Attention to Detail Makes a Difference:Paying careful attention to detail to your upcoming patient cases, your applications for prior authorization, your documentation and the CPT codes charged can speed up your cash flow and prevent lost revenue…
Vein practices are currently confronted with the reality of declining reimbursement for their bread and butter vein ablation cases. CMS re-evaluated the practice expense (PE) component of the RVU reimbursement formula and are cutting reimbursement for ablation cases by approximately 24 % over the next 4 years. To adapt, it is critical to make many adjustments in your vein practice to either increase revenue or decrease costs, or both, going forward.
One way to increase revenue is to reduce or eliminate prior authorization denials. We’ve noticed that it is common for insurance companies to deny claims for lack of prior authorization because of simple single digit errors in the CPT code in the application. Specifically, we’ve noticed a trend in prior authorization denials for the CPT codes 36465 and 36466. Providers are requesting prior authorization for 36466 but are billing 36465.
You would not think one number off would make much difference, but it is all in the CPT description:
Many insurance companies are denying such claims because the exact CPT code that was authorized was not the exact CPT code that was billed. This results in the submission of an appeal, which at best slows down your cash flow. However, appeals are not always successful, depending on the patient’s insurance plan. Also, one cannot simply re-file the denied claim with the CPT code that was authorized without also amending the medical record documentation. Moreover, one cannot bill for a 36466 if the records do not state that multiple veins were treated. And, of course, the documentation and codes must reflect the actual treatment the patient received and cannot be amended just to get a claim paid. Doing this would be considered fraud. So, such cases often lead to lost revenue.
Following these steps carefully will help you increase your rate of cash flow and prevent lost revenue.
Click here to see what StreamlineMD can offer your vein practice: StreamlineMDVein.pdf
If you have any questions, please contact your StreamlineMD client rep or StreamlineMD sales at 866-406-2224 or firstname.lastname@example.org.