Story:
You’ve just finished a series of hyperbaric oxygen therapy (HBOT) treatments with a patient. They’re feeling better, your team’s on point, and it’s time to wrap up. But here’s the kicker—the claim gets denied. Now you’re in a bind, trying to figure out why the insurance company won’t pay for the services rendered.
Does this sound familiar? If you’re involved in HBOT treatment and billing, you’re likely familiar with the rollercoaster of coding issues, documentation errors, and, of course, the occasional claim denial.
Here’s the thing: HBOT billing is tricky—but it doesn’t have to be. With the right knowledge, you can avoid the common mistakes that lead to denied claims and lost revenue. Whether you’re a seasoned provider or new to the game, this post will break down tactical advice to get your billing process in order, share expert insights, and make sure you’re not leaving money on the table.
Ready to take control? Let’s dive in.
Expert Advice: Insights from the Pros
1. Dr. Caroline Fife, MD – Hyperbaric Medicine Advocate
"One of the most significant mistakes I see in HBOT billing is not prioritizing accuracy in coding. Often, it’s something as simple as place-of-service errors or missing diagnosis codes that cause a claim to be rejected. My advice is to stay up-to-date with coding guidelines and double-check everything before submission."
Dr. Fife emphasizes that attention to detail can make or break your billing process. By keeping abreast of the latest CMS regulations and regularly reviewing your codes, you can avoid these costly mistakes.
2. Bill Sweeney, Founder of Sweeney Consulting
"The biggest mistake I see is the failure to submit claims promptly. The earlier you submit, the better your chances are for a timely reimbursement. If you wait until after treatment, you’re setting yourself up for delays, denials, and confusion. Be proactive."
Bill’s advice is simple: don’t wait until the end of treatment to submit your claims. Submit in real-time to catch errors early and stay ahead of the game.
3. Dr. Mark Johnson, MD, MPH – Undersea & Hyperbaric Medical Society (UHMS)
"In the face of reimbursement cuts and evolving industry standards, it’s essential to be proactive. Engage with CMS and private insurers to advocate for fair reimbursement rates. Don’t just accept the ‘industry standard’—make sure you’re getting what you deserve."
Dr. Johnson underscores the importance of advocacy in the face of challenging reimbursement rates. By getting involved in policy changes and engaging with insurance companies, you can help ensure that your practice is fairly reimbursed.
5 Tips to Improve Your HBOT Billing Process
1. Nail Your Codes Every Time
Here’s the reality: coding errors are one of the most common reasons for denied claims. CPT 99183, HCPCS G0277, APC 5061—these codes need to be spot on, or you’ll face delays and denials.
Tactical Tip:
Create a cheat sheet with your most-used codes and keep it somewhere visible. Double-check every single code before submission. Accuracy is key.
2. Prior Authorization: Don’t Wait
In some cases, Medicare and other insurers require prior authorization for HBOT treatments. If you don’t get this cleared before treatment, you’re setting yourself up for claims rejection.
Tactical Tip:
Submit your prior authorization request early in the treatment cycle. Early submissions reduce the likelihood of unexpected denials and prevent the hassle of getting approval after the fact.
3. Pay Attention to Place-of-Service Codes
This is an easy mistake to make, but one that’s costly. Place-of-service codes indicate where the treatment occurred, and using the wrong one can result in a denied claim.
Tactical Tip:
Always verify the place-of-service code before submitting. Whether it’s a hospital outpatient facility or a private practice, make sure the code matches the location of the therapy. Don’t skip this step—it’s crucial.
4. Question the “Best Practices”
I know, I know—industry best practices are supposed to be the gold standard. But let’s get real: sometimes, they don’t work for every practice. Following the same old best practices can lead to inefficient processes and lost revenue.
Tactical Tip:
Take a step back and think about what works for your practice. Do you need to submit claims at the end of the treatment period? Or is it better to submit them as you go? Be open to rethinking the status quo.
5. Communicate with Your Patients Upfront
Patient expectations are key. If a patient thinks HBOT is fully covered, but they end up with a surprise bill, you’ll likely face complaints and frustration. Set the record straight from the beginning.
Tactical Tip:
Communicate clearly about what is and isn’t covered by insurance. Whether it’s out-of-pocket costs or coverage limits, make sure your patients are aware of what they’ll owe upfront. This will save you headaches later.
FAQs: Your HBOT Billing Questions Answered
Q1: What are the top reasons for HBOT claim denials?
A1: The main reasons include incorrect coding, missing prior authorization, and place-of-service errors. Double-check everything before submitting!
Q2: Why is prior authorization so critical for HBOT treatments?
A2: Many insurers require prior authorization to approve HBOT services. Without it, the claim is likely to be denied.
Q3: How can I improve reimbursement rates for HBOT?
A3: Submit claims in real-time, stay up to date on coding changes, and advocate for fair rates with insurers.
Q4: What should I do if my claim is denied?
A4: Review the denial reason, correct any errors, and resubmit the claim. If necessary, appeal the denial with additional documentation.
Q5: How can I stay informed about updates to HBOT billing codes and regulations?
A5: Keep an eye on CMS updates, regularly visit resources from the Undersea & Hyperbaric Medical Society, and follow the latest from private insurers.
References
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CMS Update on Hyperbaric Oxygen Therapy Reimbursement Rates
This article discusses the 2024 outpatient payment rate correction for hyperbaric oxygen therapy, with implications for reimbursement policies. -
Undersea & Hyperbaric Medical Society Guidelines
The UHMS provides comprehensive clinical practice guidelines for hyperbaric oxygen therapy, including best practices for treatment and billing. -
Hyperbaric Oxygen Therapy: A Billing Case Study
This blog post offers an in-depth HBOT billing guide, covering documentation best practices and strategies to reduce claim denials.
Call to Action: Get Involved!
Are you ready to stop letting HBOT billing mistakes drain your time and revenue? Get involved—take control of your billing process today. Review your codes, submit claims early, and communicate effectively with your patients.
The HBOT landscape is changing, and now is the time to stay ahead. Whether you’re a clinic owner, medical director, or just getting started, make sure you’re proactive about billing.
Jump in, make the changes needed in your practice, and ignite your momentum. Don’t let billing mistakes hold you back—get the tools and knowledge you need to succeed. The time to act is now. Start today.
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