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Common Nephrology Billing and Coding Errors and How to Avoid Them

Professional coders and physicians frequently struggle to understand the complexities of nephrology billing and coding due to ongoing changes to the codes and regulations. The substantial changes brought about by ICD-10, CPT codes, and E&M guidelines have continued to evolve, leaving practitioners to deal with new payer requirements and needed specificity. It’s essential to learn how to avoid the most typical nephrology billing and coding issues and find some of the finest methods to prevent denials. Little errors can, unfortunately, build up to expensive denials.

Common Errors in Nephrology Coding and Billing

It is very crucial to understand that we have to  follow nephrology billing and coding guidelines. There are numerous possible causes for your nephrology claims to be rejected, the following are some of the most recurring billing and coding errors that lead to rejections and obstruct the practice’s cash stream.

The First Error is Providing an Unspecified Diagnosis

With the introduction of ICD-10, greater emphasis has been placed on precisely coding a diagnosis. Providing as much specificity as feasible has remained the common trend with the most recent modifications in 2018 and 2019.

  • The second error fails to present evidence demonstrating the causal relationship between the diseases. It’s crucial to present evidence proving the connection or cause between two diseases when categorizing them as a single entity.
  • For instance, chronic renal disease and hypertension.

When proof demonstrates that a patient’s chronic kidney disease is genuinely caused by renal hypertension, it is incorrect to record these two conditions separately.

  • There is no longer a distinction between controlled and uncontrolled diabetes mellitus. You must identify the type of diabetes when coding it, such as drug- or chemical-induced, Type 1, Type 2, or related to an underlying medical condition.

Acute tubulointerstitial nephritis has replaced the previous term, “acute pyelonephritis.” The term chronic tubulointerstitial nephritis has replaced chronic pyelonephritis.

Nephropathy and chronic kidney disease caused by diabetes should be referred to as diabetic nephropathy and diabetes-related chronic kidney disease, respectively.

Multiple Claims Processing with Nephrology Billing and coding Software Advantages:

  • In the past, claims were submitted individually for each patient to guarantee that everything was done correctly and accurately.
  • It not only takes up a lot of the time of the nephrology physician, but it also raises the possibility of incorrectly submitted claims, unbilled claims, and late payments.
  • People consult doctors for the same issue in droves, necessitating the use of nephrology billing software.
  • Also, it saves providers from having to submit claims one at a time. Instead, this technology simultaneously submits hundreds of claims.

Make the Most of Payments:

  • Each of these advantages focuses on the capability of the nephrology billing software to increase reimbursements inside the practice.
  • Nephrology billing software can seek changes where they are needed and where specific services should be provided by identifying care.
  • By raising the standard of care that the practice must deliver, you can focus more on the patients.

Using Outsourcing to Reduce Nephrology Practice Costs

Due to the continuing complexity of nephrology billing and coding, many practices find that outsourcing is a fantastic method to cut costs while also getting better coding accuracy and fewer denials. By outsourcing to a nephrology coding provider, you can ensure that your practice codes claims with the right level of detail, maximizing per-code collections and minimizing denials. In addition, a good business can offer you code utilization information to learn more about the most profitable processes for your clinic.

Nephrology practices can profit specifically from outsourcing in a number of ways. You can expect to work with experts with more resources and experience than most medical practices when you outsource to a reputable business.