Archive for The Month of May, 2006
Archive for the Month of May, 2006
Welcome to the medical billing blog archive for the month of May, 2006.
Here you will find links to every article added to the Outsource Management Group web site during the month of May, 2006.
You can browse this month's archives by clicking the "More" button from any of the excerpts below.
How to Avoid "Medically Unnecessary" Medical Billing Denials
There is very little more frustrating in the realm of medical care than to receive a medical billing claim returned and notated with the words of doom for any medical billing claim: “Medically Unnecessary Procedure”. This is frustrating because it essentially means the services were performed for free and won’t be reimbursed by the insurance carrier or Medicare. There’s little you can do in your practice to ensure that your medical billing claims have proper documentation to show medical necessity of the procedure. ECGs get regular scrutiny for the necessity of the procedure. If your staff is too overwhelmed by the day-to-day business of keeping your patients happy and your …
Modifier v57.1 to Get Close Examination
If you use V57.1 (Other Physical Therapy) in your medical billing claims, be prepared for some close scrutiny of all your submitted medical billing claims. These claims in particular will be closely monitored to ensure that they were medically necessary services actually done by the physician. This review will be taking place in Iowa and other states are slated to follow suit in the coming months. Currently, the review will affect Part B Medicare patients only who are part of the outpatient home healthcare program. The reviewers will select home health outpatient claims with type of bill 34X, revenue code 042X and V57.1 as primary. With the close examinations of …
Make Sure Your DME Deal Doesn’t Look Like a Kickback
Based on a recent deal in which a supplier of DME products would provide equipment to a physician in exchange for a prime space and fees, would directly violate the federal anti-kickback statute, according to the HHS Office of Inspector General latest advisory. The basis of this decision was based on the situation where the agreement would have allowed the physician to become a DME supplier for non-Medicare patients, and the DME supplier would have rented space in the physician’s office to supply DME directly to the physician’s Medicare patients. The reason that this arrangement raised eyebrows is because the in-house DME supply programs either together or individually, pose a …
Correctly Coding E/M in Medical Billing
New medical billing coding interpretation may add more reimbursement to your reimbursements. The Centers for Medicare & Medicaid Services clarified the rules for a new patient evaluation and management codes. In reality, there has been no real medical billing policy change to the language the policy is written in; it is simply going to be interpreted differently by the Centers for Medicare & Medicaid Services. Now, the definition of “new patient” means someone none of the physicians in the practice have seen in the last 36 months face-to-face. Some medical billing staff members may get confused when it comes to lab work and other non-face-to-face procedures. If a patient is …
Take Advantage of the Preventative Care Medical Billing Increases
The Centers for Medicare and Medicaid Services updated the healthcare payment amounts for certain medical procedures related to preventative care. The Outpatient Prospective Payment System (OPPS) has ruled in favor of the provider on a few financial issues. There are some medical billing changes implemented in the January 2006 update that will increase your revenue if you use them correctly. The main medical billing change issued by the Outpatient prospective payment system (OPPS) deals with preventative screening exams. Beginning in January 2006, Medicare will now reimburse at a higher rate for most preventative services provided. For instance: Many patients receive a “Welcome to Medicare” physical. Now, if hospitals provide this …
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