November 2023

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Welcome to the Kids Health First's Billing & Coding Connection newsletter- an all-in-one resource dedicated for all things billing and coding.


Do you have billing topics, best practices, claim questions, or good news to share? Email KHF at Payorconcerns@khfirst.com.


To add billing staff members to the distribution list, please also email us at Payorconcerns@khfirst.com

CURRENT TRENDS

The Payor Issue Database is now live in the Members section of the KHF intranet under the Financial menu. The Payor Issue Database contains a list of payor issues KHF is tracking on behalf of the practices. Included is a description, resolution and practices impacted. Please encourage your billing staff to reference this helpful resource!

TCCN’s annual Pediatric Coding Seminar was held November 16, 2023. You can listen to the presentation at your own pace and prepare for 2024 coding updates and guidelines. To access the seminar, please follow the links for the webinar recording and the presentation slides.

PCC Pediatric EHR Solutions is hosting FREE pediatric billing training on December 14, 2023! Registration link: https://info.pcc.com/billing-drop-in-2023-december  

Timely charting is a best practice that contributes to a practice’s success. 


Timely charting ensures:

  • the timely initiation of a claim encounters billing workflow,
  • claims are submitted within a payors timely filing,
  • a patient copay/payment can be promptly posted to a patient’s visit,
  • reduction in outstanding A/R due to open charts, and
  • reduced risk management impact to the practice. Please see advice from Curi below.


Kids Health First received guidance from Curi and our broker, Sterling Seacrest Pritchard, to share with practices. They state, “We are not aware of any requirements related to medical record completion; however, please reference the guidance from Medicare. Although Medicare is not the most common payor for pediatric patients, we reference this as it is instructive of the view from federal payors.”


Medicare providers must comply with documentation requirements, including the timeliness of documentation in connection with the provider signature. Unless the documentation for a service is completed, including signature, a provider cannot submit the service to Medicare. Medicare states if the service was not documented, then it was not done.


Providers are expected to complete the documentation of services "during or as soon as practicable after it is provided in order to maintain an accurate medical record." This statement is from the Centers for Medicare & Medicare Services (CMS) Internet-Only Manual (IOM) Publication 100-04, Chapter 12, (PDF) Section 30.6.1. CMS does not provide any specific period, but a reasonable expectation would be no more than a couple of days away from the service itself.


Click to read more about Medicare Documentation Signature Timelines



Curi’s guidance is as follows:

 

Is there a time frame within which we are required to complete documentation in a patient’s medical record?

 

To keep the information fresh and accurate, the patient’s record should be completed as soon as possible after each encounter. We recommend a turnaround time of one business day (24 hours). This policy can help ensure that medical records remain available and are complete for the patient’s next visit or telephone call, and it improves the credibility of the dictation.

 

However, we recognize that a 24-hour turnaround time is not always practical. Your practice should set a standard that realistically can be met by all providers. A reasonable maximum turnaround time is three business days (72 hours). Note, however, that your policy is only as good as your practice’s adherence to it. For the policy to be effective, compliance should be monitored.

 

An additional consideration is the development of a timeframe is the 21st CURES Act. Under this law, an unreasonable delay in the patient’s ability to access their notes could be considered information blocking. Read more here.

PAYOR UPDATES

Anthem

Filing Digital Claim Disputes

Filing digital claims disputes: Transparent and trackable - Provider News (anthem.com)

CareSource updated the usage of modifier 25 effective 12/1/2023

medicaid-ga-policy-reimburse-py-1361-20231201 (caresource.com)

Cigna

Network News – 4th Quarter 2023

Cigna Network News: Fourth Quarter 2023 (editiondigital.net)

Humana

Claim Management and Remittance Webinar held 12/21/2023. Covers claim-related tools available on Availity Essentials: Claim Status Tool, Remittance Inquiry, Humana’s Code Edit Simulator Tool. Meeting Registration - Zoom

United Healthcare

UHC’s Coding Corner contains educational coding videos on a variety of topics and specialties. Check out the Office/Outpatient/E&M Coding section!

Coding Corner | UHCprovider.com

BEST PRACTICES & QUICK TIPS

Please remember a patient’s PHI must be sent securely to KHF and other entities! Do you have claim examples and documentation that need to be reviewed?  Request a secure email at PayorConcerns@khfirst.com and we will send you an email to attach your information in.

We Want To Hear From You!


Do you have billing topics, best practices, claim questions, or good news to share? Email KHF at PayorConcerns@khfirst.com.

RESOURCES

Kids Health First Intranet Page