Physicians who refer patients to your hospital or imaging center must code their own orders. You cannot do it for them, even if you had the time. However, you will face consequences like payment reviews if referring physicians do not code their orders properly. Online service order management can help alleviate this problem.
What the coding is all about
This is probably familiar territory for you, but it’s worth a quick recap in this context. Orders for services like MRIs and CT scans must be accompanied by codes in order for them to qualify for reimbursement by Medicare and other payers. Technically, the code is a combination of numbers and letters that a computer can “read” as it sorts out what procedures can be reimbursed and which need a payment review.
Remember how people used to worry that we would all end up working for computers one day. Well, guess what… that day is here. Medical practices are very much working for computers, trying as hard as possible to please the computer program’s logical operations.
Specifically, referring physicians must provide Current Procedural Terminology (CPT) codes with their service orders. They may also need to include International Classification of Diseases (ICD) codes. The code combinations describe the procedure and the diagnostic justification for it. CPT codes refer to procedures. ICD codes describe diagnostic categories. For example, a doctor might order an MRI if he or she sees symptoms of a brain tumor in the patient. The MRI and brain tumor each have its respective codes that must be added to the MRI order.
Why coding matters
Coding is important because payers are diligently focused on checking them. There are legitimate reasons for this. The payer is interested in reimbursing medical procedures that are necessary. Unfortunately, due to errors and, once in a while, fraud, doctors may order services that are not medically necessary. This is a waste of money and bad for patient care. So, payers are very fussy about codes. Of course, code obsession can take on a life of its own and become quite an administrative headache.
From the perspective of the hospital or imaging center, inadequate physician coding translates into payment denials, reviews and refunds. If a physician sends in an order for an MRI, but does not include the correct codes, that MRI might never get paid for – and worse, the review process will absorb work cycles for your billing staff.
How to make sure coding goes right for your referring physicians
Order management software like iOrder gives your referring physicians the ability to add relevant codes to service orders. The coding process is built into the ordering interface. iOrder can suggest the appropriate code for a given procedure. This includes compliance with qCDSM, the new, government-mandated decision making standards for medical services. iOrder offers “Guided Intelligence Protocol” (GIP), which takes the referring physician through intelligence-based decision support.
Your referring physicians are responsible for coding their orders, but you are on the hook for their accuracy. Now, there’s a way to make sure your referrers are being as accurate as possible with their codes at the moment they place the order. Ask us how we can help you implement this capability.