Top 10 Errors in Coding and Billing
By Clarke Newman, OD, FAAO
- Not learning the text, the pre-text, and the sub-text instructions from CPT for each and every code billed by the provider and reviewing that knowledge on an annual basis.
- Not learning the billing policies for each and every code for each and every carrier for which the doctor is a provider on an annual basis.
- Contracting as a provider for insurance plans that do not make financial sense for one’s practice.
- Failing to pre-verify patient coverage of medically necessary contact lenses before seeing the patient.
- Poor documentation and failing to establish medical necessity based on the ordering, interpretation, and plan modification of tests rationally based on the chief complaint.
- Failing to charge for follow-up visits when appropriate and knowing when one can charge for those services.
- Using CPT codes for non-covered services that do not meet the text, pre-text, and sub-text meaning of the CPT code.
- Failing to provide clear direction, verbally and in writing, to the patient with regard to who is responsible for paying for what.
- Failing to have a skilled insurance coordinator on your staff and meeting with him/her on a daily basis.
- Failing to have pre-written letters of medical necessity and brochures about medically necessary contact lenses.