Coding and insurance authorizations

[GmaC13]

I am trying to get an idea of how other agencies handle getting the ICD9 codes and insurance authorizations. I our small agency we have to depend on a coder at the hospital that really has no idea how to code for HH. She does not understand that we need supporting codes if we have a V code. She has not been trained for HH coding. Nice lady and all but not effective for what we need. Also insurnce authorizations are done by the admitting nurse. Sometimes it is impossible to get moving to see the patient because you are waiting for the insurance to call or fax. I worked for a different agency where we had an intake nurse. She did all of this and much more. Are there actually other nurses out there required to get insurance auths and figure out your own coding before you can go on and be a nurse?? Thanks for any input.

[purpledaisies]

We have a Utilization Review dept that does all of the insurance stuff for us, and our QA nurses deal with the coding if we have questions. I have asked the QA nurse to help me with a code when doing an SOC. HTH:nurse:

[old rural nurse, RN]

When I worked as a Clinical Coordinator for our fairly small HH agency, I, myself did the preauthorizations and coding. But I was mainly in the office "coordinating" and only did visits for vacations, therapy admits, or in a pinch. If I couldn't figure out a specific enough ICD-9 code, I called either the physician's office coder, or the hospital coder, or both!

[vlntrnurs]

"Are there actually other nurses out there required to get insurance auths and figure out your own coding before you can go on and be a nurse?"

The answer is: no.

Coding and insurance authorizations are not part of the RN or LPN education. However, nurses can get educated and certified as an RN-coder, Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), or Certified Professional in Utilization Review (CPUR). Perhaps a nurse with this background could help you run your medical billing and claims more efficiently and effectively.

Check out the American Academy of Professional Coders (AAPC), American Health Information Management Association (AHIMA), or the American Medical Billing Association (AMBA) websites.

[NRSKarenRN, BSN, RN]

i learned much of my coding: on the job along with a one day course in 2000. over the past 3 yrs, inservices were provided by my hha employer

coding for hospitals, medical practices and home health all have different focus. however, since the advent of medicare pps system and icd codes = $ or $$$$ , it is important for any agency to have a staff member attend education program geared for home health coding as can make or break an agency.

i manage central intake office and staff obtain initial authorization for homecare within 24-48hrs referral. in phialdelphia area, many manged care companies have web based programs one can obtain electronic auths if in-network provider ---saving time and money. i have trained clerical staff to obtain our electronic auths, freeing our rn's to obtain non-contacted, work comp auths and rate negotiations.

your agency might also invest in publications that help include home health line , eli's report or

diagnosis coding pro for home health