Medical Billing - HCPCS Updates

Tip! Avoid firms who offer too many different types of service. Medical billing is a very highly specialized field.

If you’re really into medical billing you know the importance of doing a HCPCS update. You also know the headaches that doing these can give you. In this particular installment, we’re going to look at some basic things about HCPCS, including, for the uninformed out there, what they are, how the updates are done and what problems you are likely to encounter when doing yours.

The first thing that probably should be explained is what HCPCS stands for. HCPCS is an acronym for HCFA Common Procedure Coding System. So just what is this system? Well, it’s a system where every procedure and piece of equipment that is sold in the world of medicine is given a specific code to identify it. Now you might be thinking, “Why is this so important?” Well, look at it this way. Imagine a medical biller needing to look up the pricing for a particular item and this item just happens to be one of 100 different items that start with the same alphabetic characters, such as the word motorized for wheelchairs. Without the procedure code, this biller would have to look through every single description until they found the one they wanted. With a procedure code, they can go right to it as the codes are all unique and indexed in alphanumeric order.

While this may seem like a wonderful thing and it is, there are problems with HCPCS codes that drive medical billing people crazy. For starters, the codes are constantly being modified. Usually every quarter there are new HCPCS codes that are added to the list. So medical billers have to constantly keep on top of this. And if they do their billing with software, then it’s not enough to just have a manual of the new codes. These codes also have to be loaded into the software so that when billing an item, the correct code gets pulled. Otherwise, the claim form will be printed without the code or the electronic billing transmission will go without the code included. In either case, the claim will most certainly be denied. You can bet your last dollar on it.

Tip! Most medical billing companies today will provide medical billing software and training on how to work with the software to help make the process easy for you and your employees. For example, if the medical billing software is designed to be integrated with Microsoft Office, you might receive a video or materials for yourself and employees with the necessary Microsoft Office training.

Most of the HCPCS updates are done in one of two ways. The first way and one that is slowly becoming outdated, is where the medical billing agency subscribes to a service and every quarter the service sends the agency a CD with the new codes on it for them to install into their software. It will also include a printable version as well. The problem with this is that the updates are usually so small that to justify putting such a tiny file on a CD just doesn’t make sense.

So what is becoming more common these days is for these subscription services to have a direct download from the Internet or their private BBS system. There are several problems you may run into with these kinds of updates such as bad Internet or modem connections or files that simply don’t download correctly and ultimately have to be sent via postal mail.

Tip! For the most part, electronic medical billing is a wonderful thing, but problems do occur and it is important to be prepared for those problems.

HCPCS updates are as vital to a medical billing business as the patients you’re billing. Without these updates, your billing operation will effectively be shut down.

Michael Russell

Your Independent guide to Medical Billing


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