Category: News

Understanding Social Determinants of Health (SDOH)

Social Determinants of Health (SDOH) encompass the array of conditions that people are born into, grow up in, work, and age. These determinants include environmental, social structures, and economic systems that deeply influence health outcomes, access to healthcare, and disparities in health. With the World Health Organization (WHO) attributing 30-55% of health outcomes to SDOH, it’s clear that their impact surpasses that of genetics and healthcare access combined.

The Role of Coding in SDOH

Coding SDOH involves the use of standardized codes like ICD-10-CM (specifically the Z codes), and CPT, to capture and report data on social factors affecting health. This coding practice allows healthcare professionals and stakeholders to understand the social needs of patients and communities, fostering interventions that address these critical determinants.

Benefits of SDOH Coding

• Enhanced Clinical Documentation and Decision-Making: By accounting for SDOH, healthcare providers can ensure more accurate clinical documentation, influencing diagnosis, treatment, and prognosis.
• Improved Healthcare Quality and Value: Interventions addressing SDOH can elevate patient satisfaction, adherence to treatments, outcomes, and can potentially reduce healthcare costs.
• Support for Population Health Management: SDOH data is instrumental in identifying health disparities, trends, and gaps, serving as a foundation for informed policies and programs.

Gathering and Documenting SDOH Information

SDOH data can be collected through health risk assessments, screening tools, or direct patient-provider interactions. It’s vital to document SDOH information only when there’s clear evidence of its impact on the patient’s health, as noted in the medical record. This documentation can stem from various healthcare professionals, including social workers, nurses, or directly from the patient, provided it’s included in the medical record.

Implementing SDOH Coding

• Broad Categories of SDOH Codes: These codes range from Z55 (education and literacy issues) to Z65 (other psychosocial circumstances), covering a wide spectrum of social determinants.
• Educational Initiatives: It’s crucial to educate healthcare providers and coding professionals on the significance of screening, documenting, and accurately coding SDOH data.
• Review and Coding Process: Coding professionals play a key role in reviewing medical records to identify and apply the appropriate ICD-10-CM codes based on documented SDOH.

Next Steps

To harness the full potential of SDOH coding, it’s imperative to educate all stakeholders about its importance. This includes ensuring healthcare providers are proficient in screening for and documenting social needs, alongside equipping coding professionals with the knowledge to accurately code these determinants.

By integrating SDOH coding into healthcare practices, we can pave the way for more holistic, effective, and equitable healthcare delivery. Symbion Coding is committed to supporting this transformative journey, enhancing healthcare outcomes and equity across communities.

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This program has been approved for continuing education unit(s) (CEUs) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting of Approved CEUs from AHIMA does not constitute endorsement of the program content or its program provider.

Strategies to Combat Medical Claims Denial – Elevate Your Practice with Symbion

Dear Healthcare Professionals,

In the intricate landscape of healthcare, managing medical claims stands as a pivotal aspect that underpins the financial vitality and reputation of medical practices. The journey through medical billing and claims management is fraught with complexities that demand not only our attention but a strategic approach to navigate successfully. Symbion Coding is committed to empowering healthcare providers by unveiling and addressing the common pitfalls in the claims process, thereby ensuring your practice’s operations are as smooth and efficient as possible.

Understanding the Landscape of Claims Denials

Navigating the Claims Denial Minefield:
Denials in medical claims can stem from a myriad of reasons, each potentially undermining the financial foundation of your practice. Understanding these reasons is the first step towards fortifying your operations against such setbacks. Common culprits include:

• Prior Authorization Failures: A significant fraction of denials occur due to the lack of pre-approval by insurers for required services. This oversight can halt the reimbursement process in its tracks.
• Inaccuracies in Submission: Errors in patient or provider information are a leading cause of denials. Such inaccuracies can range from misspelled names to incorrect service codes.
• Contesting Medical Necessity: Insurers may refuse claims if there’s a dispute over the necessity of a service or if the supporting documentation is insufficient or unclear.
• Coverage Complications: Not all services are covered under a patient’s plan. Uncovered services, like certain cosmetic procedures, are naturally prone to denials.
• Out-of-Network Services: Services rendered by providers outside the insurer’s network often face partial coverage or outright denial, complicating the reimbursement process.
• Duplicate Claims: Submitting the same claim more than once for the same service can lead to denials, often due to miscommunication or administrative errors.

