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.

Proper Coding For Dry Eye

Proper Coding For Dry Eye Medical billing for dry eye syndrome can be pretty complicated. There are several different ways to code for this syndrome. The different methods of medical billing for DES all depend on the documentation and treatment given by the physician. Dry eye syndrome is when patients have a decrease in their tear gland function. Their tears also begin to evaporate more quickly. If dry eye syndrome goes untreated, it can lead to thickening of the cornea which, in time, will impair vision. When doctors see a patient for this reason, medical billing claims should not be submitted to vision insurance. Vision insurance is for routine eye

By: Melissa Clark, CCS-P, RT - CEO
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Correct Medical Billing For Group Visits

Correct Medical Billing For Group Visits With the emergence of more and more group doctor appointments, medical billing processes have had to adjust. A group visit is when patients with similar diagnoses or background have a medical appointment for educational reasons. In these visits usually full history is taken and physicians may individually take out patients for decision making and treatment. There are several medical billing options for this type of visit. Since group visits are fairly new, many medical billing staff members code it incorrectly. This miscoding can lead to payment denials. There are two main ways to code group visits. One way to do medical billing for a

By: Melissa Clark, CCS-P, RT - CEO
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Demonstrating Medical Necessity For Foot Orthotics

Demonstrating Medical Necessity For Foot Orthotics Along with medical a billing claim, many insurance companies require a letter of medical necessity to be sent along with the claim for orthotics. A letter of medical necessity could mean the difference between getting your claim paid or getting it denied. The letter of medical necessity for orthotics needs to have several elements to be sent along with a medical billing. The first necessary element of an orthotic letter of medical necessity is patient information. Along with the medical billing, the letter of medical necessity should always include the patient’s name, insurance information, and date of birth. This section should also include the

By: Melissa Clark, CCS-P, RT - CEO
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Getting Your Ob-Gyn Claims Paid With Correct Coding

Getting Your Ob-Gyn Medical Billing Claims Paid With Correct Coding There was a medical billing study done at the University of Illinois Hospital from 1999-2001. This was a study to see how many coding errors occurred in patients admitted for eclampsia and preeclampsia during this time. The study was astonishing. There were 67 total errors in this one study. Medical billing coding errors frequently happen with ob-gyn patients. Surprisingly, in this medical billing ob-gyn study, over 80% of the coding errors happened with clinicians. That means actual doctors were, and are, incorrectly coding ICD-9 codes and CPT codes. Most of the time people blame the actual coder instead of the

By: Melissa Clark, CCS-P, RT - CEO
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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.

By: Melissa Clark, CCS-P, RT - CEO
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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

By: Melissa Clark, CCS-P, RT - CEO
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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

By: Melissa Clark, CCS-P, RT - CEO
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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

By: Melissa Clark, CCS-P, RT - CEO
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