Archive for The Month of August, 2006

Archive for the Month of August, 2006

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

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

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

The Removal of Sutures

Medical billing allows for very little wiggle room in your descriptions and documentation. Almost all surgeries, whether performed in the doctor’s office, or in the operating room have a follow-up period. This means that during that particular 15-day, 30-day, 60-day, etc. period, any treatment the surgeon does for that surgery is included in the medical billing of the surgery itself. However, there is an exception to this rule. An example of an exception to this medical billing rule deals with mentally handicapped patients. The removal of sutures is usually a procedure performed within the postoperative follow-up period. Medical billing is usually done only for the surgery. However, if a mentally

By: Melissa Clark, CCS-P, RT - CEO
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Get Your Therapy Medical Billing Claims Paid

No type of medical billing claim raises more eyebrows with Carriers more than therapy bases medical billing claims. Most therapy claims are 100% legitimate but because of the amount of fraud that has been perpetrated by a few unscrupulous individuals all of these types of claims get closer looks than ever. One way to insure your claims are submitted correctly is to make sure the documentation is done absolutely accurately in your therapy department. In a recent audit of claims, the CMS found that the number one error in reporting therapy medical billing claims is with the minutes billed. Make sure the amount of therapy given to the patient is

By: Melissa Clark, CCS-P, RT - CEO
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Using Care When Using Modifier 24

If you are a practitioner or medical biller that has a client who sees patients in need of services for post operative complications and you are bundling the services into the global period of surgery, you could possibly be missing thousands of dollars in reimbursements yearly using this method of doing your medical billing. In many cases you can legitimately report patient evals made during the post-op period, according to the individual carrier’s rules. A good rule of thumb for most carriers is if the post operative complication evaluation is unrelated to the original procedure and this can usually be distinguished by medical necessity and date alone, then you can

By: Melissa Clark, CCS-P, RT - CEO
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Correct Billing for Same Day Services

Medical billing for same day services can sometimes be confusing. Only skilled professionals can tell the difference between same day services and code them correctly. A good example of same day services that can be confuses involve fine needle aspiration (FNA). If a FNA is performed on the same day as a more extensive procedure, the Centers for Medicare & Medicaid Services will only pay for the procedure that is more invasive. This is called the “sequential procedures policy” in medical billing. This usually occurs when a physician decides to do a FNA, but later after the procedure, decides it did not accomplish what it was supposed to. That same

By: Melissa Clark, CCS-P, RT - CEO
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Correct Medical Billing Reimbursements for Power Mobility Devices

Due to the unfortunate incidence of fraud, there are some strict medical billing requirements for getting reimbursed for power mobility devices. Additionally, the time the physician spends working on the extra documentation is also billed at the current rate of an extra $21.60 for the extra time spent on power mobility medical billing. Recently there was an increase in the amount of documentation that is needed to do medical billing for power mobility devices. Medicare requires the prescription, patient’s medical records and any other supporting information. Instead of lowering the amount of medical billing documentation for power mobility devices, Medicare decided to properly compensate for the extra time it creates.

By: Melissa Clark, CCS-P, RT - CEO
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Medicare to Conduct Reviews for Medical Billing Overpayments

The states of New York, California, and Florida are involved in a pilot demonstration led by the Centers for Medicare & Medicaid Services. The Centers for Medicare & Medicaid Services has hired a Recovery Audit Contractor (RAC) to do extensive evaluation of medical billing claims for three years. You may be asking: What does this medical billing audit mean to your practice if you don’t reside in one of those states? If the demonstration in these three states is successful and the Centers for Medicare & Medicaid Services are able to recover money in medical billing overpayments, it could mean a lot to your practice. It would mean that the

By: Melissa Clark, CCS-P, RT - CEO
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Correct Medical Billing for Endoscopy Procedures

Endoscopic procedures are getting a closer look by Medicare and Medicaid. The University of Rochester’s Strong Memorial Hospital submitted claims from September 2001 to December 2003 for endoscopic procedures that were found in an audit conducted by both agencies to be billed incorrectly. In total costs, the hospital repaid over $500,000 combined to these organizations. There were two main reasons the medical billing was incorrect. Many of the procedures claimed that the head of surgeon, Ma Sundaram, performed the surgeries. In all actuality, most of the time, the head surgeon was not even present. The other reason the medical billing was incorrect was because medical necessity was not substantiated for

By: Melissa Clark, CCS-P, RT - CEO
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Using Disaster Related Codes in Medical Billing

Disasters such as 9/11 and natural disasters like Hurricane Katrina have made it apparent that medical billing needs to be able to reflect these unfortunate situations. The Centers for Medicare & Medicaid Services issued new codes to reflect these conditions. Not all medical billers are aware of them and how to use them. The new condition code that should be used in medical billing for coding disaster related service claims is DR (disaster related). The new medical billing modifier is CR (Catastrophic/disaster related). Any institution can use either one of these codes, no matter what the location of the facility is. There is one exception to this rule. Suppliers and

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