Strategic Measures to Mitigate Denials

Crafting a Robust Defense Against Denials:
To shield your practice from these financial setbacks, a multi-faceted approach is required. Our strategies are designed to address the root causes of denials, ensuring your claims process is both effective and efficient:

• Insurance Verification: Prior to any service, verifying insurance coverage and eligibility is crucial. This preemptive step can circumvent issues related to prior authorization and out-of-network services.
• Accuracy in Patient Information: Implementing rigorous data entry protocols and leveraging technology to highlight discrepancies ensures the information submitted is both accurate and complete.
• Adherence to Coding Standards: Staying updated with the latest coding standards is essential. Precise coding not only supports the medical necessity argument but also minimizes errors that lead to denials.
• Comprehensive Documentation: Detailed and thorough documentation underscores the necessity and specifics of the services provided, fortifying your claims against scrutiny and denial.
• Timely Filing and Diligent Follow-Up: Adherence to filing deadlines and a consistent follow-up on the status of claims are key practices that prevent unnecessary denials.

Empowering Your Practice Through Insights and Analysis

Turning Insights into Action:
A systematic approach to tracking, analyzing, and responding to each denial lays the groundwork for not just addressing current issues but preventing future occurrences. By identifying patterns and educating your team on best practices, you can significantly reduce the incidence of denials.

Join Forces with Symbion for Unparalleled Support

Enhance Your Claims Process with Expertise:
Symbion stands ready to partner with you, bringing our deep expertise to bear on your claims process challenges. Through quarterly audits, we pinpoint and address issues leading to denials. Our comprehensive staff education programs ensure your team is equipped with the knowledge and skills to prevent future denials.

Together, we can safeguard your revenue streams and reinforce the credibility and efficiency of your practice. Embrace a proactive stance in claims management with Symbion by your side.

Dear Healthcare Professionals,

In an era where regulatory scrutiny is intensifying, the significance of governmental coding audits within the healthcare sector cannot be overstated. These audits serve as a cornerstone for maintaining compliance, ensuring the integrity of medical billing and coding practices. Symbion Coding is committed to guiding you through the complexities of these audits, offering insights and strategies to safeguard your practice.

I. Introduction to Governmental Coding Audits

At their core, coding audits are systematic reviews conducted to verify the accuracy of medical records coding. These assessments are crucial for compliance and are performed by various governmental agencies, including the Office of Inspector General (OIG), Centers for Medicare and Medicaid Services (CMS), and designated Recovery Audit Contractors (RACs) across specific regions. Their primary aim is to ensure healthcare providers adhere strictly to coding guidelines, thereby guaranteeing correct service level reporting and appropriate reimbursement.

II. Understanding Types of Audits

Coding audits are categorized into two main types, each with a unique focus and implications for healthcare practices:

• Prospective Audits: These preemptive audits aim to catch errors before claims are submitted, offering an opportunity for correction and preventing future discrepancies.
• Retrospective Audits: Conducted post-reimbursement, these audits can lead to financial recoupments, penalties, or other corrective measures if inaccuracies are discovered.

III. Audit Methodologies and Selection Criteria

The methodology behind coding audits is meticulously designed to cover various aspects of healthcare provision, employing either random sampling for a broad overview or targeted sampling for specific areas of concern, such as high-risk procedures or services with substantial reimbursement rates. Audits may zero in on areas like Evaluation and Management Services, Surgical Procedures, and Diagnostic Tests to ensure comprehensive coverage.

