Urodynamics is performed by thousands of medical practices across the country, but is most often performed by urology, urogynecology, and ObGyn practices. BHN provides urodynamics testing to hundreds of these practices, and through our work we encounter dozens of instances in which Urodynamics is billed incorrectly, which often leads to underpayment and other issues.
The most common mistakes we encounter are:
- Billing the Technical Component (TC) or Professional Component (PC) and not billing the full Global Charge – Urodynamics can have the Professional Component and Technical Component billed separately, or urodynamics can be billed Globally. We see many practices only bill the Technical Component or Professional Component, when they should be billing both or billing globally. This effectively halves the reimbursement they are entitled to. We typically advise our clients to always bill globally if they can in order to cut down the risks of receiving reduced reimbursements. We encountered a practice a few weeks ago that had been billing the technical component only for many months because of an improperly selected billing template. They should have been billing globally. This mistake undoubtedly cost them many thousands of dollars.
- Not billing highest level or appropriate level CMG code – For urodynamics testing, a group of CPT Codes is always used, but the exact group of CPT Codes may vary. It is very easy to incorrectly select a CPT Code that doesn’t exactly match the test. This can lead to improper billing, which can lead to problems in an audit and can also lead to under or over billing. In particular, it is critically important to select the right CMG code (51725, 51726, 51727, 51728, or 51729). For example, we often encounter practices that routinely bill CPT Code 51726 because it is “in the billing system as a default”. However, the same practice will be performing the Ureteral Pressure Profile (UPP) measurement during their testing which would indicate billing CPT Code 51729. This is a minor issue and would likely not cause a problem in an audit, but it would cause the practice to under bill by approximately $60 to $90 on each patient. Similarly, we have encountered practices that always bill 51729, but they are often doing a test that would indicate billing 51726. This equates to overbilling and could lead to major problems in and audit. We are always quick to point this mistake out if we encounter it.
- Not pre-certifying each patient and risking denial – Urodynamics testing is a core test that is routinely performed. Medicaid, Medicare, and all private insurance companies know its value and reimburse for it. However, in today’s crazy healthcare insurance world, it is always best to pre-certify any patient when they are undergoing a specialty diagnostic test like urodynamic testing. Pre-certifying often prevents issues before they occur.
- Not applying a no-show fee – No-shows are a problem for every practice. They make practices less operationally efficient, which is costly. We test for practices that do and do-not apply no-show fees, and there is no doubt that the no-show rate is much lower for those practices that have a no-show fee. You may not think this is a urodynamics billing issue, but in our eyes billing is revenue and no-shows directly affect revenue. Additionally, given the nature of urodynamics testing, a higher than normal no-show fee is warranted.
- Lack of Proper Documentation (to support CPT codes billed) – No practice ever wants an audit, but if you do have one you must have the proper documentation. A separate report and interpretation should be provided for each of the services that are performed. Each urodynamic procedure must be documented by using the printed images and tracings as proof of the clinical services having been performed. A written report must outline the interpretation of each test and documentation must include the medical necessity of each test, the ICD-10 diagnoses, and an explanation of the complexity of the problem requiring urodynamics testing. Without the proper documentation, an audit could become very problematic and financially painful. For all of our customers, we ensure all of the documentation is in order and in compliance.
The above five items are the ones we encounter most regularly, however there are many more. We always do our best to help our clients avoid these problems in order to maximize their revenue and minimize headaches.
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