How much higher?
Keeping in the mind
that rates for commer-
cial payers vary, the
Medicare Adjusted
Reimbursement Rate
for CPT 29827 is
$2,744.32 and
$1,256.79 for CPT
29822. If you code
according to the
NCCI edit guidelines,
you'll receive $2,744
for the bundled pro-
cedures, about $1,250 less than you'd make by billing them under
AMA guidance.
Granted, the majority of payers are starting to follow NCCI edit
guidelines — and that's only likely to increase moving forward. But
there are still quite a few payers that follow AMA guidelines, and I've
seen a lot of facilities lose out on reimbursements by not being aware
of this. Don't miss out; check your payer contracts.
Quarterly audits a must
In addition to knowing the ins and outs of your payer contracts,
you'll also need to schedule external audits of your coding and
billing practices on a quarterly basis. Yes, a lot of facilities do
annual audits, but here's a major reason why that time frame isn't
ideal: What if the audit uncovers claims that need to be rebilled? If
you're doing the audit yearly, you could easily fall outside of the
payer's statute of limitations for resubmitting claims. Most times, a
Coding & Billing
CB
2 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • F E B R U A R Y 2 0 2 0
An audit is all about taking corrective
action on your policies, not your people.