Archive for The Month of September, 2006

Archive for the Month of September, 2006

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

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

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

Cost to Charge Ratio and How to Change Yours

Your provider number has a strong impact on your medical billing cost to charge ratio (CCR). If your hospital is merging with another hospital, it is important to figure in the possibly new Cost to Charge Ratio medical billing payments you will receive. There are two avenues merging hospitals can take. The first method is when two hospitals merge together while one of the existing provider numbers is kept in tact. In this instance, one hosptial keeps their medical billing number, while the other one drops theirs and joins the first. The hospital that drops their medical billing provider number will receive a new cost to charge ratio. The ratio

By: Melissa Clark, CCS-P, RT - CEO
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Accuracy in E/M in Medical Billing

Medical billing largely depends on the accuracy of the physician’s records. Many times physicians have nothing to do with the medical billing aspect of their practice or facility. This can cause them to be haphazard with their documentation for their patients. It is important to educate physicians about the importance of accurate records that are utilized in the medical billing department. With rising healthcare costs; carriers are becoming much less lenient on treatments and procedures being covered. They also have become sticklers for accurate medical billing documentation submissions. If there is anything incorrect on a claim, it gets sent back to the provider without payment. There are many evaluation and

By: Melissa Clark, CCS-P, RT - CEO
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Medical Billing Caps for Therapy Addressed

New treatment methods and less surgical procedures has made therapy medical billing dramatically rise. Not only are there more physical therapy claims, but there are also many more speech therapy and rehab claims sent in to payers. To decrease the deficit, the House of Representatives recently passed an act that puts a cap on therapy medical billing. The Deficit Reduction Act of 2005 was passed on December 21,2005 with a very narrow vote by the Senate. Senators were split in a 51-50 vote to cap therapy medical billing reimbursements. As a matter of fact, the vice president of the senate cast the tie breaking vote for the act. Although there

By: Melissa Clark, CCS-P, RT - CEO
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Indirect Supervision Codes in 3 Easy Steps

Care Plan oversight services can be slightly confusing for medical billing staff members. In order to correctly bill services, there are certain rules that should be followed. There are three medical billing steps for correctly billing indirect supervision codes. The medical billing current procedural terminology codes 99375-99380 should only be used in certain instances. These codes represent non face-to-face visits by pediatricians for special needs children. There are certain instances when it is acceptable to do medical billing for this care plan oversight (CPO): revision of care plans, review of patient status, review of lab work, and phone calls to assess condition with guardians. The second step to correct medical

By: Melissa Clark, CCS-P, RT - CEO
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No Time For Credentialing?

Did you know your medical billing partner can do far more than handling the flawless transactions of your medical coding and billing – they can also help you get credentialed with various carriers to insure that the services rendered by your practice are covered by various insurers that require a physician be part of their network in order to recognize claims submitted. If you have a busy practice, you may be putting off getting credentialed with additional insurance companies because you just don’t have the time to fill out the forms, questionnaires and other information in order to get approved with additional carriers. You know from previously getting credentialed that

By: Melissa Clark, CCS-P, RT - CEO
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Common Medical Billing Coding Confusion

A common confusing coding dilemma concerns the diagnostic investigation of the swallowing function with a few different methods. The two codes that cause the most confusion are 70371 and 74230 and knowing when to use them will make the difference between a paid medical billing claim and a denial or delayed claim. Here is a breakdown of the basics for the two codes : 70371: Code 70371 (Complex dynamic pharyngeal and speech evaluation by cineradiography or video recording) describes a radiologic study using cineradiography or video recording for pharyngeal and speech evaluation. Typically, although not necessarily, a speech pathologist is present, and the patient repeats sounds to allow for evaluation

By: Melissa Clark, CCS-P, RT - CEO
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Perinatal Billing Code Additions Coming Soon

Head’s up! There are ICD-9 code additions that will most likely impact OB/GYN’s. They haven’t been solidified yet, but here’s a sneak peak at what could be included in the coming changes. These codes are slated to be four new ICD-9 code changes that will become available in October. The four new codes will be in the perinatal sector of care and are : * 768.7 new code for hypoxia and birth asphyxia — , Hypoxic-ischemic encephalopathy (HIE)* two new codes describing other respiratory problems after birth:* 770.87 — Respiratory arrest of newborn* 770.88 — Hypoxemia of newborn Another slated change may be the addition of a fifth-digit subclassification under

By: Melissa Clark, CCS-P, RT - CEO
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How to Avoid Fraud and Abuse Charges In Your Medical Billing

Gainsharing in medical billing is highly scrutinized. The HHC Office of Inspector General is very suspicious about gainsharing activities with healthcare providers. There are three areas hospital providers should focus on in order to prevent medical billing fraud allegations. Improper gainsharing agreements are borderline fraud in medical billings. The three things hospitals can do to prevent any fraud charges are having sufficient quality controls implemented, promoting accountability, and limiting payments that lead to referral pattern changes. If all three of these elements are satisfied, your hospital will have no problem providing trustworthy medical billing. In order to run a hospital successfully, two things are necessary: quality of care, and profitability.

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