IV. Penalties and Consequences of Non-compliance

The repercussions of failing to comply with proper coding and billing standards are severe and multifaceted, encompassing:

• Financial Repercussions: From fines to civil penalties, the financial burden on a practice can be substantial.
• Exclusion from Federal Programs: Losing the ability to participate in programs like Medicare and Medicaid could be detrimental.
• Legal Repercussions: In extreme cases, fraudulent practices lead to criminal prosecution.
• Obligation to Repay: Erroneous billing often necessitates the repayment of overpayments, further straining financial resources.
• Professional Consequences: Individuals may face the loss of their professional licenses.
• Reputational Damage: The trust and confidence of patients and peers can be irreparably harmed.

V. Strategies for Mitigating Risks

The pathway to minimizing the risks associated with governmental coding audits is multifaceted:

• Robust Compliance Programs: Implementing and adhering to stringent compliance protocols is foundational.
• Continual Education and Training: Keeping abreast of the latest coding guidelines and regulations ensures accuracy and reduces errors.
• Regular Internal and External Audits: Conducting thorough audits helps identify and rectify potential issues before they escalate.

VI. Conclusion: Your Partner in Compliance

Symbion Coding stands ready to assist you in navigating the intricate landscape of governmental coding audits. Through our expert services, we aim to empower your practice with the knowledge and tools necessary for maintaining compliance, ensuring accurate coding and billing, and ultimately safeguarding your practice against potential penalties and financial losses.

Join Us in Our Upcoming Webinar

Dive deeper into the world of coding audits with our upcoming webinar, designed to equip you with the strategies and insights needed to thrive in this regulatory environment. Register today at: https://events.teams.microsoft.com/event/d65bb557-66b6-4d4e-ab9e-dd6981ce1c63@0199b4fb-f183-4e5d-abc8-7b1ecca7cbb2 

For further information and to stay updated on the latest in healthcare compliance, visit our website and subscribe to our newsletter.

Together, let’s ensure the highest standards of accuracy and integrity in clinical documentation.

For more insights and assistance, feel free to reach schedule a free consultation at: https://symbioncoding.com/contact-us/ 

Stay compliant and stay ahead!

Best Regards,

Symbion Coding

Why Are Medical Coding & Billing Due Diligence Important?

There are numerous reasons why you would want to engage in thorough medical coding and billing due diligence before a practice merger or acquisition. However, the most important is to ensure compliant and accurate documentation, as well as timely and accurate coding and billing.

By checking into this history, you can determine a lot about the financial well-being of a practice, including how it affects the overall value. Additionally, non-compliant billing and coding can increase the liability risk for a medical practice. If you are taking control of that practice, that liability carried onto you. Thus, it is important to know what you are dealing with from the very beginning by doing a thorough job of due diligence.

Coding Due Diligence Benefits

It’s important to realize that the benefits of coding due diligence go far beyond just checking for liability issues. For example, you can enjoy greater visibility in coding patterns and have a more complete basis for your purchasing decision.

Working with Symbion Coding Inc to obtain this type of report also ensures diagnoses and procedures described in the patient’s health records are appropriately coded. In turn, this allows you to identify whether the risk lies with the physician, coders, or some combination thereof.

Working with Symbion for Coding Due Diligence

At Symbion, we are here to make the due diligence portion of your acquisition or merger easy. Our experts can help detect a variety of elements including:

• Whether E/M documentation meets all appropriate guidelines or not
• Any possible missed opportunities for HCC codes for Medicare Risk Adjustment
• Determining if diagnosis and procedure coding guidelines are followed
• If file documentation routinely supports medical necessity
• Whether medical records are being copied and/or pasted versus individually prepared for each unique patient

And that is just the start of what we’re usually able to uncover. By having these details, you can make a better determination and wiser decisions during your business transaction.

