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.
Since consultation requirements have increased in the last year as far as criteria for getting them reimbursed in your medical billing claims, there are some criteria you must be certain that your claims meet in order to justify using codes 99241-99255.
It used to be simple and medical billing consultant merely had to meet the three "R's" in order to justify medical billing claims for consultations. However the criteria for what does and does not constitute a consultation has changed and in order to make sure that your medical billing claims are paid, you need to reacquaint yourself with the three R's of medical billing for consultations.
The three R's are (1) Request for opinion; (2)Rendering of services; and (3) Report to the requesting source. The first big change in late 2006 applied to the qualifying requesters. The new CMS guidelines that were issued now require that a physician make the request. It's easy to meet this requirement by simply getting a written request; but that's not all. CMS officials still insist that the requesting physician has to document the request for a consult. The only change is that the consultant doesn’t have to verify that the initiating doctor has done so.
If you don't have the medical documentation to back up the consultation, chances are good your claim won't be reimbursed or at the very best only partially so. The best advice you can follow is to let your documentation guide your medical billing and coding. If you can't meet the three R's criteria prior to billing, attempt to get the proper documentation to do so, it will mean a little extra leg work, but the practice will reap the rewards in the form of accepted medical billing and reimbursements.
The injectable contract agent named Perflutren better known as Definity has caused a lot of confusion as many providers are billing the incorrect code and Medicare and most other large payors switched the code for this service in late 2005 and 2 years later it's still showing up on medical billing and causing numerous delays and rejections on medical billing reimbursements. If you’re a service provider that is still billing A9700, you could face delays in getting paid--or even denials on your medical billing claims.
If the carrier approves the main echocardiography procedure, then it will usually approve the use of Definity as contrast. If you are not sure of the current policies of the carrier that is being billed, put all doubt to the side and verify directly with the carrier that parts of the procedure will be covered and additionally what code they are approving for the use of Definity.
Make sure your medical billing documentation outlines the reason and necessity for the use of Definity and it's a good idea to show the steps leading up to the use of the contrast agent to show how the need was established.
Sending a doctor's letter is another way to establish the necessity of the procedure and try to show the need for coverage of the procedure. This will up your chances of reimbursement for the service.
When a wound needs closing and a tissue adhesive is used the medical billing coding can be different than when sutures or stitches are used.
There are specific guidelines for medical billing when tissue adhesives are used. All adhesives including Dermabond have their own unique way of being reported on medical billing. Consult with Medicare or the carrier to ensure that you are meeting those guidelines prior to submitting your medical billing.
There are five basic guidelines that Medicare requires in order to reimburse for this service and many carriers follow the same criteria for laceration closures utilizing Dermabond. You should report G0168 for Medicare patients only; the CPT code equivalent to G0168 is the 12001-12018 series (Simple repair of superficial wounds ...)is the equivalent to the G series used in Medicare billing. You can report G0168 for Dermabond-only laceration repairs in both the inpatient and outpatient settings
If the physician uses sutures or staples with Dermabond to perform a laceration repair, you can report only the layered laceration repair code based on the length and site of the wound, and you should not use G0168. Additionally, you should not report G0168 when the provider uses tissue adhesive strips for simple laceration repairs.
Here is a tip regarding reimbursements, Medicare assigns a payment status indicator of "N" to G0168, meaning it represents an incidental service. You can report the code, but you won't receive any reimbursement for it from Medicare payers.
Will inaccurate activities of daily living scores hurt you? 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 at your facility to the other agencies in your state and 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 it's fair to assume that your building is probably downcoding ADLs and you're missing out on reimbursements.
It's a fine line and you need to check your facilities ADL scores on a regular basis or you could be billing incorrectly. That’s important to do because “if you accidentally upcode where the person goes into a higher paying RUG, you can get in trouble and owe Medicare (or Medicaid) money. Frequent checking will help you avoid this issue.
Check your records on a regular basis and ensure you both coding correctly and getting maximum reimbursements for your services to patients.
TB is in the news more and more and if you aren't already seeing an increase in TB screenings, it's likely your practice could experience it in the future. If you have a medical billing claim involving a patient that is at an increased risk for tuberculosis (TB) infection or is already having symptoms, a TB screening can be performed. If your practice runs these tests, be aware that in many cases, you can get reimbursed for the test as a medical necessity.
