20 Apr Medical Coding and Billing Challenges– Long Term Care
Of those who require long-term care, most are over 65 years old and many are in a facility specializing in this type of service. There are others who are over 65 who receive ongoing care in their home and still others under 65 who need long-term care. Those who require ongoing care are usually covered under Medicare or Medicaid.
The Center for Medicare and Medicaid Services (CMS), which is a part of the Department of Health and Human Services (DHHS), is responsible for Medicare, while Medicaid requirements are dictated by CMS, but the manner in which the money is spent is overseen by each state. Medicare covers those who are over 65, while Medicaid covers any age.
Complexities of Long Term Care
If you are involved in healthcare focusing on those requiring long-term services, you know that medical coding and billing associated with this type of care can be daunting. The Medicare Manual is extremely large and very complex. It covers all healthcare related processes and procedures for Medicare claims. Understanding this handbook and being able to properly utilize it will help ensure that your healthcare efforts are properly reimbursed.
Range of Codes
There’s a wide range of codes associated with Medicare and processing such paperwork can be time consuming. Many healthcare practices and workers will opt to utilize a medical coding and billing company that has a primary focus in processing Medicare claims.
Examples of basic coding categories related to the status of a patient include New Patient Assisted Living, Established Patient Assisted Living, New Patient Home, and Established Patient Home. Under each of these categories are codes relating to specific subcategories. Also, it’s important to note that nursing home care involves special requirements that are federally mandated and must be followed.
Thus, it’s evident that when working with patients who are covered by Medicare it’s very important that proper billing procedures are maintained. In long-term care situations, physicians, nurses, physical therapists, and others may find that visiting patients in facilities, reacting to new patient needs or developing health problems, and meeting Medicare requirements taxes their time. On top of having a week filled with numerous visits at various facilities, is the need to keep comprehensive SOAP notes while properly documenting all visits, procedures, and treatments.
Although billing may be ongoing, and in many ways may involve the same observations, assessments, and treatments, it important to delineate differences and changes that occur with each new visit. In other words, codes and bills for those in long-term care situations may over time look repetitious.
Although that may be the case, it’s very important to properly document each visit, as CMS is always on the lookout for signs of fraud, and one such signal are medical claims that are the same in everyway. Also, suspicions may be raised if a healthcare provider seems to be working an inordinate number of hours and possibly overbilling Medicare.
One way a medical coding and billing company specializing in Medicare claims can assist those involved in offering medical services is by carefully monitoring the manner in which claims are being submitted as well as the volume of such claims. The Medicare Manual notes, “Claims for an unreasonable number of daily E/M visits by the same physician to multiple patients at a facility within a 24-hour period may result in medical review to determine medical necessity for the visits.” Your coding and billing company will be on the lookout for such situations.
Keeping it Clear and Clean
Thus, whether you’re making a large number of visits to various long-term care patients in a 24-hour period or very few visits, it is essential that you document everything. Your medical coding and billing company can certainly work with you to make sure that you track every single visit and the reason for it. Making sure that all documentation is clear and clean will be very helpful if you must justify your billing during a Medicare audit.