Receive a Complete and Detailed Report from Symbion

So, what does Symbion provide with our medical coding and billing due diligence service? First, we offer a quick turnaround time to help you get the information you need when it is most important. Second, the report we offer is fully confidential and we also routinely work with attorneys to ensure attorney-client privilege. In the end, you will receive a report that not only shows errors, but also identifies possible root causes, opportunities for documentation improvement, analysis of results with potential impact, and recommendations to address the identified issues.

As most practitioners and nurses would agree, health records are the most critical document used within the medical care setting. After all, they are the primary vehicle for recording and communicating health information and ensuring continuity of care.

There are numerous pieces of information within a health record that are used for various purposes. For example, notes and information within these documents are used to evaluate adequacy and appropriateness of care. They also provide clinical data for research and show quality of care. On the financial side, these records can support reimbursement from insurance providers and make keeping the healthcare center profitable a reality.

In short, documenting the patient’s condition completely and accurately is a paramount part of the healthcare process. That is why it is so important to review your document program and have a plan for making needed changes for better accuracy.

What is a Clinical Documentation Improvement (CDI) Program?

So, what exactly is a clinical documentation improvement (CDI) program? Essentially, it is the process of improving healthcare records to ensure improved patient outcomes, data quality, and accurate reimbursement. The overall goal is to ensure the patient’s true severity of illness is documented and reported appropriately.

While that might all sound like a mouthful, what it all comes down to is having a process of reviewing your documentation to make sure your entire medical team is reporting healthcare data accurately and completely at all times. This is something that needs to be done often to ensure all protocols are followed and that your patients are getting the best care possible. It is also something that should be checked to discover any bad habits or problems that arise with specific staff member reporting.

Reasons for Clinics to Implement a CDI Program

Hospitals have been doing inpatient CDI programs for years and regularly make changes to their documentation protocols. The unfortunate part is that most individual clinics and doctor’s offices don’t have the same level of funding to be able to do this on a regular basis, nor does the staff usually have time in the day due to other responsibilities.

Think about this for a moment. What time during the day does an office manager or receptionist have to go through existing medical records and review them for complete and total accuracy? What about a medical biller or coder? Generally, their day is busy with just trying to keep up with the normal duties of their position. Thus, it can be a good idea to work with a third-party to implement a thorough CDI program.

Clinical Documentation and the Changing Healthcare Environment

The healthcare environment is rapidly changing, and it can be more critical than ever to ensure all patient health records are accurate and complete. In order to receive payment for health services rendered, the quality of records submitted can make a big difference in amount and speed of pay.

Payment systems utilizing ACOs and bundled payments incentivize efficient care, but also require physicians to document specifically, clearly, and accurately. In addition, the Physician Quality Reporting System (PQRS) also offers better benefits for having better health record documentation.

Plus, many health payers now use some version of value-based reimbursement that links financial reimbursement to patient severity of illness. This means that it is more vital than ever to capture and record accurate diagnoses.

What Can Individual Medical Practices Do?

When it comes to ensuring your individual medical practice has the most accurate health records possible, one option to consider is to hire a third-party to implement a CDI program. On a small scale, your organization can hire a medical coder with specific CDI experience to help review existing records and implement better protocols for new records.

Likewise, you can also opt to work with a third-party coding and billing partner, such as Symbion Coding (www.symbioncoding.com). We offer clinical documentation improvement advice and review within the services that we already offer, which can give your practices a two-fold approach to improved reimbursement and accuracy.

Both are excellent options that lead to one final and successful result: a better healthcare records system that ensures your patients are getting the best care possible and that your practice is receiving the appropriate reimbursement for the treatment provided.

Conclusion: Benefits of Having a CDI Program

What this all comes down to is that every medical practice should have a CDI program in some form. Whether this is an individual party who is trained to handle chart review tasks or a third-party organization with a wealth of experience analyzing records in bulk really comes down to your individual clinic needs.

However, the end result is still the same of better-quality documentation within the medical record. Better data and accurate reimbursement for the practice. And an overall reduced compliance risk associated with improper billing. For most practices, these benefits alone far outweigh the cost of hiring third-party help and make the CDI process incredibly worthwhile.

