Coding

Coding, documentation, and reimbursement aids are made available under the direction the ACA Coding Advisory Board and representatives to the AMA CPT® and RUC coding process.

Coding Alerts

Coding Guidance

About ICD-10

ICD-10 is the tenth edition of the International Classification of Diseases. ICD-10 is an internationally recognized medical coding system primarily designed by the World Health Organization (WHO). It lists health conditions by categories of similar diseases and further delineates more specific conditions under these, thus mapping nuanced diseases to broader morbidities. Learn more about ICD-10 by clicking here.

Verification of Benefits

A proper verification of benefits is an essential step in billing insurance.  It provides the foundation for proper coding and billing, as well as appealing denied claims when it becomes necessary.  Learn ACA’s Clinic Management Series takes participants through the steps of verifying benefits, giving examples of  what to look for and the questions to ask, and highlighting specific scenarios, including instances when special questioning may be necessary. This course is intended for anyone whose work focuses on clinical administration: CAs, claims billers and coders, office managers, and doctors.

The Clinic Management Learning Series Includes:

  • Verification of Benefits: Understand the necessary components of a properly executed verification of benefits and know instances when certain special questioning is needed.
  • Appeals: Understand the importance of appeals (including ERISA) and the basic process and follow through needed for optimum chances of overturning a denial.
  • Self-Audits: Be able to apply the information provided in order to help ensure necessary components of medical records are in place and self-audits are performed.
  • HIPAA: Be able to identify whether their clinic is in compliance with HIPAA’s basic changes and will understand both consequences of a breach and notification requirements.
  • Provider contracts: Be equipped to confidently review and understand essential portions of provider contracts and what questions to ask of payers.

Audits

Prevention & Response

Although documentation may not be required for initial billing of services, providers should always completely document each patient encounter. While billed services may be completely legitimate, the documentation is the only record of the encounter.

Start here for more on audits, recoupments, external audit requests and when to seek counsel.

 

Anti-Trust and Fees

ACA often receives concerns from providers regarding reduced fees or fee schedule changes implemented by insurers. ACA is a nonprofit professional association and vigilantly follows anti-trust regulations, which forbid discussion or organization about fees and pricing information between providers and other groups. ACA is prohibited, by anti-trust laws, from gathering or disseminating any current data that would indicate an appropriate dollar figure for any given treatment or procedure.

In addition, ACA is prohibited from permitting discussion of any term, condition or requirement upon which any chiropractor deals or is willing to deal, with any payor; or any intention or decision with respect to entering into, refusing to enter into, threatening to refuse to enter into, participating in, threatening to withdraw from, or withdrawing from any existing or proposed participating agreement with any third-party payor or vendor.