This
blog contains information regarding Medical
billing outsourcing news, HIPAA news,
recent information and changes to
the medical billing & medical
coding industry, as well as the thoughts
of our authors.
The word "outsourcing" has become a dirty word for many physicians that have been burned by medical billing companies that either outsourced their claims to medical billing companies that use neither secure networks nor adhere to HIPAA regulation in order to maximize their profits; or the outsourcing company just turned out to not be reliable and it wound up costing the practice money to utilize their services.
Don't let a bad experience keep you from partnering with a legitimate medical billing company that can not only help you get your reimbursements faster but also realize great profits by maximizing every single medical billing claim that is filed to make sure that all services and procedures are counted by the carrier and reimbursed.
If you've been hesitant about outsourcing your medical billing because you aren't sure it would actually help your practice or you've been burned; do a little research on your own and ask for references. Ask the medical billing company what they will do for you. OMG will not only help you get the best reimbursements on your medical billing, they will also help you manage your practice by keeping your and your staff informed of coming CPT coding changes that will affect your practice as well as helping keep your patient accounts organized and you can log in and see where a patient's account stands for insurance payments versus out of pocket. This is a very efficient way to run your practice and when you have the extra time due to partnering with a competent medical billing partner, you will finally be able to help your practice really grow!
If you haven't already, make sure that your staff is using the updated CPT codes that were released in October 2008.
Not doing so can lead to kick backs that will require more staff hours to research, redo and resubmit and if this happens on a number of claims it can seriously affect your reimbursements and in turn - slow your revenue flow to a mere trickle.
One way to avoid this dilemma is to outsource your medical billing and yes, there are some horror stories out there about outsource companies that threw away patient billing, had lax attitudes towards billing submissions and wound up costing the physician a lot more money than they made through reimbursements. However, that's not how it has to be.
Do a little research and find the best fit for your practice. Your best friend may also be a colleague but the medical billing company he uses may be a terrible fit for your own practices. How do you find the right one? First of all decide what services are most important to your practice. Make a list of the tasks your office staff is performing the most in relationship to medical billing and see if a medical billing partner could possibly lighten the load. Also, find out if your potential medical billing partner can do your credentialing for you - it's a great way to maximize the amount of insurances you can take as well as cut the paper chase for yourself.
Often, patients who are confined to beds for long periods of time develop pressure ulcers. They are painful and need to be treated as quickly as possible as infections can set up within them that can be life threatening when the patient is already in a weakened condition.
When a service is performed for a patient such as treatment of a pressure ulcer on an area of the body such as the lower back, the usual manner of treatment is to remove any devitalized tissue from the ulcer using a water jet and forceps. The area is then covered to allow it to not be rubbed on so the skin can begin to repair itself.
When you report this type of claim, read the description of the code carefully. You will notice the since the water jet is normally used, it is already bundled into the claim itself. If you report it additionally, you are setting yourself up for a total claim rejection. You would want to report this claim as follows (make sure you know the measurements of the wound being treated):
* report 97597 (Removal of devitalized tissue from wound(s), selective debridement, without anesthesia (e.g., high-pressure water jet with/without suction, sharp selective debridement with scissors, scalpel and forceps), with or without topical application(s), wound assessment, and instruction(s) for ongoing care, may include use of a whirlpool, per session; total wound(s) surface area less than or equal to 20 square centimeters) for the debridement. You will also want to link 707.03 (Decubitis ulcer; lower back) to 97597 for the pressure ulcer.
A recent report showed that HHA's (home health agencies) and hospices are billing Medicare on an accurate level according to a report compiled by the CMS' Comprehensive Error Rate Testing.
The report showed that HHAs had a 1.4 percent error rate and hospices a 1.0 percent error rate in the November CERT report, which covers claims from April 2006 to March 2007.
DME (durable medical equipment) suppliers had a wide range of error rates broken out by supplier type. The lowest was 0.6 percent for a medical supply company with prosthetic/orthotic personnel certified by an accrediting organization while the highest was a whopping 51 percent for “unknown supplier/provider" where it could not be ascertained exactly what the DME device was that was issued to the patient.
A summary of the CMS' report showed that overall, the national error rate for Medicare was 3.9 percent. In terms of money this translates to $10.8 billion in improper payments, $1 billion of which were in the form of underpayments, according to the report. The good news is that this report shows that figure is down from 4.4 percent in the 2006-2007 report.