Jean Delva
Founder & CEO of Symbion Coding, Inc.

Over the last few years in particular, insurance plans with high deductibles have become very popular – which means that patients are responsible for larger percentages of their own healthcare costs than ever before.

At the same time, many people are under the (unfortunately mistaken) impression than unpaid medical bills in a credit report will NOT cause any damage to their credit score over the long-term – meaning that they may not feel the urgency to pay in some situations.

Thankfully, improving patient collection in your practice to this point is not nearly as difficult as you may be fearing. You just have to take a few key steps today that will pay huge dividends (both figuratively and literally) tomorrow.

Improving Patient Collection: Steps to Take Before the Patient Appointment

After a patient books an appointment but before that day actually arrives, you should always verify all insurance information on-hand to make sure that the patient in question has the appropriate coverage. At a bare minimum, check to see that they have a deductible and if the answer to that is yes, ensure that the deductible has been met. There is software out there that can help your medical practice and your staff members do this automatically, all so that you can save a great deal of time in the process.

Likewise, have someone reach out to and communicate with the patient if there is any copay or deductible (or past due balance) before the appointment. Make sure they understand the situation and do what you can to help them take care of it in a sympathetic way, all before their appointment happens.

What to Do During a Patient’s Appointment

Once the patient’s appointment day is here, try to collect their copay, deductible or past due balance before the patient sees the provider (if possible). It is natural to meet a bit of resistance to that point, so be sure to frame your communications in a way that puts their mind at ease.
For example: rather than asking patients if they want to pay today, ask them HOW they want to pay today. Let them know about any special payment arrangements that they can make and generally just make sure that they understand all of the various options available to them.

Likewise, make sure that someone in your office can actually accept a credit card to facilitate the payment (if applicable). Really, what you are doing is trying to take care of potential issues now to create the most hassle-free payment experience possible for people. Not only will this help take care of any perceived issues with this appointment, but the positive experience will also help make people more inclined to pay again in the future.

Billing Considerations for After the Appointment and Beyond

It goes without saying that, at times, you may not be able to collect patient medical bills before or even on the day of an appointment. This is especially common these days, given the economic uncertainty brought on by the ongoing COVID-19 pandemic. Everyone has a different and unique situation, and you can never be too sure of what challenges someone may face. But at the same time, that does not mean that you do not have steps available to you after they have left your office.

First, be sure to follow up with the patient about any past due balance as soon as you can after the appointment – even as soon as the next day is okay in a lot of situations. Generally speaking, it may be more practical for medical practices to send statements to patient homes as a first option. This statement should include as much relevant information as possible including when the service was provided, what specifically was done during the service, the portion of the bill being paid by insurance, and more. If the patient receives the statement but still does not pay, that is when you will want to reach out by giving them a call.

Again, you are trying to put their mind at ease and remind them of what they are actually paying for. A lot of times people will be much more open to the idea of making this type of late payment if they understand what you are trying to collect for.

If possible, offer an option to pay bills online as this can absolutely help increase collection. Someone may not like the idea of giving a credit card number over the phone, and that’s understandable – but let them know that you have a secure online payment portal that they can take advantage of at their convenience.

Likewise, if you are able to, offer a payment plan for larger amounts to help all parties involved. Not only do patients not have to worry about suddenly coming up with a huge amount of cash at once, but you also get to collect on the bill itself – albeit in small portions. Oftentimes, this compromise can make all the difference in the world. All of this will not just improve your relationships with your patients – it will help support your revenue cycle as well.

At Symbion, we pride ourselves on acting as a partner to medical practices like yours – and one that wants to help you optimize your collection and achieve the most accurate, timely reimbursement possible. So if you’d like to find out more information about these and other simple strategies that you can use to improve patient collection in your medical practice, or if you’d just like to discuss your own needs with someone in a little more detail, please don’t delay – give us a call today at (800) 672-8149 or visit us at www.symbioncoding.com.

