Within this page, you will find Industry Perspective blogs written by the UCA Corporate Support Partners (CSP); Insights from UCA Chief Executive Officer Lou Ellen Horwitz; Practice Management blogs to help you better manage center operations; and bonus UCA education in Educational Insights.


EDUCATIONAL INSIGHTS: UCA2019 Take Home Tactics Dose 4: Coding, Billing and Reimbursement - What Every Clinician Should Know

Posted: Jun 7, 2019
Comments: 0
Author: UCA Admin

“It’s All In The Details” 

Diagnosis and documentation are key to reimbursement! It is essential that clinicians understand how documentation of the clinical encounter leads to the coding and billing that eventually leads to provider paychecks. This course will provide an overview of today's billing, coding and reimbursement environment, as well as give clinicians the tools to both avoid common billing pitfalls and employ best practices that maximize reimbursement.

Take Home Tactic #1: Chart documentation leads to code assignment which demonstrates the reason for the clinical encounter and the severity of the presentation.

Discuss the “why” of treatment – write the story by noting pertinent contents of old records (and the date) reviewed, document impression of ancillary test results, note discussions with PCP or other consultants, medications, etc.  Paint the entire picture of the encounter so that all of the information is available and documented.

Take Home Tactic #2: Diagnosis is a financial issue. Urgent vs. Non-Urgent diagnosis provides the payer with reimbursable detail.

Payer denials are increasing for non-emergent diagnosis.  Clinical documentation must be appropriate. Specificity, laterality and chronicity are musts for all payers.  Acknowledging that diagnosis drives reimbursement can help in gaining compliance from clinicians.

Take Home Tactics #3: Procedures require thorough and complete description.

Get back to focusing on the details and complete your story with identifiable procedure notes that are:

  • Specific step-by-step details
  • Clear and concise
  • Location, laterality, depth, length
  • Time involved

Record injury details to validate severity of injury and medical necessity. Include type and extent of repairs by documenting mechanism of injury with the activity and place of occurrence.



Sharon L. Nicka, RN, CPC, is the founder and president of Nicka & Associates, Inc., a company that specializes in urgent care and emergency medicine coding, compliance and consulting. Having served as a member of the American College of Emergency Physicians' Committee on Coding and Nomenclature, she has had the opportunity to not only contribute her knowledge but to shape the framework of urgent care and emergency medicine coding. She is a board member of EDPMA, a faculty member for past UCA conferences and frequently travels to speak at national conferences and educate providers in documentation best practices.


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