On October 17, 2007 - the Senate Finance Committee met to discuss ways to pay for a fix to physician payment rates in 2008 and 2009, according to press reports. The heart of the meeting was to talk about the
$30 billion in cuts needed to avert the doc pay cut and make other Medicare changes, and home care once again landed on the chopping block to have many home services radically reduced or have their funding cut all together. Some of the specifics of the home care that were discussed to be directly affected were wheelchair suppliers and oxygen providers are under discussion for reimbursement reductions to pay for the fix. The parties involved were sharply divided. The Democrats presented their plan which would finance the physician pay hike by cutting payments to certain Medicare managed care plans. Republicans, however, insist that rural patients depend on Medicare HMOs which would be affected under the Dem's plan. The goal of the Democratic leaders was to mark up a Medicare bill by the end of October, but “they’re dreaming,” Sen. Trent Lott (R-MO) commented to reporters.
The end of October has come and gone and no firm decisions have been made as of yet, we'll update you as soon as we hear changes are agreed upon for Medicare funded home visits.
Want to know why your emphysema claims aren't being fully reimbursed? Often, the reason is that you're lacking two things when you submit your claim. You aren't being detailed enough with your coding and your don't have enough detailed medical documenation to back up your full diagnostic testing that is required to accurately diagnose emphysema and narrow the degree and type. When you're compiling the medical billing for an established patient with active emphysema (492.8, Other emphysema) and they present and are complaining of shortness of breath (786.05); the physician provides inhalation treatment, trains the patient on using the nebulizer at home, and provides an expanded problem-focused examination and medical decision-making of low complexity, how would you report this?
There will be multiple codes for this visit as the emphysema was the reason for the visit however the physician also provided services and consulted regarding the nebulizer so there will need to be additional codings on the medical billing to take all the services rendered into consideration.
Be sure and capture 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered-dose inhaler or intermittent positive pressure breathing (IPPB) device]) to cover the comprehensive service the physician provided regarding using the nebulizer. Additionally, add in 99213, and back it up with documentation to show that the physician performed an exam of an existing problem with low- complexity decision-making.
If your documentation shows that the physicians's primary intent was to treat the difficulty in breathing at the time of the visit, switch to 94640(Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device).
It's important to always show if the emphysema is currently active at the time so further claims can use that diagnosis as part of the history where applicable.
As more research is done regarding the relationship between varicose veins, blood clots and other complications; more and more patients are having the simple surgery and as a result there has been confusion about exactly how to code this procedure to get the fairest reimbursement for this service. Once you know the basics for setting it up - it's easy!
A good example would be if a patient with varicose veins in her left lower leg presents to the ED and is stating she has severe pain in her leg. One of the veins is clearly bleeding so the doctor will use a standard suture ligation to stem the bleeding and winds up removing one of the veins in the procedure. Suture ligation isn't an uncommon way to treat a bleeding varicose vein, however there is currently no specific CPT code for it. The answer? Break it down!
A good way to report this on your medical billing would be to use code 37785 (Ligation, division and/or excision of varicose vein cluster[s], one leg) for the ligation. Be sure to attach ICD-9 code 454.8 (Varicose veins of lower extremities; with other complications) to 37785 to prove medical necessity for the procedure. You should be aware that 37785 has high RVUs and may be considered by some carriers to be more indepth of a procedure than was actually performed. A good rule of thumb would be to verify directly with the specific carrier that you are reporting to and make sure they will cover the procedure as such. If they won't a good alternative reporting method on the medical billing would be to report 12002 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities which includes hands and feet]; 2.6 cm to 7.5 cm) for the repair and attach ICD-9 code 454.8 to 12002 to prove medical necessity for the procedure.
Include all your documentation and be as detailed as possible, especially in the case of not being certain what the carrier will cover - simply ask and document the time, date and full name of whoever you speak with - this will insure all bases on your claim are covered.
RVUs (relative value units) cause a lot of confusion in the medical billing world when you're dealing with imaging procedures. It's really just a matter of listing your services rendered logically then tallying them up from largest to smallest. For example, imaging codes aren't discounted under the multiple-surgery payment reduction, so you typically list surgical codes first, in order by RVU, then the imaging codes.
Your final coding report should look like this in order :
* 35471 main coding
* 36245 main coding
* 75722-26-59 procedure with modifier
* 75966-26. procedure with modifier
Just remember to list the "heavier" codes at the top of your list and the lighter codes such as imaging, at the bottom. You should include a diagnosis code where appropriate that is based on what the radiologist documents. Tie this in with what the treating physician documents and you should have a specific diagnosis for the patient to show exactly what the RVUs are that you are billing for.
