Archive for The Month of July, 2006

Archive for the Month of July, 2006

Welcome to the medical billing blog archive for the month of July, 2006.

Here you will find links to every article added to the Outsource Management Group web site during the month of July, 2006.

You can browse this month's archives by clicking the "More" button from any of the excerpts below.

Understanding Medical Billing and Revenue Codes

Not all medical billing is generated from physician’s services. Sometimes services are rendered to patients and the medical billing created from those procedures need to be submitted to the various insurance carriers, but they also need three things: a price, a procedure code, and a revenue code. Revenue codes indicate to the type of service that you are billing for; revenue codes are 3-digit codes, and those revenue codes must match up with specific procedure codes to designate what services were rendered. For instance, if you are using a 360 revenue code, you’re stating that the services rendered were performed in the operating room, and therefore, the procedure codes that

By: Melissa Clark, CCS-P, RT - CEO
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Changes Coming to Follow Up Care in September 2006

If your practice routinely provides burn or laceration follow up care, head’s up because after September of this year, there will be three new post-op codes added that will better detail the services rendered during the patient’s visit and should improve your reimbursement rate. Be sure and alert your staff that V58.3 will no longer be a valid code to use and the new three designations should be chosen from when coding the patient’s visit. The three new designations are as follows: * nonsurgical wound dressing change or removal, V58.30* surgical wound dressing change or removal, V58.31* suture removal, V58.32. Having more exact coding designations to go with the ICD-9

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

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

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

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

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

By: Melissa Clark, CCS-P, RT - CEO
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Choosing A Medical Billing Company

Deciding to outsource your medical billing is not a decision to be taken lightly, and in the beginning you may not even need to outsource your billing in the beginning. But soon, you will find that your staff is so busy servicing your patients and running your office with its day-to-day goings on, finally you have to look at outsourcing. There have been some horror stories out there about physicians outsourcing their medical billing or practice management to a company and then finding out it cost them even more money because the company just wasn’t up to date on their coding books or simply not experienced enough to handle the

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