while all coders must comply with the same set of general guidelines,
each specialty also has its own set of rules. To simplify the process,
start by understanding the coding requirements of your organization's
top 5 payers, and remember, Medicare sets the standard.
Communication among departments can also affect the volume and
frequency of coding-related denials. When surgeons' offices, coders,
the front desk and the business office communicate clearly and regu-
larly, claims are submitted correctly and paid more quickly, more
often.
Triage denial trends
When a systemic problem with denials exists, try triage. Identify
the barriers to claims processing and prioritize them. Here are a few
common trends and solutions to look out for:
• If several claims are held or denied for registration issues such
as incorrect ID, eligibility, coverage termination or group number,
then more instruction must be given to your staff responsible for
intake.
• If claims are rejected for modifier usage, specificity or sequencing,
then it's your coding department that needs additional training.
• If denials occur for failure to pre-certify or pre-authorize, fee
schedule issues or duplicate claims, alert your accounting office.
Train, train, train
Failure to keep up with training will result in reduction of rev-
enue, penalties for noncompliance, and pre-payment and post-pay-
ment audits. That is why credentialed coders are critical to every
team, regardless of size and scope.
Only half of the medical billers and coders in the field are certified,
according to one recent survey. However — considering the increas-
2
3
M A R C H 2 0 1 6 • O U T PA T I E N TS U R G E R Y. N E T • 4 1