Make sure that your medical billing has the necessary documentation to get the best reimbursements possible. Your documentation showing medical necessity for any service you're looking for reimbursement for should be clear to the carrier or you risk partial payments or outright denials on your medical billing claim.
In 2007 the OIG zeroed in on incident to billing claims. The HHS Office of Inspector General plans to issue a report on whether all the requirements for incident-to billing, including direct physician supervision are being followed. 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 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 violations where the physician has billed the patient more than Medicare co-pays for a service. They will also be ascertaining if the physician is notifying patients of their right to not be overcharged.
Imaging services will also come under close scrutiny. Medicare paid out $7 billion in 2005 and will be looking at all imaging services for medical necessity and proper medical billing. To keep overpayments on this type of service at a minimum.
The popularity of eye surgery is also under the microscope of scrutiny. If the OIG suspects that you’re billing for cataract and LASIK eye surgeries in ways that don’t meet Medicare requirements, you could find yourself under audit and quickly. The smartest thing you can do is consult with a medical billing partner and make sure that every claim you file is to the letter proper and help you avoid setting off audit triggers.
For correct payment amount, accurate place of service codes are required. The failure to provide the correct place of service code with the correct current procedural terminology code for E/M services will cause your claim to get denied. One of the most important elements of medical billing is the place of service code.
In medical billing, the place of service codes for an evaluation and management are commonly misused. There are several current procedural terminology codes for an evaluation and management session that correspond to different medical billing place of service codes. When using CPT 99341 (Home visit for the evaluation and management of a new patient) through 99350 (which means the same as 99341 except with an established patient), the only POS code available for use is 12. This means home.
Many billers get confused with these medical place of service codes. If a patient is in an assisted care center, many people consider this a home and bill with place of service code 12. This would be incorrect. POS 12 is reserved for house, apartments, etc visits. There is actually a more specific code for an assisted care center in medical billing, the correct POS code would be Medicare Contracting Changes Could Bring Reimbursement Delays When billing to Medicare, expect some medical reimbursement delays in the upcoming years. The Centers for Medicare & Medicaid Services is currently reforming contractor workload for medical billing claims that come in. The speedy implementation of this medical billing reform may lead to reimbursement delays and errors.
Congress mandated that the Centers for Medicare & Medicaid Services reform their contracting system. This needs to be completed by October of 2011. However, since estimates of huge savings have been made, the Centers for Medicare & Medicaid Services wants to speed up this medical billing contractor reform. Their goal is to have it completed by 2009, which is two years earlier.
This change to the contractor method will take many Part A and Part B contractor work loads and transfer the loads over to the Medicare Administrative Contractor. Unfortunately, by making this reform too soon it is very likely that medical bills will be reimbursed incorrectly or with much delay. It seems as though the Centers for Medicare & Medicaid Services has not thought of possible medical billing and reimbursement problems of implementing this system too soon. The Government Accountability Office has suggested to CMS to wait until 2011, but they have refused.
If your practice is planning on billing Medicare in the coming years, it would be wise to keep close track of those medical claims. Make sure they are not lost in the cracks. Also be sure they are reimbursed at the correct rate. This extra effort could become a headache for your practice. Medical Billing firms can alleviate this stress. Their job is to make sure your claims are paid on time and accurately. They know how to deal with payers. Medical billing companies can save your practice much headache once Medicare makes contracting reforms.13.
Basically, for every current procedural terminology code, there is a correct place of service code that corresponds to it. if these medical codes are used incorrectly in billing, it will cost your practice time and money. Insurance companies will deny the claims and your office will have to correct the problem. With the use of an outside medical billing company, you can erase this problem from your mind. Medical billing companies are versed in the correct billing procedures for every medical service. They check claims for accuracy before they are submitted and take care of any claims that come back unprocessed. Correct medical billing POS codes are essential for maximum practice profitability.
Are you swamped? So overwhelmed with patients, billing, invoices, emergencies and other day to day practice worries that you don't even have the time to get yourself credentialed with all the carriers possible. No one has to tell you that the more insurances you accept, the more patients you can see and the more revenue you can generate for your practice. Credentialing is the key. Did you know your medical billing partner can take some of the heat off you and not only compile and submit your medical billing, they can also get your practice credentialed with any carrier you choose.
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 the process can take months for the carriers to process the paperwork and you just do not have the time to fill out the detailed forms and then call the insurance company for follow-up on your application. Wouldn't it be great if someone else could take over the hassle for you?
