Insurers overpaid more than $18 million in HCPCS level II code claims in just the first nine months of 2014, according to reports from the Office of Inspector General (OIG). Public and private insurers in the US healthcare system use Healthcare Common Procedure Coding System (HCPCS) level II codes to report drugs, supplies and other services not identified by CPT level I codes. Using the wrong drug code, billing improper unit amounts, coding bundled items and/or having inadequate documentation can cause an insurer to request payment back from healthcare providers.
To avoid the emotional and financial turmoil that overpayment proceedings can have on a practice and insurer, coders and billers require a streamlined system that looks up the code and provides the related compliance requirements in one place. Fast Coder, the only noninsurance company owned web-based Encoder, comes to the rescue providing credible compliance information so that coders and billers code more accurately and physicians and staff members document more compliantly.
Compliance essential! Common words including abbreviations and generics added to plug holes caused by the HCPCS dataset omission of natural word terms. SuperCoder’s coders pore over OIG reports looking for HCPCS omitted terms that caused financial loss. These terms are added to the SuperCoder dictionary to prevent subscribers from making the same mistakes.
Case study: A contractor overpaid $274,074 due to the provider billing the incorrect units for gemcitabine hydrochloride which is a drug that the HCPCS index and drug table omit. With SuperCoder lookup, gemcitabine hydrochloride’s matching code and units are shown.
New for 2015! National Drug Code-Drug Crosswalk – Prevents improper drug and unit billing by tying the HCPCS code with drug brand names, dosages, and equivalent units. Two providers have to pay back more than $300,000 for using the wrong dosage and units for leuprolide acetate. Your practice can avoid being the next statistic with the info provided directly to your billers through this crosswalk.
2015 Enhanced! More than 300 codes’ plain English explanations added or updated. These straightforward summaries and/or tips help readers understand a code’s proper application.
5-in-1 Part B Fee Schedule – Automatically pulls the information from the code’s assigned fee schedule such as DMEPOS or ASP preventing miscoding and overpayments. Medicare paid twice as much for vacuum erection systems as Medicaid and private payers. Having the Medicare state-allowed rate gives practices ammunition to challenge nonMedicare rates – and contractors a check on the approved amount.
CPT® code crosswalk – Shows procedure codes commonly reported in conjunction with a health care equipment and supplies level II code.
Coding scenarios citations – Gives references to thousands of articles from Coding Alert newsletters, CMS, OIG, HHS, Medicaid, and HCPCS Coding Clinic.
LCD and NCD Lookup – Connects each DMEPOS, supply and other code with Local and National Coverage Determinations that detail diagnoses and documentation requirements.
Contractor-specific coverage symbols –
Prevents reimbursement loss stemming from payments and policies that vary by state.
Simultaneously searchable table of drugs and chemicals and indices – Provides results from tables, indexes, and tabular list for an easy-to-read display of substances and their associated codes.
CCI Edits – Alerts billers to HCPCS level II codes that cannot be reported on the same claim.
Official coding guidelines – Read the associated instructions at code level for speedier protected payments.
With high overpayments for supplies and drugs level II codes, practices and insurers can continue to expect scrutiny of correct coding and billing for HCPCS level II codes in 2015 and future years. Protect yourself with the fastest option on the web that combines compliance essentials like code range guidelines and coverage indicators along with time-saving tools like cross-references, unit display views and three crosswalks. With access to the HCPCS code set connected information required for compliant coding, coders, providers and billers have the information they need to protect payments.