Coding Compliance Self-Test

Information regarding coding, coverage, and payment is provided as a service to our readers. Every effort has been made to ensure information accuracy. However, HMP and the author do not represent, guarantee, or warranty that coding, coverage, and payment information is error-free and/or that payment will be received. The ultimate responsibility for verifying information accuracy lies with the reader.

While sharing wound management reimbursement coding, payment, and coverage education with wound care physicians, qualified health care professionals (QHPs), and hospital-owned outpatient wound management provider-based departments (PBDs) throughout the country, this author frequently receives the following comments from some attendees:

• “I have not been following the coding guidelines that you taught and have been paid for the past 5 years.” 
• “None of the wound management physicians I know follow the coding guidelines you taught. We would never make any money if we coded like that.” 
• “As long as I keep getting paid, I am going to keep coding the same way and using the same modifiers to push my claims through the system.”
• “If I do not like the Medicare allowable rate for a code, I simply report a different code that has a rate I like better.”

Interesting enough, this author often receives calls for help from the very same physicians, QHPs, and/or PBDs when they receive Targeted Probe and Educate notices or notices from higher authorities such as Recovery Auditors or the Office of Inspector General. They always say, “I should have listened better to what you taught us and should have changed my practice to align with the coding, payment, and coverage guidelines.” While assisting these wound management stakeholders to achieve compliance with coding guidelines, this author makes lists of reimbursement topics that continue to plague the wound management industry.

This author then includes those topics (1) in the various national, regional, and local educational courses she teaches; and (2) in her wound management reimbursement columns throughout the year. Because many readers like to learn from the mistakes of their peers, this author has prepared a coding compliance self-test for the entire wound management revenue cycle team: physicians and QHPs, PBD program directors, Charge Description Master directors, PBD coders and billers, and all other members of the revenue cycle team. Feel free to share this coding compliance self-test with anyone who would like to test their knowledge of frequently audited topics.

After completing the self-test, go to todayswoundclinic.com/articles/codingselftest2019 to compare your answers with the answer key. If you achieve a perfect score, celebrate and keep up the good work! If you answer any question incorrectly, carefully examine your actual practice to be sure you are not making similar mistakes over and over when you submit claims to Medicare. Remember, you should not under-code or over-code. You should simply code correctly. You do not want to be one of the providers who are paid improperly by Medicare. In 2018, more than $31 billion was improperly paid by Medicare. Those improper payments will lead to increased repayments and increased audits. 

Click here to view the PDF to test your knowledge with the coding compliance self-test.

Kathleen D. Schaum oversees her own consulting business and is a founding member of the Today’s Wound Clinic Editorial Advisory Board. She can be reached for consultation and questions at kathleendschaum@bellsouth.net