Archive for The Month of October, 2005
Archive for the Month of October, 2005
Welcome to the medical billing blog archive for the month of October, 2005.
Here you will find links to every article added to the Outsource Management Group web site during the month of October, 2005.
You can browse this month's archives by clicking the "More" button from any of the excerpts below.
Not Coding Correctly, You’re Not Getting Paid
If You’re Not Coding Correctly, You’re Not Getting Paid The coding process is the most complicated element of medical billing. Instead of having one coding system governed by one body, there are two. ICD-9-CM is governed by the Federal government. This is used to do medical billing for diagnoses and inpatient procedures. The other major medical billing coding system is CPT (current procedural terminology). This is governed by the American Medical Association. It is used to code physician office and outpatient services. Differencing maintaining bodies for coding systems makes it difficult for correct medical billing. If you do not have correct coding in medical billing, claims will not get paid. …
Correct Medical Billing For Sleep Apnea
Correct Medical Billing For Sleep Apnea With the increasing number of patients with obstructive sleep apnea, the DMERC recently changed it’s requirements for the medical billing of a CPAP machine. A CPAP machine is a continuous positive airway pressure device. It is used to assist patient in breathing at night. Recently, the DMERC has made the restrictions less harsh when it comes to doing medical billing for these devices. In 2002 new requirements were set for the purchase of CPAP machines. A patient now has to meet one of the two criteria. The first criteria for medical billing is that the patient’s AHI is greater than or equal to 15 …
Getting Your DME Billing Claims Paid
Getting Your DME Billing Claims Paid Many times medical billing questions arise about how to get DME claims paid. Some companies bill for durable medical equipment all the time, while others only do it a few times a year. Following simple medical billing tips will get your Durable medical equipment claims paid as accurately as possible. It is very important before a product is dispersed to see if the patient needs precertification from their insurance company. If medical billing is performed on a piece of durable medical equipment that needed precertification, but precertification was not obtained, many insurance companies will deny the claim. This may seem like a time consuming …
DME Fraud Claims Settled
DME Fraud Claims Settled AdminaStar Federal Inc. agreed to pay six million dollars to the federal government due to medical billing fraud allegations. This durable medical equipment company allegedly overcharged Medicare and intervened with their Medicare evaluations. The Centers for Medicare & Medicaid Services hopes this settlement gives the warning to all that medical billing fraud is not acceptable among their contractors. AdminaStar Federal Inc. was uncovered by two whistle blower medical billing lawsuits. They were in Indianapolis and fell under the False Claims Act. Apparently from 1991-1998, the medical billing employees at AdminaStar knowingly changed claim information. They also would hang up on customers just to appear to have …
Itemized Bills Help Catch Billing Errors
Itemized Bills Help Catch Billing Errors In billing, itemized medical charges prevent overcharging errors. It is estimated that about 5% of all medical bills contain large errors. This is huge. It means that if you have a $10,000 medical bill, on average, $500 has been billed in error. Many of these errors are the product of unitemized bills, or itemized medical bills with hard to read verbiage. Patient-friendly itemized medical billing will help ensure medical billing errors are not overlooked. For the most part, large medical billing mistakes are not done on purpose in a fraudulent manner. Many times billers don’t catch the over billed amount. Then the claim is …
Outsourcing Your Medical Billing In Georgia
Outsourcing Your Medical Billing In Georgia You have a busy medical practice in Georgia and your staff is pushed the limit just servicing the phones and the patients. Forget about submitting your medical billing claims in a timely manner, and when your claims get rejected from time to time because your staff doesn’t have time to keep up with all the coding changes that happen…well you get the idea. So, now you’re thinking about outsourcing your medical billing to an outside source. That’s a big decision if you’ve never done it before. You may have even heard horror stories from other physicians who have outsourced their medical billing with not …
Medicare Still Unsure On Coding For Prostrate
Medicare Still Unsure On Coding For Prostate Screening The Medicare medical billing dilemma about prostate screening coverage is still a heated issue. Almost all preventative care in the past was not covered by Medicare. Recently, they decided to allow billing for medical prostate cancer screening charges. The problem is that the Centers for Medicare & Medicaid Services never removed V76.44 (Special screening for malignant neoplasms of the prostate) from the non-covered codes list. This medical billing problems has brought much confusion to the medical world. Many medical billing personnel have become confused by this conflicting new rule. As the Centers for Medicare & Medicaid Services have it now, the current …
Watch Your Upper Payment Limits Or You Could Be Responsible For Refunds
When receiving medical payments after billing, it is important to make sure the upper payment limit is accurate. If the upper payment limit is too high, you may end up having to refund Medicaid or Medicare. North Carolina is currently going through this medical billing upper payment limit problem. In North Carolina, the Office of Inspector General did an audit and found that in 2003, the state was miscalculating inpatient payments. Apparently, when doing medical billing, they began figuring the upper payment limit by taking Medicaid charges changed to costs. They were supposed to figure the medical billing limit by using the hospital’s recent cost reports. The result was a …
The Three R’s Of Radiology Medical Coding
The Three R’s Of Radiology Medical Coding When performing medical billing for radiology it is important to remember the three R’s. To ensure your radiology claims will be processed accurately and without delay, there are three elements that should be included with your medical billing: request, render, report. The first medical billing R for radiology is request. This means a physician has requested the opinion of a radiologist. This must be a formal request and needs to be written down in the patient’s record. If this is in a hospital setting, the request can be in the medical record, progress note, or a completely separate written request. The second element …
Proper Coding Of Arterial Stent Avoids Audits
Proper Coding Of Arterial Stent Avoids Audits A medical billing audit on arterial stents could highlight your coding errors. It is important when billing to provide the most accurate and up to date medical coding possible. To ensure all medical payments are correct, proper arterial stent billing is necessary. Recently, the HHS Office of Inspector General did an audit for claims processed in 2002 for arterial stents. These medical billing claims were all from Texas providers processed by the contractor called Trailblazer Health Enterprises, LLC. Out of seventy two arterial stent bills, twenty of them were incorrectly processed by Medicare. This billing resulted in a medical over payment of over …