When processing the medical billing for a TB skin test (86580) or blood test (86480) due to pulmonary TB symptoms or known TB exposure or risk. The ordering diagnosis should be V74.1 (Special screening examination for bacterial and spirochetal diseases; pulmonary tuberculosis),and be sure to back up the need for the additional test with ironclad documentation.
If you can show the medical necessity for the procedure and the history of the patient leading up to the reason for the test, you should be able to get reimbursed for any additional testing as a necessary procedure as part of the whole care for the patient. If you're tired of keeping up with the changes in the medical billing industry that directly affect the reimbursements your practice is getting, it may be time to consider outsourcing your medical billing claims to a professional company that get you the maximum reimbursements as quickly as possible. Look into outsourcing today and reap the rewards.
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.
Due to high usage and informational usage by the medical billing community at large, the Medicare website has revamped certain areas to make their site easier to search and access. When a medical biller is looking up information, at the Medicare coverage site located at www.cms.hhs.gov/mcd/search.asp, it is now easier than ever to search for the coverage limitations and other required information that you need.
The page is now set up to ask if the biller is asking for a local or national coverage determination to avoid confusion and misinformation that was previously disseminated as there are certain differences between local and national coverages for certain procedures.
Medical billers may also now search under geographic area, keyword, ICD-9 code, CPT/HCPCS code, coverage topic, and effective dates. After you've typed in your criteria, click "search now" and wait for the results to pop up.
This will make it much easier to find out what you need to meet your Medicare criteria to get the maximum reimbursements for procedures done and also if a procedure isn't fully covered, find out what components are indeed covered so that the medical billing superbill can reflect that and ensure that the physician receives the best possible reimbursements for procedures and services rendered.
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 you would want to report 24600 (Treatment of closed elbow dislocation; without anesthesia) for the elbow reduction. Then attach ICD-9 code 832.03 (Dislocation of elbow; closed; medial dislocation of elbow) to show the reason for the reduction) and then add the modifier 52 (Reduced services) to 24600 to show that you are not reporting a fully successful reduction.
Some physicians may choose not to bill at all for a painful procedure that isn't successful however do include the medical necessity and documentation of the procedure to show the reason for another or more expensive procedure.
Cover yourself and make sure all your medical billing claims are thoroughly documented, this will result in better reimbursements and airtight claims from your practice.
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.
If you work in the mental health area, you can expect there to be a coming clarification on how HIPAA and FERPA should be interpreted along with a other state and federal privacy laws dealing mostly with situations concerning mental health workers when dealing with patients in conjunction with educations and law enforcement. This change is largely in part to the misinterpretations of privacy laws that were contributed to the Virginia Tech shootings earlier this spring, however it was not attributed to the laws themselves, concluded federal officials in a report to the President.
The report was a compilation of data that was put together by several different agencies including The Department of Health and Human Services, the Department of Education, and the Department of Justice that all made the report after interviewing mental health professionals, educators, and law enforcement officials around the country. In part the report states, “Critical information sharing faces substantial obstacles, education officials, health care providers, law enforcement personnel, and others are not fully informed about when they can share critical information on persons who are likely to be a danger to self or others, and the resulting confusion may chill legitimate information sharing.”
In particular, the report addressed how three bodies of law influenced the actions of people who taught and treated Seung Hui Cho in the months before the shootings: 1) the Health Insurance Portability and Accountability Act (HIPAA), 2) the Family Educational Rights and Privacy Act (Ferpa), and 3) state laws and regs. The report noted that many state laws and regs are restrict information sharing more rigorously than federal laws. Mental health professionals routinely consider these laws when deciding whether to share information in order to protect a patient or those he might harm.
The problem that presented was this : “In some sessions, there were concerns and confusion about the potential liability of teachers, administrators, or institutions that could arise from sharing information, or not sharing information, under privacy laws, as well as laws designed to protect individuals from discrimination on the basis of mental illness.” But it was confusion about the laws, and not the laws themselves, that create the “information silos” that mental health professionals and educators sometimes create, the report argues.
Through this report a solution to help prevent tragic situations such as this was found. The report recommends the development of tools that help providers and educators assess the safety risk and identify instances where protection trumps privacy. Educators, law enforcement officials, and mental health professionals at Virginia Tech could have taken these actions before the shootings without breaking any laws.