There is no doubt that the COVID-19 pandemic has changed the medical community as a whole. Where most people used to just make an appointment and show up at the office, many are now opting for telephone encounters to help prevent virus spread.

For practitioners, this is a much more convenient way to offer patient centered care. Instead of trying to see a set number of people within the walls of the office each day, doctors can now treat more patients in a much more convenient format.

Here is what you need to know about telephone encounters including what they are and why they need to be documented correctly.

What Are Telephone Encounters?

Simply put, telephone encounters are clinical exchanges that occur via telephone between providers, nurses, and patients. Telephone encounters can be very useful for numerous reasons, including:

• Increased Clinic Access: Patients who might not otherwise be able to make it into the clinic physically now have access to care.
• Reduced Unnecessary Burden on Patients: Travel time and other obstacles are now reduced or completely eliminated.
• Reduced Unnecessary Hospital Visits and/or Readmission: By having easier access to primary care physicians, less patients are physically visiting emergency medical centers.
• Improved Continuity of Care: Subsequent visits to follow up for specific conditions is much easier.
• Maximize Physician and Nurse Time: Calls usually only last a few minutes, which allows for treatment or more patients within a day.

In short, there are many reasons why a practitioner would consider adding telephone encounters to their schedule that are beneficial to the overall clinic (This article does not examine the amount pay by health plans to medical practices).

Not All Phone Calls Are Telephone Encounters

However, it is important to realize that not all phone calls are telephone encounters. Knowing the difference is important, as it can mean the difference between having bills approved by insurance companies or outright denials.
The real benchmark is whether or not the call includes information that can be communicated by non-licensed staff. This includes communication of normal results, billing inquiries, or other generic phone calls. Additionally phone consults that result in an in-person appointment less than twenty-four hours later would not be considered a telemedicine visit.

Criteria for Telephone Encounters

To ensure practitioners are using the telemedicine system appropriately, there are a few guidelines that determine whether an event is truly a telephone encounter. At least one piece of criteria must be met to be considered an eligible telephone encounter:

• Medical Decision Making: The call includes medical decision making and/or care coordination that results in the involvement of a physician, nurse, or pharmacist, such as treatment plans or changes in prescription medication.
• Substitute for In-Person Clinic Visits: To be a telephone encounter, the call must be deemed an alternative for a physical visit to the clinic.
• Refills of Medications: The call includes refills of medications that would have otherwise required an in-person clinic or emergency room visit.
• Follow-Up Visit: The conversation serves as a follow-up to a previous in-person visit.
• Educational Visit: The call or involves a form of patient education such as counseling, informed consent, or motivational interviewing.

Furthermore, it is important to note that only established patients are eligible for legitimate telephone encounters.

Documentation of Telephone Encounters

When it comes to medical billing and coding, there is a specific amount of documentation that needs to be done correctly. All telephone encounters should be documented to the medical record in the same manner as an in-person clinic visit. A few of the most common documentation requirements include:

• Notation of Initiation: It should be well documented that the patient, parent, or guardian initiates the phone call.
• Notation of Consent: Documentation that the patient consents to the telephone call.
• Notation of Reason: Include notes on the reason or chief complaint requiring the telephone call.
• Medical History: Document relevant medical history, background, and/or results for the patient.
• Assessment: The practitioner’s assessment of the patient with full and detailed notes.
• Treatment Plan: The provider’s plan for treatment of the patient, including all relevant medications or other instructions.

It is also important to include detailed information to show the medical necessity on the total time spent with the patient. While it might be tempting for some patients to discuss their grandchildren’s soccer game or some other personal topic, this filler conversation should not be included in the documentation.

Wrap Up: Protecting Your Practice During Telephone Encounters

It continues to look like telephone encounters are going to stay popular long after the COVID-19 pandemic fades. That is why it is so important to learn these guidelines now and apply them within your practice. Failure to do so can lead to denials and delay of payment, which nobody wants to deal with. Instead, train your team now to help make the billing and coding process easier in the future.

