Four Tips for Growing Your IV Reimbursement with Correct HCPCS Code Documentation
Is your home infusion business constantly battling payer audits and denials? The problem could be in your coding, but the good news is that you can reduce denials and increase payable claims by ensuring your Healthcare Common Procedure Coding System (HCPCS) codes are accurate.
Home infusion providers use HCPCS (commonly pronounced hick-pick) codes every day. These codes are a standardized system that Medicare and other payers rely on to “ensure that claims are processed in an orderly and consistent manner.” (1) Although the logic is to provide a consistent form of claim tracking, this process is not as easy as it may sound for providers.
When providers receive new inventory items, inventory staff assign these items with actual codes and HCPCS codes based on the National Drug Code (NDC) numbers of the items. Errors may occur when staff work from memory, assign miscellaneous codes, or guess which code to use. If a code is wrong for one item, all future claims using that code are subject to denial because the documentation does not match with Medicare.
Submit correct HCPCS codes with Mediware’s Reimbursement Services!
Here are some helpful tips that will ensure your claims include the correct HCPCS codes and that your internal processes incorporate compliance checks to reduce errors.
1. Verify the correct HCPCS code and quantity with an NDC crosswalk. Instead of guessing which codes to use, check your work with a convenient online tool. Based on the NDC number, this tool helps determine the correct HCPCS code and quantity. Be careful to read the narrative of all codes, so you choose the correct HCPCS code. Visit this site for more information about the crosswalk tool: https://www.dmepdac.com/crosswalk/2016.html
If your staff doesn’t know what code to use, do not resort to a miscellaneous code. Miscellaneous codes are for inventory items for which HCPCS codes have yet to be assigned by Medicare and should not be used as a “catch all” when you don’t know the appropriate code.
2. Create quality checks in your intake process. Ideally, it’s best to limit the number of staff who input codes to minimize errors. In fact, it’s best to have just one person consistently assign HCPCS codes for inventory items, and then have another person check the work to make sure the two staff members agree. Correctly assigning the right code to new inventory items can help avoid problems with subsequent claims, patient information, and insurance verification issues.
3. Don’t assume your HCPCS codes are correct, even if your claim is paid. Paid claims aren’t necessarily a stamp of approval that your documentation in the claims is correct. Instead, it could just mean that Medicare didn’t immediately catch the error. Later, when the error does surface, additional claims processed with that code, which you assumed was correct because your claim was paid, will also be
4. Appeal denials when appropriate. In the event of a denial, review the reasons for the denial, and determine if there is cause to appeal. Occasionally, for example, you may use the correct HCPCS code for the patient, which is noted on the delivery slip, but then enter the code incorrectly prior to claim submission. In this case, you can supply the delivery ticket information that shows that you did use the correct code. Your claim will be re-evaluated and most likely approved for payment.
If you take these steps to ensure that your billing system includes accurate HCPCS codes, these small details will be less likely to threaten your entire business. Instead, these guidelines can help you with the battle of payer audits and denials. If you need further assistance with infusion billing, Mediware Reimbursement Services can easily manage your IV billing and HCPCS code documentation so that you can collect more with fewer headaches.