Medical Billing & Medical Coding Blog...

You bet. ADL coding is something that auditors will be watching heavily and if you’re not calculating yours correctly, you’ll penalized and fined. One way to make sure your facility is well within the guidelines of billing permissibly and ethically is to do a RUG profile of your residents and compare your facility to the state and national averages. You can compare your facility to the other agencies in your state against the national averages at the Centers for Medicare & Medicaid Services Web site:(http://www.cms.hhs.gov/www.cms.hhs.gov/apps/mds). If you find that your facility has far fewer rehab RUGs ending in C’s and far more A’s than the national or state average, than …

The HHS Office of Inspector General (OIG) has released its 2007 work plan, and it’s drawing ample attention to therapy services. If you frequently bill for therapy services in your practice be sure that your documentation is iron clad to show the necessity of the therapy services. The general overview of the plan includes the OIG planned review of medical necessity, correct billing and proper documentation for Medicare rehab services. Regarding specific facilities, a sampling of hot items on the OIG’s checklist include the following items: *inpatient compliance with the 75% rule for admission criteria. *home health agency compliance with higher therapy paying threshold services. *the medical necessity of skilled …

In 2007 the OIG is planning on zeroing in on incident to billing claims. In the update issued in October 2006, the HHS Office of Inspector General plans to issue a report on whether you are following all the requirements for incident -to billing, including direct physician supervision. The OIG wants to know whether these services met the Medicare standards for medical necessity, documentation and quality of care, according to the OIG’s 2007 Work Plan. Other topics include: Other things that will be closely studied in the report include global periods and how they are determined in the medical billing. The agency will also be in the lookout for assignment …

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 …

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 …