If you had to make a list of some of the major pain points associated with most medical practices, resubmitting claims would undoubtedly be right at the top.

Not only does this mean that a medical practice has to wait longer periods of time to collect money that they’re owed, but you also have to consider the costs associated to rework that claim in the first place – costs that add up in a frustrating and often surprising way.

This has always been problematic, but it is an especially difficult situation to find yourself in given everything that is currently going on in the world. During a period of time when practices need to remain more productive and more competitive than ever, you cannot afford to spend so much time working and reworking claims that do not have to be this difficult. You also certainly do not want to extend your ability to get paid for the work that you have already done any longer than you absolutely have to.

Thankfully, there are a number of straightforward steps that you can take to reduce denials in your own practice and often prevent them altogether. You just have to keep a few key things in mind.

What You Need to Know to Prevent Denials: Breaking Things Down

By far, one of the most important things to do to prevent denials from happening at all involves the acknowledgement that billing absolutely begins with the front desk.

Your front desk employees need to be checking someone’s eligibility as soon as you can – ideally two to three days before an appointment. They should verify that the provided demographic information is accurate and that they have every other relevant bit of data they need to submit the claim in the first place. Likewise, you should be educating your staff members on coding and the impact of clinical documentation on the revenue cycle. The providers themselves especially need to be educated. All of these things will make a big, big impact moving forward.

In addition to taking steps to prevent denials that occur because of coding errors, you can also make use of an external person to provide the aforementioned education to your employees. Think about it like this: the costs associated with hiring that external educator are often far lower than the loss of revenue due to a provider’s lack of knowledge. Even if you go through comprehensive training sessions twice a year with a special emphasis on the most common diagnoses and procedures used in the medical practice, you could still increase your reimbursement in the long run.

Track Denials for Better Outcomes Moving Forward

Another one of the best ways to reduce denial rates in your medical practice involves coming to a better understanding of why they may be happening in the first place. Far too often, medical practices know that denials are happening, but they are not really sure why. They are certainly not aware that, more often than not, they are falling victim to the same few mistakes that are happening over and over again. If they would just make some slight adjustments to their workflows here or there, the lion’s share of their problems would be over. But some medical practice may not have the knowledge or the resources to do that, so this frustrating cycle repeats itself indefinitely.

To get to that point, you will need to determine the root causes that you are dealing with. Oftentimes, this involves issues at the front desk (like incorrect demographic information), billing errors (like CCI edits or incorrect modifiers), coding problems (like a ICD-10-CM code for female being used on a male patient) and more.

Once you have a better understanding of why those denials are occurring, be sure to share the results with providers and office staff members so that they are aware of what is going on. Implement new processes to avoid making similar mistakes and definitely continue to monitor things in the future.

Based on that, you will definitely want to conduct internal audits on a regular basis as sometimes this can be the most efficient way to find revenue cycle gaps that would have otherwise gone undiscovered. Do not be afraid to seek independent outside help if you need to or if you happen to be busy on other projects. Symbion Coding, Inc., for example, charges a reasonable fee to provide audit services that come complete with a recommendation on how to close those revenue cycle gaps once and for all.

In the end, while the above steps may be a significant amount of effort above what you are used to, you need to consider the raw value that they will bring to the table. Not only will you spend less time re-working claims that never should have been denied in the first place, but you’ll also speed up the frequency at which you get paid and increase revenue to your practice as well. All of this frees up more time in your day to focus on those matters that really need you, thus paving the way for an even more successful medical practice in the future.

If you’d like to find out even more information about how to reduce and eliminate claim denials as much as possible in your medical practice, or if you’d just like to discuss your own needs with someone in a bit more detail, please don’t delay – contact Symbion Coding, Inc. today at (800) 672-8149 or visit our website: www.symbioncoding.com