Archive for the Week of July 28, 2006
Archive for the Week of July 28, 2006
Welcome to the medical billing blog archive for the week of July 28, 2006.
Here you will find links to every article added to the Outsource Management Group web site during the week of July 28, 2006.
You can browse this week's archives by clicking the "More" button from any of the excerpts below.
Undercoding Your Medical Billing Can Cost Your Practice
A well-known secret in the medical billing industry is that many physicians purposefully undercode because they are fearful of the penalties for overcoding or unbundling their medical billing claims. Another big mistake some physicians make is to leave their coding to their staff, which is guaranteed to have errors because the staff has no way of knowing exactly which services occurred in the exam room and which did not. In capitated care issues, physicians who don’t code for supplies reimbursement on their medical billing claims lose a lot of money. Imagine if every patient that you provided services to was worth an extra $50, imagine how that revenue would add …
Get Reimbursed for Tests
Diagnostic testing causes a lot of confusion in medical billing. One rule of thumb when doing the billing is to only report what your documentation will support. It is tempting to report a diagnosis that comes after a pathology test because common sense would tell you that it is more likely to be paid. Instead report the reason for test and use your medical necessity such as patient complaints and symptoms to back up the reasons for the test. Use your judgment when reporting testing and don’t use presumed diagnosis where an illness or condition is trying to be “ruled out”. Instead code the signs and symptoms the patient is …
Coding Dual Procedures
If you have a core biopsy and an FNA (Fine Needle Aspiration) performed on the same day, your CMS manual states you cannot report fine needle aspiration (FNA) codes 10021 and 10022 with another biopsy procedure code for the same lesion. A good example of this is when a physician performs an FNA and core biopsy for the same breast lesion during the same encounter, but does not document that the FNA sample was inadequate for diagnosis. The physician performed the services described by 10022 (Fine needle aspiration; with imaging guidance), 19102 (Biopsy of breast; percutan-eous, needle core, using imaging guidance), and 76096 (Mammographic guidance for needle placement, breast [e.g., …
The Importance of DME Preapproval
Durable Medical Equipment refers to wheel chairs, braces, shower chairs and other assisted living equipment. And are generally purchased as an outpatient. It really does not matter if your patients are insured through Medicare, Medicaid, Workers’ Compensation or through a private insurance carrier, nearly all DME claims must be preapproved prior to submission of the medical billing claims. Many of these policies have strict guidelines that must be followed in order for the DME medical billing claim to be paid. Some providers will require that the DME be purchased through their own sources and have a listing of specified providers. Many HMOs are very narrow about the DME they will …
The Trickiness Coding Radiology Services
Medical coding for radiology services can be very tricky. Most radiology procedures, unless emergency, normally need pre-approvals in order to receive reimbursement for services rendered. Failure to get a pre-approval can result in your medical billing claims for radiology being denied and rejected. Make sure you have a pre-approval on file before the services are rendered. Contact the carrier, note the date and time that you called. Get the first and last name of whoever approves the services. You may very well need this information in the future if your medical billing claim is denied. There are also CPT coding changes that happen often in the field of radiology. Keeping …
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