Board member insights : Using resources to educate your clinical staff

Wednesday, November 15, 2017

by Diane Weiss, CPC, CPB, CCP

An ounce of prevention is worth a pound of cure.   

I believe that avoiding denials in the first place is the way to utilize our revenue cycle resources, especially our human resources. The more times we have to touch or rework a claim, the lower the value our final reimbursement becomes. Our goal is to get it right the first time. This can best be accomplished by education with our clinical staff in a way that they can relate and understand the general coding and billing concepts. 

To begin, we focused on our most common denials and misuse or lack of use for modifiers 59 and 25. These are two modifiers that are easily misunderstood. With many of our most commonly performed services bundled into each other per the National Correct Coding Initiative Policy Manual, we quickly recognized the need to know when and how to use modifier –59. To bring the education and understanding right to the point of care, which is actually where all billing begins, we created one particular resource that works much like an old school multiplication table.

This resource is the Multiple Procedure Modifier Grid. The tool helps us to determine whether a procedure is separately payable/billable, and if it needs a modifier. The grid can also be adjusted for other services that are routinely bundled but could be modified in some instances.   

Since shifting a little more effort and focus on preventing denials and being a little more proactive in that education, we have assisted in reducing denials for our partner hospitals and helping our clinical staff better understand how to report and capture their services for the most appropriate level of reimbursement.   

Editor’s Note: You can find the RestorixHealth Multiple Procedure Modifier Grid, along with other revenue integrity forms and tools in the NAHRI Resource Library. Diane is a NAHRI advisory board member and the vice president of revenue integrity and education at  RestorixHealth in Metairie, Louisiana.


Found in Categories: 
Denials and Appeals, Revenue Integrity