Sometimes after a gastric band procedure, the band may slip during healing and need to be adjusted. The uncertain thing is how to bill the procedure since you have already billed the global.
HCPCS temporary code S2083 (Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline) or CPT code 43771 but both of these require that the physician use a laparoscope during the procedure and usually moving the band is done through injecting saline or removing saline from the band to make it easier to adjust through a subQ port.
For most instances you can use S2083, normally you will only use 43771 if patient is taken back into surgery due to complications in the moving of the band such as a prolapse or other issue. If a flouro is used in the procedure, code 77002 may be more fitting for your medical billing and another alternative that may be a better fit, depending on the situation, is 90779 (Unlisted Therapeutic, prophylactic or diagnostic intravenous or intra-arterial injection...) which was one of the range added to the CPT in late 2006.
The key is obviously find the best fit for your procedure and back it up with the strongest documentation you can, especially since there isn't a specific code for this procedure at this time.
A little known fact about well-woman care is that in many cases, you can break out the breast exam and pap smear and realize a reimbursement for both procedures if the patient is covered by Medicare.
If the physician provides a complete well-woman exam for a Medicare patient, you should report G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination) for the breast and pelvic exams. When the physician also obtains a Pap smear, use Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory)and this will enable your practice to realize a reimbursement for both services.
Just make sure that you have the necessary medical necessity and documentation to back up the breaking out of both services and in most cases you must attach modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service). An important thing to remember, for Medicare patients at normal risk, you can report a Pap smear only once every two years. The diagnoses your physician will use in these cases include V72.31 (Routine gynecological examination), V76.2 (Special screening for malignant neoplasms; cervix) and V76.47 (... other sites; vagina),
Using these techniques, you should be able to increase your Medicare coverage of this common service to your medical billing claims and see a better reimbursement when you perform this service.
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.
Your provider number has a strong impact on your medical billing cost to charge ratio (CCR). If your hospital is merging with another hospital, it is important to figure in the possibly new Cost to Charge Ratio medical billing payments you will receive.
There are two avenues merging hospitals can take. The first method is when two hospitals merge together while one of the existing provider numbers is kept in tact. In this instance, one hospital keeps their medical billing number, while the other one drops theirs and joins the first. The hospital that drops their medical billing provider number will receive a new cost to charge ratio. The ratio will be figured from the hospital with the existing provider number.
The second scenario involves a brand new medical billing provider number for the merging hospitals. When each hospital forfeits their provider number, a new provider number is formed. In this instance, there is no prior history to conduct a cost to charge ratio study. Instead, the merging hospitals will use the statewide average medical billing Cost to Charge Ratio until they have history.
If the Cost to Charge Ratio assigned to your hospital is unsatisfactory to your liking, you can request a lower or a higher number. However, there must be substantial evidence to back up your claim. Medical billing cost to charge ratios are difficult to change because they need to be fair to all hospitals involved.
The bottom line is: make sure your hospital is ready for medical billing reimbursement changes if you are merging with another facility. The failure to prepare for such changes could severely impede your financial and medical billing departments for a long time to come. Once your revenue flow is slowed down it can take a long amount of time to recover.
It's a valid concern. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) has had a major impact on health care providers who do business electronically as well as many of their health care business partners. Many changes involve complex computer system modifications.
HIPAA compliance requirements have been standardized into 4 main aspects.
1) Electronic transactions and code sets 2) Security; 3) Unique identifiers; and 4) Privacy
One common misunderstanding is that you are required to only report electronically to be HIPAA compliant; however that isn't accurate. HIPAA does not require a health care provider to conduct all transactions and medical billing electronically. Rather, HIPAA dictates that if you are going to conduct any one of these business transactions electronically they will need to be done in the standard secure format outlined under HIPAA. So in a nutshell, you're not required to submit your medical billing claims electronically, however you must be HIPAA compliant if you do.
That's one of the main questions to ask when you're looking for a medical billing partner. First ask if they do electronic billing, then ask if their billing methods are absolutely HIPAA compliant. If you get a long pause or the rep doesn't seem sure exactly what you're asking, keep shopping. Another qualifying question can be to ask about the submissions process from start to finish and, that can be a big clue as to whether the medical billing company has secure transmissions.
