Rule of the Month: More on athenahealth’s Behind-the-Scenes Calculator
In our November 2007 Rule of the Month we told you how athenahealth’s “behind-the-scenes calculator” saves clients from tracking complicated Medicare expenditures by hand. This month we turn our focus to another use of the same calculator – age based procedure codes.
Have you ever billed a procedure only to have it denied for using the incorrect age based procedure code? Some codes are based on age in months, others are based on age in years, and others are based on age ranges. How do you ever keep track of all these rules?
Let’s take a look at flu vaccine codes for example. CPT 90655 is used when the child is 6 – 35 months of age. CPT 90656 is used for children and adults 3 years and older. Consider also the preventive medicine codes. There is one code specific for early childhood (age 1 through 4 years), another for late childhood (age 5 through 11 years), and yet another for adolescents (age 12 through 17 years); and finally specific codes for age ranges 18-39, 40-64, and 65+. With all of these rules, it becomes extremely hard to know which code to use!
Once again, athenahealth’s Rules Engine to the rescue!
athenaNet®, the web-based software component of the athenaCollector service, has a built-in Rules Engine that looks at the date of birth in the patient registration screen, calculates the patient’s age and then measures the parameters of the procedure code you entered against the patient’s age. When you save the charges entered, a claim note will appear to warn you of any discrepancy before the claim is submitted. Another warrior in our clean claims submission efforts!
End Result: Claims submitted cleaner and faster!
As always, if you have any questions please call the Client Service Center (CSC) at 866.265.7922