Your medical billing partner can do this as well as your medical billing and coding. They have the knowledge and expertise to not only get your claims paid but to also get you credentialed with as many carriers as you want to be able to provide services through. This includes Worker's Compensation, most large insurance carriers and Medicare. Whether you want to be credentialed through an individual carrier or one large network, the choice is yours.
Once your application is submitted, your medical billing partner will stay on top of your credentialing request and keep checking the status and make sure your application is handled in a timely manner. This will enable you to do what you do best- service your patients without the headaches of getting yourself credentialed and chasing your medical billing claims.
For help with performing the care plan oversight services if you are having a hard time with the 993xx series these steps should help to get you started.
Step one is to count these care services as 99374-99380. The 993xx series codes allows pediatricians to bill for coordination of care of special needs children without face to face visits. You can report these care plan oversight CPO codes as 99374-99380 for Doctor supervision. This is only for when the patient is not present for the following doctors services,
a) revision or development of care plans for multidisciplinary and complex modalities.
b) related lab and other studes review
c) patient status report reviews
d) assessment of care decisions by way of telephone calls and internet communication of healthcare professionals, family, primary caregivers and legal guardians.
e) new information assimilation into the medical treatment plan or medical therapy adjustment.
2. Code Set identification
The CPO codes facility supervision entities are going to be expanded in 2006, however these services may only be reported when the patient meets one of these three conditions:
a) the patient is under a home health agency care--99374 or 99375.
b) patient is on hospice--99377 or 99378.
c) patient is a nursing facility patient--99379 or 99380.
3. Make sure you have the Total Monthly Minutes for the Exact Code
CPO codes must be billed based on 30 minute segments. To document and perform 15-29 minutes of CPO services in a month, use the first code in each of the above sets which are: 99374, 99377, 99379). For services that are longer, 30 minutes or more, within a calendar month report the second set of codes 99375 and 99378.
When using 434.91 make sure you take all of the specifics into account. When a doctor says that a patient has had a stroke make sure that you know all of the details of the situation or else some procedures can be hard to justify and therefore your medical billing reimbursement may be denied.
In the past for diagnosis of a stroke the ICD-9 index listed 436, which is acute but ill defined cerebrovascular disease, as the code to use. Now the index has code 434.91 as the code to use. This is cerebral artery occlusion, unspecified with cerebral infarction. The new ICD-9 index automatically translates a doctors diagnosis of a cerebrovascular accident to an occlusion with an infarction.
This new listing is good news for you in that you might now get renumerated for services that were not covered in the past for patients of stroke. This is obviously good news and something that you will want to make sure that you are on top of.
Keep Documenting those Details
Consultant Sandy Nicholson with Pershing Yoakley & Associates in Atlanta, states that you should still make sure that physicians write down precise diagnoses. As of right now physicians can write down "stroke" without going into greater detail and you must discourage that. This means that you could be missing out on the diagnostic details that justify the procedures the doctor performed and therefore missing payment.
An example of this would be where the doctor doesn't note a cerebral hemorrhage with a stroke, which would understate the seriousness of the patient's condition. This is vital information for other providers so that they can realize how to treat the patient so not to kill him or her. Embolic strokes have 1/5 the death rate of hemorrhagic strokes and if there is nothing saying a patient has a hemorrhage and they are given coumadin or aspirin it could kill them.
The coder will use ICD-9 code 431 for Intracerebral hemorrhage if the doctor indicates that the patient has had a hemorrhage. There is a difference in what procedures Medicare will cover for differences in strokes. For a stroke without hemorrhage Medicare will not cover surgical or transcatheter interventions. So making sure that the diagnosis is specific and correct is very important.
Knowing when to use code 90782 in emergency department procedures can help with your medical billing reimbursements. For example, if a doctor examines a patient in the ED for an injury, and injects a preventative tetanus toxoid, your first instinct might be to use 90782 as a modifier for this procedure.
But you would not receive a medical billing reimbursement because the incident to provision does not apply in the emergency department so you would not be able to justify having the doctor administer this injection. There would be no way to justify the medical necessity of such a shot.
However, when you are in an office setting the CPT intructs that you are to select the name of the procedure and or service that ids as best possible the service that was performed. You want to make sure that you report as accurately as you can the service that was performed rather than just approximate it. The more accurate code here would be 90703 which is Tetanus toxoid absorbed for intramuscular use.
Medical Billing Hint: It is better to not append to modifier 51 for multiple procedures, to vaccine product codes or to the administration codes. If there is a significant separate service that the doctor performs you should report that separately. Also make sure that you remember to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code.
