Are you staying ahead of new coding changes impacting federally qualified health centers (FQHCs) in the coming year? By keeping up with the latest coding practices, you’ll ensure high rates of correct and quickly-paid claims for reimbursement.In healthcare, medical coding uses alphanumeric sequences to track every diagnosis, medical service, procedure, and piece of equipment used during patient appointments. As a result, all healthcare providers and reimbursement sources nationwide have a universal language to process payments for medical services rendered.
Proper coding is an essential part of the U.S. healthcare system’s accountability-based reimbursement for programs like Medicare and Medicaid. Without proper coding, these programs will deny or delay your valuable reimbursements, impacting your revenue cycle.
In this article, we’ll highlight the most important coding-related updates for FQHCs and healthcare centers with Medicare patients, including those in the state of California.
Coding Changes for 2023 and 2024
Medicare typically issues International Classification of Disease (ICD) coding updates twice a year to highlight new changes impacting all Medicare-eligible facilities in the upcoming months. A significant coding change update was issued in April 2023.
It sets forth 42 new diagnostic codes within the ICD, Tenth Revision, Clinical Modification (ICD-10-CM), and Procedure Coding System (ICD-10-PCS). You can download code lists and descriptions, plus other related documents, from CMS.gov or work with Altruis to stay in sync with these changes.
California Coding Challenges
New California coding changes are impacting facilities across the state. Here are highlights from the coding experts at Altruis.
Behavioral Health Payment Reform
The CalAIM Behavioral Health Reform initiative is moving California’s counties away from cost-focused reimbursements to value-focused reimbursements for Medi-Cal and Medicaid. It’s a multi-year project with key changes in 2023 and 2024.
Behavioral healthcare facilities in California should:
- Ensure you’re using the new Medicaid Section 1115 Demonstration application, which was introduced in 2023 and remains in place for 2024.
- Read the California Department of Healthcare Services’ summary of the Medi-Cal changes to behavioral health.
- Discuss these changes with Altruis to see how your behavioral health center can adopt them while continuing to optimize and refine its revenue cycle.
From CPT to HCPCS
In October 2023, the Centers for Medicare & Medicaid Services (CMS) announced a transition from traditional Current Procedural Terminology (CPT) coding to the Healthcare Common Procedure Coding System (HCPCS) for drugs and biologicals.
New public-use coding system files are now available for January 2024. Check to see if your organization is using the correct coding information according to the latest information from the CMS.
Billing for Street Medicine
Street medicine, or caring for the homeless, is a trending issue in California. The CMS has issued an official description of street medicine for coding purposes, which is:
A non-permanent location on the street or found environment, not described by any other POS code, where health professionals provide preventive, screening, diagnostic, and/or treatment services to unsheltered homeless individuals.
Providers must properly code for street medical services to receive the correct reimbursement from Medicaid. To this end, please review the latest Place of Service Code Set from the CMS regarding definitions and codes related to street medicine.
Tips for Optimizing Medical Billing and Coding
Keep your FQHC running smoothly by working proactively to incorporate new billing and coding changes. Here are our tips and best practices for meeting the challenges of new coding changes.
Keep Codes Current
As you can see from the information presented above, outdated codes are always a risk and can cause problems with the reimbursement process. Keep your coders up to date on new coding information to facilitate a smooth workflow.
Build Coding Alignment
Align clinical notes with the latest medical codes. Include code reviews as a built-in part of your process and prevent any reimbursement request from leaving your facility until it is 100% correct.
Set Speed Standards
Do you have standards for how quickly coding should occur? Ideally, reviews should happen within 8 to 12 hours, and some systems allow just 72 hours to wrap up the process. Make it a goal to keep reviews within 12 hours to reliably stay within this window.
How Altruis Can Help You Adapt to Coding Changes
Altruis helps our partners accomplish fast, proactive, and effective coding through an industry-leading collaborative approach. We work with you in a customized and individualized process that always conforms to the latest coding standards.
Our fully digitized and automated processes help you eliminate coding errors while ensuring you capture every available dollar for the services you provide. Altruis is so much more than just a billing and coding platform. We’re your full-service partner in optimized revenue management.
To learn more about adapting to the latest trends in medical coding, please contact us for a free billing assessment and a discussion of your needs.
