| Medical coding solutions |
| Healthcare professionals and administrators are burdened with enough responsibilities. Coding doesn't have to be one of them. |
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The ZII Continuous Coding Quality Monitoring package brings coding into a new era. CCQM eliminates expensive periodic onsite audits and outdated reports. CCQM is a customizable, pre-billing coding review and educational program that reviews records and corrects errors in real time--before the billing gets into the mail.
The innovative, compliant CCQM uses professional benchmarks, RBRVS norms, and other standards to focus on known areas of problematic coding. We offer medical coding services for ICD9 and CPT. We also do optimizations for billing purposes. |
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Coding of Evaluation and Management Services
We will examine patterns of physician coding of evaluation and management services and determine whether these services were coded accurately. In 2003, Medicare allowed over $29 billion for evaluation and management services. In prior work, we found that a significant portion of certain categories of these services is billed with incorrect codes resulting in large overpayments. We will also assess the adequacy of controls to identify physicians with aberrant coding patterns. |
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| Use of Modifier - 25 |
We will determine whether providers used modifier - 25 appropriately. In general, a provider should not bill evaluation and management codes on the same day as a procedure or other service unless the evaluation and management service is significant, separately identifiable service from such procedure or service. A provider reports such a circumstance by using modifier - 25. In 2001, Medicare allowed over $23 billion for evaluation and management services. Of that amount, approximately $1.7 billion was for evaluation and management serves billed with modifier - 25. We will determine whether these claims were billed and reimbursed appropriately.
Use of Modifiers With National Correct Coding Initiative Edits
We will determine whether claims were paid appropriately when modifiers were used to bypass National Correct Coding Initiative edits. The initiative, one of CMS's tools for detecting and correcting improper billing, is designed to provide Medicare Part B carriers with code pair edits for use in reviewing claims. A provider may include a modifier to allow payments for both services within the code pair under certain circumstance. In 2001, Medicare paid $565 million to providers who included modifiers with code pairs within the National Correct Coding Initiative. We will determine whether modifiers were used appropriately. |
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| Collection service |
As a billing/collection service, we submit claims electronically to insurance companies and mail statements out to patients to collect their portion. While most claims get paid within a few weeks, a small percentage of claims do not get resolved and can be difficult to conclude. We typically file tracers and even make phone calls to the insurance companies but, unfortunately you receive marginal if any response. This small percentage of claims often remain uncollected for months. Since our billing service is not setup as collection agency to deal with these unpaid accounts, you the doctor, is usually faced with two difficult choices: They can either write off the unpaid accounts or they can refer them to a hard-core collection agency, in which case the medical practice loses 30 to 50 percent of the value of the claim as the fee. In addition to this high fee, the practice will most likely lose the patient as a client because harsh collection measures usually result in the loss of patient goodwill.
As a successful billing service, you need a tool that can help you pursue and effectively resolve 100% of unpaid insurance claims - at a minimal cost to you the doctor. ZII's collection services is the answer! Our collections plan handles both insurance companies and patients. It is also designed to help you generate additional revenue for your business. The sections below explain how. |
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| Dealing with Insurance Companies |
The insurance industry is very highly regulated. Given the current climate in the medical field, it is extremely difficult for almost any practice to enforce these regulations upon the industry. Virtually all states have legislation in place requiring insurance companies to pay or deny claims within 30, 45 or 60 days. Yet, billions of dollars in claims are not paid or are denied even within these legal requirements.
Our company has developed a program specifically designed to utilize the states' insurance laws and regulations to force insurance companies to meet the legal requirements governing them.
There are four types of "insurance resolutions" that our program ultimately helps you get: |
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- Cash -- payment for the claim
- Denial from the payer (which allows the provider to bill secondary insurance, re-bill the primary with different coding or information, or convert to self-pay)
- Information from the payer that no claim is on file (which allows provider to resubmit the claim, attaching the correspondence from our collection agency to achieve maximum efficiency)
- Suspension of action on the claim for whatever other reason the payer might have
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| The point to all of these is that NOTHING happens without some kind of response from the insurance company. It is a lack of a response when you have a problem. Therefore, response generation is exactly what our collection program provides. |
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| WHY? Two major reasons |
| A) Being a collection agency, we are required by the FDCPA to include a "Federally Mandated Dispute Clause." This clause states that all portions of this claim shall be assumed valid unless disputed in writing within 30 days of receiving this notice. The payer is not only put on notice legally but forced to deny or pay within 30 days or lose not only the right to dispute the claim but also be obligated to pay 100% of the claim. Also, being a national collection agency provides a very strong paper trail of non-compliance with state legislation and regulations. |
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B) Because of the changes in the mix of payers (HMOs, Managed Care, etc.), our Collections division has designed specific communications for insurance companies that have all the necessary information for them to process the claim. We have the ability to "touch every claim" every 10 days for a fixed fee, that is impossible for the provider or any other billing service to match. We will contact the payer up to five times requesting payment or denial.
In summary, what we wish to provide you the doctor an ability to close the books on every insurance claim by utilizing this tool only on those specific and few claims requiring this type of additional effort. We will provide this at a fee which frankly is not possible for your company or your staff to approach, not even considering the impact and effectiveness of our national collection program. |
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| "Driven by accuracy and compliance, Satisfied only by your confidence and repeat business" |