Remember, when you're looking for medical billing partner, the best fit for your company may not be located near your practice. If you're using secure data transmissions, it opens the field for you to use any medical billing company you choose, as long as they meet your criteria for HIPAA compliance and other issues such as claims follow up and the handling of denials and rejections, on the rare occasions they will occur once you switch to outsourcing your medical billing.
It's expensive to keep up with the technology required to be HIPAA compliant in your billing and it's also difficult for your staff to keep up with the never ending changes in the CPT. If you are finding your staff is spending more time chasing claims then helping service patients, it may be time to give outsourcing your medical billing a long, serious look.
Just when you got a handle of medical billing, another policy throws a curve ball at you. In some instances, the same CPT code is used for two different procedures. An example of this is when performing both and extra digit removal and a skin tag removal. The same medical billing CPT code, 11200, would be used in both of these instances.
The medical billing code 11200 means, removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions. This means that if an individual needs an extra digit AND a skin tag removed, than you would use 11200 to report both.
To let the payers know the reasons, you would report two separate medical billing ICD-9 codes. For instance, you could use 757-759 (congenital anomalies), for the extra digit. Then you would use a medical billing code such as 757.39 (other specified anomalies of skin) to report the skin tags. This way, the payer will know that there were two different procedures performed.
One thing to keep in mind when doing medical billing for 11200, is that it can only be billed once per instance. The code actually describes removal of up to 15 different lesions during the same session. This is why it is so important to report the correct diagnosis codes when doing medical billing. They payer will have no idea how many lesions your remove if the codes are not reported.
Make sure all your staff are aware of the correct medical billing policies that could affect your practice. If you are a radiology facility, make sure you staff are up to date on all radiological procedures. Although it would be difficult to keep current with all medical billing policies, staying as current as possible is extremely beneficial.
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.
In 2006 several changes were made to the CPT regarding skin graft procedures and this included the retiring of several codes and the addition of 37 new skin graft codes to make identifying the procedures more exact for medical billing claims. The skin graft section was also renamed to Skin Replacement Surgery and Skin Substitutes.
There are new codes for autografts, sections 15100 through 15261, allografts, sections 15170 through 15176 and xenografts, sections 15400 through 15431. These codes seem to have been created in order to represent some new procedures and techniques. Many of these new codes are also specific to a particular technology or product make sure that your medical billing claims reflect these codes or you may be missing a substantial amount of reimbursements for procedures done.
It seems that there has been a lot of struggle for payment to be received for some of the expensive and specialized products. This is especially true if a general skin graft code was used, observed John Bishop who is President of Bishop & Associates in Tampa FL. The products that are usually harder to receive payment for are Integra, Appligraft, Biobrane and Dermagraft.
Bishop states that paying attention to the amount and the composition of the synthetic product you are using is key. Many of the new codes cover the initial 100 cm and then have additional codes for more product used. Make sure that your staff is using the most updated codings to reflect services rendered and you should be able to receive better reimbursements instead of denials and delays for your skin graft claims.
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.
When do I use medical billing modifier 59? This is a great question. It is one that many don't ask, but most don't know the correct answer to. One of the most important things to know about the medical billing modifier 59 is which code on which to append it. There are some basic medical billing rules that can teach you which code to use with modifier 59.
The general assumption about modifier 59 (Distinct procedural service) is that it should be linked to the lower-valued code of the pair. Although this may be true a lot of times, it is not always true. There is a much better rule to follow to have correct medical billing documents.
The better rule to use with the medical billing modifier 59 is to append it with the component code, or the code in column two. The NCCI (National Correct Coding Initiative) code list consists of different edits with two types of codes. The edits have columns. One column is the comprehensive column, and column two is the medical billing component column. If on the same day, you report from both columns, the Centers for Medicare and Medicaid Services will only reimburse for the first column.
The medical billing modifier 59 should be used if you bill from both columns on one date of service. You should always append the modifier to the code in the second column. This will ensure correct medical billing reimbursement. Many times this is the lower valued code, but not always - as always with medical billing, it's usually a judgment call based on other factors in the medical billing claim.
Coding for tissue adhesives can be confusing because there isn't one set procedure for this. The coding that is used is determined by the type of wound and the severity of the repair when tissue adhesives are used for wound closures.
