Since the implementation of ICD-10 has become mandatory in nephrology medical billing, the need for coding has been significantly raised with a higher number of specificities in the past few years. In addition, the additional and continuous evolution in medical coding made nephrology medical billing and coding more intricate to adhere to.
Besides these changes, there are a number of other requirements from payers that nephrology medical billing has to deal with for a successful claim processing. This is why it is important to comply with all the additional requirements of ICD-10, CPT, and E&M coding to help your practice in accurate nephrology medical billing.
Ways that nephrology medical billing will help your practice
No matter what your practice specialty is, practitioners have to travel from one place to another to offer care to patients. This falls especially true with nephrologists who have to move from one place to another to provide dialysis and perform complex treatments for chronic kidney patients. Along with treating patients, they have to keep billing and coding procedures on top. Due to this, nephrologists have to deal with the tedious phase of filing claims as they have to file individual claims for every dialysis patient they see.
They also need specific claim procedures to manage and improve nephrology-specific account receivables. To help improve nephrology medical billing, these features will help nephrologists.
1. Real-time eligibility
To file a claim to the payers, it is essential to have accurate and complete details of the patient’s coverage and insurance plans. To verify the coverage, the physician’s front office has to put in a lot of time which in turn can create reimbursement issues if not claimed in a proper direction.
On the other hand, in case of no medical coverage, physicians are required to approach patients for the payments of service received. Here, nephrology medical billing offers real-time eligibility to the patient. With this feature of the nephrology medical billing, the front office of the nephrologist can verify the status of patients’ coverage, co-pay, benefits of insurance and co-insurance plans, and the services received in the past with just a few clicks. Besides, this feature allows the staff to know if the patient is eligible for the service or not.
2. Electronic claim submission
As said, nephrologists file claims separately for each individual patient which is time-consuming. While utilizing a standard billing software, they file claims for dialysis patients. Nephrology medical billing specified software allows nephrologists to claim for multiple reimbursements at a time. With this feature, nephrologists can file claims depending on their visits and based on the level of insurance providers.
For instance, if a provider is seeing 20 level 4 patients who are covered by ABC Health Insurance, a nephrologist can file claims for all 20 patients from ABC Health Insurance in just a single click.
The single-click claim submission feature of nephrology medical billing software as it allows the providers to reduce the time consumed in nephrology medical billing. Moreover, it also minimizes the errors in the claim submissions and denial rates. This normally happens due to a high increasing number of dialysis patients that nephrologists see in a day, week, or month.
Some other features of Nephrology-specific billing
Physicians do not only take advantage of nephrology-specific billing in reducing the repetitive tasks of filing individual claims for the same insurance or do not only use them to offer real-time claim verification.
In addition, they also use them to find the gaps in revenue and find the RCM gaps by identifying the difference between care provided and the claims reimbursed.
With this ability to differentiate between payers of mid-month and end-month billing providers can manage and maximize revenue by finding out and eliminating any slipped income from your fingers. Plus, the software helps to provide support to those who are eager to have the most from not just the software but from their billing practice.
How does nephrology specify billing software aids nephrology?
With the following features, nephrology-specified billing provides;
- Advanced Dialysis tracking – This allows nephrologists to track the list of visits and patient rounds. Also, they can remind you of the monthly visits and claims to file payments receivable monthly.
- Custom Templates – Improves workflow whether you are consulting, examining, or treating any kidney diseases. Plus, if they are conducting any other nephrology procedure.
- Comprehensive Dialysis Reporting – Identifies patients who have completed four-session threshold visits for the deliverance of effective care.
- Patient portal – A patient portal allows a patient to track their records, know their health and treatment history, access their vitals, schedule appointments, see results of their tests, send and receive HIPAA-compliant messages, and also complete digital forms surveys.
- A mobile app – The mobile app of nephrology-specified billing allows nephrologists to remain connected with EHR systems. With this, they can access patients’ information from anywhere anytime using their smartphone. It is recommended to see and explore vendor’s websites to know if they support and use the nephrology-specific feature. If you don’t find the specified information on the website, ask the sales contact to provide the specified information, templates, explanation, and other workflow information to support your specialty billing.
Documentation required for nephrology coding and billing
In the contemporary situation, it is required to comply with the specified code with the HIPAA compliance, where lack of specified claims can result in denied claims and penalties. This non-compliance is not just limited to Medicare but any other private payer. Ensure that your practice is dealing with accurate nephrology medical billing; it is mandatory to provide the required documents. For a quick memory refresher, here’s a list of things you need to document for nephrology medical billing;
- Laterality
- The onset of care
- Site specificity
- Combination codes (non-specified/specified)
- The severity of the disease
- Manifestation and etiology
- Any specified condition that can worsen
Also, a couple of things are there as well that need to keep in mind for a nephrology medical specified billing;
- Make sure you don’t code overwhelmingly. If you went to see the patient specifically to treat a kidney issue, then you should add it. Otherwise, in case of a not specified visit, do not code.
- You can use additional coding to describe the condition of the patient. For example, in complying with the coding conventions, if you think there must be more codes to define a patient’s condition fully, then you should use more of the relevant ones.
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