Proper documentation of evaluation and management services
• Inadequate payment for biologicals and injectables
• Guidelines for establishing medical necessity for services and diagnostics provided
• Carrier policies regarding establishment of medical necessity for prostate exams and the bioelectrical impedance analysis test
• Billing guidelines for nonphysician practitioners, registered nurse practitioners, and physician assistants
• Provide research and assistance with payor disputes relating to appropriate coding and documentation of covered services

Assistance in billing, coding, and reimbursement is provided by the Academy through Rheinisch Medical Management, Inc. You can reach the Reimbursement Hotline at 877-REIM-HOT (877-734-6468) or at reimbursementhotline@aahivm.org.

Back to The Nexus Winter 2002 contents page.