Archive for The Month of April, 2007

Archive for the Month of April, 2007

Welcome to the medical billing blog archive for the month of April, 2007.

Here you will find links to every article added to the Outsource Management Group web site during the month of April, 2007.

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

Reimbursements For Therapy Medical Billing

One of the biggest eyebrow raisers for carriers as far as medical billing claims go are any claim submitted for reimbursement for therapy based 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

By: Kathryn Etienne, CCS-P, RT - DOO
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Don’t Make Mistakes On Admission Codes

As you know, a hospital admission requires face-to-face service. However a common dilemma that many medical billers find themselves in is when a surgeon “admits” the patient and then isn’t present when the patient arrives at the hospital to check in. In most cases the physician will dictate the history and physical (H&P) over the phone to the hospital and then send the patient over, however the dilemma for the medical billing occurs over the fact that the face-to-face interaction between physician and patient doesn’t occur until the following day. First of all, your dates must correspond. If the physician doesn’t see the patient in the hospital that day (performing

By: Kathryn Etienne, CCS-P, RT - DOO
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Use Modifiers Carefully To Avoid Audits

If you commonly use modifier V57.1 (Other Physical Therapy) in your medical billing claims, be on the alert that the close scrutiny that started in 2006 will continue for your medical billing claims submitted. The reason for the close scrutiny is that some medical billing claims were submitted with medically unnecessary services actually done by the physician. This review started in Iowa and now is taking place in many states and will continue to do so until all states have been audited. 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

By: Kathryn Etienne, CCS-P, RT - DOO
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Using Modifier 51 With Lesion Removal

Lesion removals can be complex to report, however if you just break down the medical billing claim, you’ll find getting your filing points just right is a breeze. Your claim will usually start in the emergency room and remember that in almost all cases, the excision site before sending the patient home. If this closure represents a simple repair, the work involved is bundled into the lesion excision code you report on the claim. The other side of that type of claim however can be if the repair of the excision site gets more complicated, you’ll be able to report the closure as a separate procedure from the excision procedure.

By: Kathryn Etienne, CCS-P, RT - DOO
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Laceration Medical Billing Claims Made Easy

Lacerations are a common occurrence in the ED and knowing the in’s and out’s of medical billing for these types of claims will make filing each and every single one of them a breeze. For example if you have a patient that presents who was using a table saw on the job and lacerated index and middle fingers on the palmar surface, but there is no significant bleeding and he is otherwise healthy. How would you report this? On further examination the physician finds on the pad of the distal phalanx of both involved fingers is a 1.5-cm laceration that is jagged with protruding fat. The notes read that the

By: Kathryn Etienne, CCS-P, RT - DOO
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Coding Pediatric Injections For Max Return

Therapeutic and antibiotic injections went through some changes in 2006 and make sure that your medical billing claims reflect those updates or you might be suffering from partial payments or rejections of your medical billing claims. In the past there were separate injection administration codes for a therapeutic, prophylactic, diagnostic, and antibiotic injections. Instead of choosing to report administration of a prophylactic Synagis treatment (90378) with a 90782 (Therapeutic, prophylactic or diagnostic injection , you now simply use 90772 as a universal injection code. On E/M coding, you will generally still need to attach modifier 25 to insure your claim is handled. Modifier 25 states that this procedure or other

By: Kathryn Etienne, CCS-P, RT - DOO
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Switching to Outsourcing Made Painless

Most practices start out very small and usually with just a doctor and one other person. Between yourself and the other person, you answer phones, greet patients and grow your practice and soon you may find that you need help keeping up with your medical billing claims. Many doctors start expanding their staff at this point, hiring assistants and office personnel to handle the additional workload that happens as the practice continues to grow. And then new fees are added to your overhead in the form of additional salaries to pay, unemployment and state and federal taxes. This is when many physicians begin thinking about outsourcing and for the majority

By: Kathryn Etienne, CCS-P, RT - DOO
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Revisiting Modifiers 25 and 57

If you have a number of medical billing claims getting rejected, once you rule out any larger reasons, you might start looking for the key in the use of; or rather the lack of not using modifiers as a part of your medical billing claims. Two of the main modifiers that get people in trouble with their medical billing claims in the forms of rejections are modifiers 25 and 57. Modifier 25 reads , “Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service” is kind of a catch all modifier for procedures that may not have an exact

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