Archive for The Month of October, 2006

Archive for the Month of October, 2006

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

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

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

Tuberculosis Test Requires Special Handling

As tuberculosis becomes more prevalent; it’s showing up more often as a coding dilemma. One of the most common questions is if the PPD test should be charged separately and the answer is yes-sometimes. The reason is that when a skin test such as the one for tuberculosis is done, if the results are negative the test will be considered inconclusive for diagnosis; however if the results of the PPD test are positive, then you are opening the door for further visits from a physician and treatment for a condition. If you have no way of knowing the outcome of the test when you are compiling the medical billing, the

By: Melissa Clark, CCS-P, RT - CEO
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Critical Care Medical Billing

Critical care is often confusing in the world of medical billing as a number of factors can come into play and whether you need to bundle services or not will also be an issue. Due to the nature of the critical care – notes are often made hurriedly and in many cases are incomplete and it is up to the medical billing professional to put it all together into a package that will be clear, concise and easy to read for the carrier so that the services may be reimbursed. A good example is if a surgeon performed 64 minutes of critical care for a patient in cardiac arrest. During

By: Melissa Clark, CCS-P, RT - CEO
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Using an Extended History in Your Medical Billing

You can use the 1997 audit guidelines that state an extended history for a patient can be created by updating the status of at least three chronic or inactive conditions that the patient has or has had. It is not imperative that the information be placed in the history of present illness (HPI) section. However what is imperative is that your medical billing reflect the medical documentation of all illness that you choose to use – both past or present- to create an extended history of illness. For audit purposes it is helpful to have the notations in both the HPI section and the assessment section. Most physicians will make

By: Melissa Clark, CCS-P, RT - CEO
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Medical Billing Dilemma – Billing Global

Babies are going to come when they are good and ready and when a baby is being born there is nothing that can be done to stop it in the event of a normal vaginal birth, a doctor may not be on hand to deliver the baby. A situation that isn’t uncommon is for a nurse to deliver a baby when the ob-gyn is in the next room doing a procedure on another patient such as an episiotomy; then the question arises, can the service still be billed globally? Fortunately in many cases you can. It is up to the individual payer and you can find out quickly by either

By: Melissa Clark, CCS-P, RT - CEO
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When You Can Discard Modifier 25

Modifier 25 cuts a fine line in the medical billing world. Auditors tend to target medical billing claims with this modifier however CMS recently clarified again that they do indeed want this modifier used where appropriate in medical billing claims. The best rule for when to use modifier 25 is met when your physician provides a significant and separately identifiable E/M service on the same day as a procedure with a global period. If your services meet that requirement, you are free to use the modifier without worry in your medical billing claims. The CMS updated the usage language of the modifier in the release on August 20, 2006 and

By: Melissa Clark, CCS-P, RT - CEO
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Medical Billing Dilemma – Medial Dislocation

A common occurrence in the emergency is the dislocation of various joints. They are sometimes incorrectly handled as breaks but shouldn’t be and you could be setting your practice up for a denial at best and audit at worst if you report these procedures incorrectly on your medical billing. Even if the reduction of the dislocation fails, the attempt should be reported on not only the medical billing as a procedure but also in the documentation as another procedure will have to be tried to relocate the elbow to its proper placement and you can show the timeline for the necessity of other and more involved treatments. On the claim

By: Melissa Clark, CCS-P, RT - CEO
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Medical Billing Watch – CMS Watching Radiologist Billing

A two year study by Medicare showed that Radiology providers billed Medicare inappropriately for a staggering 100,034 radiology services according to HHS Office of Inspector General (OIG). This translated into Medicare overpayments to the tune of $20 million dollars where Medicare Part A covered radiology services but providers still billed Part B for the technical component of those services as if they were outpatient services according to the OIG report. In a nutshell, Medicare paid these claims twice. Prepayment edits are the proposed solution to this matter and would disallow the submission of any medical billing claim that had the same services under Part A and Part B claims. If

By: Kathryn Etienne, CCS-P, RT - DOO
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The Upcoming Changes to Power Mobility Devices are Clarified by CMS

Power mobility devices (PMD) have become a very big business and also given patients a new lease on life by being able to get around in an easier fashion. Previous reports had stated Medicare would no longer pay for PMD devices, however Medicare will still pay for a Group 2 power mobility device (PMD) when appropriate according to a memo released by the Centers for Medicare and Medicaid Services. A fact sheet released by CMS on Sept. 20 clarifies this as saying many facilities misinterpreted that medical billing claims for PMD devices would not be paid, however that is not correct. When the new statues went into effect on October

By: Kathryn Etienne, CCS-P, RT - DOO
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