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!

Labels: audit, consulting, denials, hipaa, injections, mastectomy, medical-billing, medical-coding, medical-data, modifier-51, modifiers, nurses, outsourcing, paper-trail, physician-credentialing, security

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.

Labels: audit, claims, consulting, denials, medical-billing, medical-coding, modifier-51, modifiers, outsourcing, physician-credentialing

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.

Labels: audit, claims, consulting, denials, medical-billing, medical-coding

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.

You may view this report online https://www.cms.hhs.gov/apps/er_report/preview_er_report.asp?from=public&which=long&reportID=7.

Labels: audit, claims, medical-billing, medical-coding, outsourcing

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.

Labels: audit, claims, medical-billing, medical-coding, medical-data, outsourcing

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.

Labels: audit,