Because medical coding rules keep changing, it is a difficult job for medical coders and healthcare providers to keep up with the dynamic nature of nephrology billing and coding. When ICD-10 coding came in, they had to be more specific with their codes.
In 2021, there were even more rules and new codes for nephrology billing, making it even trickier. Navigating through all these new rules and codes can be tough. On top of that, insurance companies now have extra requirements for nephrology billing.
Since the big changes with ICD-10, CPT codes, and E&M guidelines, nephrology medical billing has changed. This means practices have to deal with even more requirements from insurance companies, and they have to be super specific.
Making small mistakes can lead to expensive denials. That’s why it’s important to learn how to avoid common denials in nephrology practice. Some tips can help prevent these denials from happening again.
Understanding Nephrology Billing
Nephrology billing and coding are important money skills in healthcare. They help manage finances, especially for kidney-related medical services. Nephrology billing is mostly about organizing and sending out bills for kidney care. The billing process has three main steps: documenting the services, checking insurance details, and sending a claim.
It also ensures that the right codes are used for procedures and diagnoses. Good billing means healthcare providers get paid fairly for their work.
What are the Common Mistakes in Nephrology Billing?
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There are many reasons why claims are denied, but a few big mistakes can cause an excessive revenue loss in nephrology practice.
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Let’s look at these common mistakes before we learn how to avoid them.
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Not giving specific diagnoses:
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Since ICD-10 changed, it’s more important to be specific when coding diagnoses.
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The trend now is to be as specific as possible to avoid denials.
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Not showing how diseases are connected:
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When coding for multiple diseases, it’s important to show how they relate in the documentation.
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Sometimes, certain medical conditions need to be coded together.
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For example, if a patient has both hypertension and chronic kidney disease, it’s a mistake to code them separately if the documentation shows that the hypertension is causing the kidney disease.
Using incomplete codes
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Incomplete codes are another common reason for denials. If a code is missing a fourth, fifth, or sixth digit that gives more detail, it often gets denied because being specific is important in coding now.
Tips to Avoid Denials in Nephrology Practice
The billing and coding rules for nephrology are guidelines to help manage the finances of kidney care services properly. Here are some important points about these rules:
Keep Good Records
Doctors and nurses need to document kidney care treatments, tests, and patient visits accurately.
Use the Right Codes
It’s important to choose the correct codes that match the services provided. This helps avoid billing mistakes and ensures fair payment.
Follow the Rules
Billing and coding in nephrology must follow the laws set by the government. This keeps things legal and fair.
Send Bills on Time
Payment claims should be sent promptly. Failure to do so can cause delays or even denials of payment.
Keep Learning
Healthcare workers need to stay up-to-date with training on new rules and changes in coding. This helps them do their job well and avoid mistakes.
Benefits of Using Nephrology Billing Software
Faster Claims Processing
Before, doctors had to file claims individually for each patient, which took time and could lead to mistakes. Nephrology billing software can file hundreds of claims simultaneously, saving time and reducing errors.
Clearer Payment Process
With this software, doctors can more easily determine when they can bill insurance companies. This helps them get paid faster and avoid missing payments.
Getting Paid More
The software helps doctors get the most money they can for their services. By keeping track of patient care and finding ways to improve, doctors can offer better quality care and get paid more for it.
Outsourcing Nephrology Billing
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Because nephrology billing and coding are complicated, many practices outsource to save money and improve accuracy.
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Outsourcing to specialized companies ensures that nephrology practices use the right codes, leading to higher collections and fewer denials.
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Outsourced nephrology billing report code usage, helping practices identify profitable procedures.
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Outsourcing offers several benefits, including access to experts with more resources and knowledge.
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Certified billing and coding teams keep up with coding updates, reducing liability and preventing errors.
FAQs
What’s nephrology in medical speak?
Nephrology, also known as renal medicine, is a special area in internal medicine that focuses on kidney health. It often deals with issues like high blood pressure. Nephrologists diagnose, treat, and handle both short-term and long-term kidney problems and diseases.
What’s the code for a nephrology referral?
To find out if you need permission from your insurance or a referral from your primary care doctor, please contact your insurance provider. Then, send the necessary paperwork to (415) 353-2530. If authorization is needed, use the CPT code 99205.
