Rehabilitation Coding: Auditor's Not The Final Word

By Author: Julia Rose
Total Articles: 89
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Rehabilitation services have few CPT codes compared to other specialties, and you know the truth - it isn't any easier to bill. As a coder, your trouble further increases when new technologies and latest treatments are introduced. And to keep your practice on track, you have to fight with the lack of specific codes and CCI edits to keep the reimbursements flowing in. Rehabilitation coding also attracts a lot of claim denials, but when someone says you've been overpaid - it's alarm bells ringing!


Don't stay down and don't get afraid if you feel you are sure about the claims. The auditor's decision on your rehabilitation coding is not always the final word. Challenge it with proper documentation and do it as soon as possible. Use plain and simple words in the supporting documentation, so that the auditor finds it easy to understand. It's always better if you provide complete documentation right from the beginning.


Some rehabilitation organizations give auditors the minimum information - for fear that the ...
... auditors will dig out even more mistakes! This, in fact, sends the wrong signal and interferes with the auditor's ability to make a good decision. If you have nothing to hide, disclose every possible detail to demonstrate why you should be paid. In the meantime, implement your own internal monitoring system where you conduct scheduled self-audits. Make sure you read the audits - this will give you a clue of recent trends and you'll actually end up correcting patterns of incorrect billing.


The confusing and dense audit documents might be a pain to read, but they'll help you spot financial traps - right on time. In fact, CMS now requires you to document outcomes a certain way. Get the latest rehabilitation coding updates and stay current with policy changes and fight denials by making sure you meet CMS' new requirements.


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