Are you ready for the updates coming on October 1? There are a number of changes that will affect that way Medicare reimburses your practice for the services rendered as well as adding and retiring other codings. All of these changes will be effective for service dates after October 1.
You can avoid a lot of paperwork hassles and denials by making the jump to outsourcing your medical billing. Your third party partner will keep up with the ICD-9 coding changes, rules and regulations and if you choose, can even do an audit of your current medical billing methods and show you how you can realize a better reimbursement rate on your services rendered. Many physicians are shocked to learn they've been basically giving away nearly 25% of their reimbursable income through faulty medical billing filing practices.
If you're ready to leave the paper chase behind and free your staff up to service patients instead of figure out what items on your medical billing got reimbursed, it's time to outsource your medical billing and you'll never have to sweat another CMS update again.
Knowing when to use code 90782 in emergency department procedures can help with your medical billing reimbursements. For example, if a doctor examines a patient in the ED for an injury, and injects a preventative tetanus toxoid, your first instinct might be to use 90782 as a modifier for this procedure.
But you would not receive a medical billing reimbursement because the incident to provision does not apply in the emergency department so you would not be able to justify having the doctor administer this injection. There would be no way to justify the medical necessity of such a shot.
However, when you are in an office setting the CPT instructs that you are to select the name of the procedure and or service that ids as best possible the service that was performed. You want to make sure that you report as accurately as you can the service that was performed rather than just approximate it. The more accurate code here would be 90703 which is Tetanus toxoid absorbed for intramuscular use.
Medical Billing Hint: It is better to not append to modifier 51 for multiple procedures, to vaccine product codes or to the administration codes. If there is a significant separate service that the doctor performs you should report that separately. Also make sure that you remember to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code.
Medical billing changes occur throughout each and every year and keeping up with those changes can be confusing. Aural Rehabilitation has become one major area of confusion since the 2006 update. The medical billing changes to Aural Rehab CPT codes has wrongly caused many people to believe Aural Rehabilitation is no longer a reimbursable service.
Medicare actually assigned status code "I" to all new medical billing codes for auditory rehabilitation. These codes are 92630 and 92633. This means that the Centers for Medicare and Medicaid Services will not pay for auditory rehabilitation, only diagnostic audiology. However, this is only true if an audiologist performs the service and the medical billing.
There are several other medical professionals that could possibly perform medical billing for aural rehabilitation. A speech language pathologist is one example of a provider who could get reimbursed by CMS for aural rehab.
It is important when reviewing new medical billing changes not to jump to any conclusions. If you did this, you could be missing out on money. For example, there may still be speech pathologists who perform aural rehabilitation, but don't perform medical billing for the service. Having a partner firm to help your staff review and alert you of any coming changes that will affect your reimbursements is invaluable.
Not to mention that hiring a medical billing firm to review new coding changes and to handle your claims will take a lot of the paper-chase and workload off your in-house office staff. Get a free consultation and find out exactly how much of your reimbursements you've been missing through handling your own medical billing, most practices are astounded to learn they are losing up to 25% of their revenue through unpaid claims that are simply filed incorrectly or procedures that could be billed separately.
As a medical biller, you may be seeing an increase in the number of gastric bypass claims that you are handling as more and more insurances are covering this procedure as a measure to remove the patient from danger of developing more serious, chronic and costly illnesses that can stem from being grossly obese.
After a patient has undergone gastric bypass surgery, eventually they will have the band removed. Many medical billing professionals are amiss at whether to include modifier 59 with their claim in order to obtain reimbursement for the procedure.
Under The Correct Coding Initiative (CCI), normally the procedure of removing the band and port removal would be bundled and reported using code (43774, Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric band and subcutaneous port components) to the gastric restriction (43644, Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy [roux limb 150 cm or less]).
The edit will already include a "1" modifier indicator, meaning you can append modifier 59 (Distinct procedural service) to report 43774 separately. But here is the hitch for this type of claim and the reason it is usually bundled, is because the surgeon would have to remove a previously placed adjustable band and port, if present, before performing the gastric bypass, which makes charging for the removal as a separate part of the procedure to put the band on when the gastric bypass was performed almost impossible.
The bottom line of this type of claims is that although Medicare and other carriers may pay for the initial procedure, they are normally going to expect the claim for removal of the gastric band to be a logical part of the procedure and in the majority of cases there will no separate reimbursement.
