In the current scenario, the healthcare industry is going through slight downtrend owing to regulatory and billing and coding challenges. Urology medical billing is one such complex procedure, that can face different difficulties if you fail to streamline the process with the help of specialized medical billing and coding experts.
What have necessitated the advent of dedicated billing team is the unending changes in the healthcare environment. The team of experts like Unify Healthcare Services, should be prompted to follow up denials and no claim responses. There is a wide range of patient care issues engulfed in Urology Medical Billing. There is one major advantage when you outsource your Urology medical billing services to an expert. They not only focus on medical billing and accounts receivable management but have a broad experience across the entire Revenue Cycle Management process of your Urology Practice.
What is Urology Medical Billing
Urology medical billing is a process in which healthcare providers bill insurance companies for various healthcare services provided to patients. To complete this procedure, medical billing and coding experts assign designated codes to various procedures which makes it easier to carry out the entire medical billing process.
Urology billing services involve billing & coding for every kind of diagnoses & treatments that are given to treat the urinary system's conditions. Billing for urology services can be more complicated than other specialties because of the complex nature of its codes & regulations.
Medical billing companies like Unify Healthcare Services assists healthcare facilities to optimize the revenue management cycle. They focus to fast pace the payment circle and ensure that a healthcare practice never runs out of funds to carry out the various functions in the organization.
CPT & ICD Codes in Surgeries for Urology
In Urology billing, the CPT codes are categorized based on various organs such as - Kidneys, Ureter, Bladder, Urethra, Male, Female genital organs, and others.
Code Range: 50010 – 58294
Let’s Discuss the Types of Procedures in Urology
- Incision/Biopsy
- Excision
- Repair
- Transplantation
- Catheter Introduction
- Laparoscopy
- Kidney biopsy
- Endoscopy (Cystoscopy, Urethroscopy, Cystourethroscopy, etc.,)
ICD-10 codes
All the new ICD-10 codes should be carefully used based on the LCD guidelines. This is done to avoid insurance denials. ICD- 10 codes that should be used in Urology billing are mentioned below:
- C00 – D49 - Neoplasm
- E00 - E89 - Endocrine, nutritional and metabolic diseases
- N00-N99 - Diseases of the genitourinary system
- Q50-Q56 - Congenital malformations of genital organs
- R30-R39 - Symptoms and signs involving the genitourinary system
One of the major challenges in urology Billing Services is to find trained urology coders. They are extremely expensive to recruit, and their ongoing training can be quite costly. In this scenario, you need a medical billing company like – Unify Healthcare services. The team comprises well-trained, CPC certified urology coders that can process various surgery reports in a day. When it comes to our Urology Billing Services, our professionals cover the most complicated portion of the CPT codes. They are trained to handle all procedural, modifier, and diagnostic coding challenges. HIPAA compliance is ensured at all stages of the billing & coding process. In order to avoid denials at every stage, the experts perform prior authorization followed by the eligibility & benefits of the patients.
Let’s Discuss the Best Practices in Urology Billing & Coding
Prior Authorization
The procedures in Urology billing are extremely costly. In this situation, the provider must obtain prior authorization from the insurance company before any services is rendered. Prior Authorizations are quite helpful for the organization to understand the submission guidelines better, submit the claims on time. This results in getting timely reimbursements instead of denials.
Medical Necessity
Another important thing for the urology service provider is to justify the medical necessity of the course of treatment. So that he is able to charge accordingly for the highly costly services they provide to the patients.
Eligibility & Benefits denials
Another practice that can be helpful to reduce denials is to verify a patient's eligibility & benefits for a particular service at least 48 hrs prior.
Avoid Missing/Invalid CLIA number
It is important to take care that CLIA number should be updated while billing for the lab test.
Non-covered Codes
Understand the fact that Medicare is not going to pay for A Codes like A4357, A4334, A5114, A4340, A4331, etc. They will be denied as Non-Covered Services. However, there are some secondary insurance providers that will pay for the Medicare non-covered services.
Coding for Maximum benefits
Another important point to consider is that CPT codes should be coded with the correct units as allowed by the specific payers for specific CPT’s. For instance, Payers will deny CPT codes 51700, 52300, 52310, 55876, and 77263 if more than one unit is billed.
Modifier 59
Whenever, Urologist is billing two urology services together and they are inclusive according to NCCI edits. Coders must not forget to use modifier 59.
LCD Guidelines
Before the providers start to bill any Urology services it is important to ensure that proper LCD guidelines are followed.
Let’s Discuss the Do’s & Don’t in Urology Billing
Do’s in Urology Billing
Ensure Proper Patient Information
One of the most important things to consider while claim submission is patient Demographic information. It is critical for your timely reimbursement. Make sure that you get the patient’s insurance data, verification and any special notes from the doctor after the visit. If you have precise information of the patient, it will allow your urology claims to get approved faster and you’ll be reimbursed faster.
Verify Provider Information
The scene doesn’t end with attaining the patient information. After the information is collected, it is important to verify that information that is collected. While filing urology claim, take care of the fact that you are having correct address and contact information, including the identification numbers and the EDI processing numbers.
Using a Clearinghouse
To be more efficient in your medical billing and coding process and avoid errors within the claims processing, you can use the services of a clearinghouse. When you choose a right clearinghouse, it will check your urology claims to ensure that each claim is free of error before the final submission is initiated. In case any error is found, the clearinghouse notifies the billing professional to fix it quickly. In this manner, the chances of claim denials are lessened, and you can see an improved revenue cycle management.
The Don’ts in Urology Billing Process
Double billing
Many Urology CPT codes have specific Global period, in which some CPT codes cannot be billed if patient is seen for same diagnosis for which a procedure was performed at first instance. Make sure you know the fact that Medicare has very clear guidelines about billing and coding for postoperative visits.
Automatically resubmitting denied claims
Whenever a urology claim is denied, there is always a good reason for that. Before your team submits it’s automatically, verify that the claim is completely error free. The situation might be that the in-house team has put incorrect diagnosis codes. In such a case, it is important to rectify the mistake and submit again. Check in-detail with the attending urologist that what diagnosis codes should be assigned. After that you can proceed with the resubmission process.
Forgetting the Clearinghouse
As already mentioned in the Do’s in Urology billing services as well, the clearinghouse ensures that each urology claim submitted is error free. A defined clearinghouse makes sure to identify errors and eliminate the risk of facing claim denial. Chances of you submitting a clear claim are less, if you don’t have a clearinghouse. When you go for submission and re submission, it takes extra time. The resources lead to a deficit in both time and money of your urology practice.
The team of urology billers & coders at Unify Healthcare Services understands every nuance of urology billing and coding. We have formed a set of urology-specific best practices. This helps us to reduce denials and improve collections. The coders and billers are proficient in ICD-10 CM, CPT, HCPCS coding based on CMS and AMA guidelines.