The Centers for Medicare and Medicaid Services have recently made it known that the reimbursement for procedural code 92696 is going to be increases by a rather large amount. To clarify a little bit further, the reimbursement to providers for such a procedure will come in at approximately four times the amount being received currently. This should make any of the providers of language, speech and hearing much happier when it comes to medical billing.
This entire thought of reimbursement may be a lot clearer if it is broken down a bit. For example, the code 92626 which is known for the description of Evaluation of Auditory Rehabilitation Status; first hour, is going to nearly quadruple in value. The old amount to be reimbursed was only $22.07, compared to the changes where the reimbursement amount is a whopping $81.76. The whole reason for the change in reimbursement is because there were previous errors in the calculations, which made the American Speech Language Hearing Association one of the main focal points.
Because of a certain decrease in malpractice costs, another medical billing code to be lowered is 92627 (each additional 15 minutes). The actual difference in the rate for this code is $22.07 down to $20.62.
As long as you are constantly aware that reimbursement rates along with all of the other medical billing policies are always changing, you should be able to remain one step ahead of the game. Being able to charge more for certain medical billing codes, such as 92626, will only be able to help out your practice in the long run, although many of the changes in medical billing reimbursement have been shown only to even out after an extended period of time.
A question that comes up often is exactly how should a medical practice dispose of the hard copies of files? The answer isn't rocket science, shredding is the only good answer. When you are ready to dispose of hard copies medical files, anything with a patient's name on it should be shredded.
If you don't have the staff available and you don't want to invest in an industrial-sized shredder, a good alternative would be to hire an outside shredding service that will either come to your offices and shred on site; or pick up your files, lock and store them in sealed containers and put them on a closed end truck that is locked. Many of these companies will ask you to sign off on both the containers as well as the truck before they leave to get your documents shredded.
It may seem like taking extra steps but it eliminates the horror stories that you may have heard about such as boxes of patient medical files falling off open pick up truck beds or boxes of files simply left by dumpsters. Many physicians are now requiring that outside services only shred the documents on site.
If you don't already have a shredding policy in your office, make sure to take the time to implement one and make every employee aware of it. You can further protect yourself by having your employees sign off that they understand the shredding policy and put that signed copy in their files.
This is another simple way to protect your practice from a simple mistake an employee could make regarding patient files. The more you educate your employees on good practices for keeping private information secure, the less likely your practice is to become a statistic for a patient privacy violation.
It can happen to any individual who is involved with coding, dealing with MUEs can end up being a nightmare if you do not know when and how to use them. MUEs, which is short for the term Medically Unlikely Edits, happen to be put in place to try and help limit the amount of billing errors. The more you understand them, the better off you will be when you find that you need to use them. If you are worried about dealing with MUEs, then you really should know that you are not alone. Luckily, there are a couple of things that you can look to and keep in mind to make sure that you use MUEs the right way every single time.
If you happen to be involved with a Medicare situation, you just might end up seeing that a case with MUEs. There is a chance that you can end up exceeding the MUE limit, which can then lead to the unfortunate ending of denial. As any practice knows first hand, a denial of a medical claim is one of the very last things that you will want to deal with. This is why it is so important that you never try to guess because it can lead to quite a nightmare of gross billing errors.
Take the time to look over all of the medical documentation that you have. Then you can look forward and begin to report the number of units, being careful not to exceed the limit and reap the benefits of tightening up your medical billing claims!
No one likes the word "audit" but sometimes it can help your practice. When it's coming from the IRS or other authority office, an audit can be a major stressor; when you enlist the services of a third party partner to do an audit on the way your medical billing is filed - there are no penalties - only pluses!
An internal audit of the way your medical coding and billing is handled can alert you to problems you may not have even been aware existed. Staff members can be adverse to change and continue using coding combinations that do not result in the maximum reimbursement for your services.
When you're not receiving the monies due for the procedures that are done for your patients, this method of filing your medical billing claims is actually costing you money. An internal audit can point out this omissions and help you get everyone on the same page for the filing of your medical billing claims.
If a large number of discrepancies in your medical billing are found, you may want to consider outsourcing your medical billing claims to your third party partner to allow them to be properly coded and billed with the correct combinations of codings and modifiers that will result in the maximum reimbursements for your medical billing claims every time. Most practices report increases of up to 25% of their reimbursable income within the first few months of switching to outsourcing their medical billing claims and a rejection rate of around 1% as opposed to greater numbers of rejected medical billing claims by practices that still file inhouse.
Outsourcing a Dirty Word toYou?