The answer to this question will be different depending on which entity is paying the medical billing claim. When you code for the use of tissue adhesives, including Dermabond; Medicare has its own guidelines for reporting this procedure that you need to follow to be reimbursed. You should report G0168 for Medicare patients only. If you are reporting the procedure for a non-Medicare patient, you should use the CPT code that is the equivalent and that is 12001-12018 series (Simple repair of superficial wounds ...).
Another tip for reporting this claim to Medicare is you may only use G0168 for Dermabond-only laceration repairs in both the inpatient and outpatient settings. If sutures or staples were also used you will have to report this as a layered laceration code on your medical billing form.
Something you may not be aware of is that Medicare assigns a payment status indicator of "N" to G0168, meaning it represents an incidental service. You can report the code but you won't receive any reimbursement for it from Medicare payers.
Private payers will have different guidelines, a quick check with the payers to see if they follow Medicare guidelines for this type of procedure will let you know whether or not to expect a reimbursement for the service.
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.
Did you know that you can actually bill separate tests performed from your practice for separate payments? Certain practices have been taking advantage of larger reimbursements by doing just that. Say that you have a patient that is new to your practice and they are coming in for an exam. You can both bill for that exam and then bill separate for any other tests or screenings that they will be having performed.
Although you may feel as though you are doing something wrong when it comes to medical billing practices such as these. However, the important Centers for Medicare and Medicaid services have been doing a good amount of research in this area. In turn, they will be sending out a wealth of information to be able to explain separate billing procedures for the hopes of better reimbursements down the road. This will help all medical practices learn a few new tricks when it comes to setting up their medical billing.
If you would like another example, if you have a patient who will be coming in for a check up and they will then be scheduled for diabetes testing, this can be billed separately. This can even be done if the patient seems to have been at prior risk for diabetes.
This is a great way to recoup losses you may have previously suffered by bundling separate testing claims. Separate out your services whenever possible and get the reimbursement you deserve for your patient services.
More and more carriers are cracking down on medical billing claims that have a lack of or incorrect place of service code. Even with the correct current procedural terminology code for E/M services, a medical billing claim that does not have a correct POS code will get your claim denied.
It is a common occurrence in medical billing for the place of service codes to be misused or left out. 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 places 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. It is POS 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 eliminate this problem. When you partner with a medical billing company, your claims are checked to make sure the correct billing procedures are used for every medical service performed and they check claims for accuracy before they are submitted. You will see your denial rate drop off and your reimbursements will arrive faster than ever before. Make sure you're maximizing your reimbursements with the correct POS codes.
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.
"Chronic pain syndrome" can be considered as a vague description of a vague diagnosis by your carrier and unless you back up your medical billing with the reasons for using this catchall term for several pain conditions, you may be seeing only partial reimbursements to denials for this condition. Traditionally, ICD-9 directs you to code 338.4 (Chronic pain syndrome) for the condition.
However, you may need to couple this diagnosis with other probable causes backed up by symptoms and doctor's notes. Other diagnosis possibilities for chronic pain syndrome include fibromyalgia/muscular pain (729.1, Myalgia and myositis, unspecified); reflex sympathetic dystrophy/regional pain syndrome (337.2x, Reflex sympathetic dystrophy) or peripheral neuropathy (337.0, Idiopathic peripheral autonomic neuropathy) caused by either diabetes (250.6x, Diabetes with neurological manifestations) or amyloidosis (277.30, Amyloidosis, unspecified). Among the listed alternatives for 338.4, coders choose 729.1 most commonly as a substitute for the generic chronic pain syndrome diagnosis code.
The best route to getting a better reimbursement on a vague diagnosis is to check with your physician to clarify what type of pain the patient has. The patient might initially report pain "everywhere" but he may be able to pinpoint his worst pain sites, such as the lower back (724.2, Lumbago) or the hip (719.45, Pain in joint; pelvic region and thigh).
Also it's a good practice to verify any of the patient's pain-related symptoms before reporting the physician's final diagnosis. Good examples of those would be back muscle spasms (724.8, Other symptoms referable to back) or derangement of joint (718.95, Unspecified derangement of joint; pelvic region and thigh).
When in doubt, ask the attending physician which diagnosis in their opinion best suits the claim. Using the notes can help you also pin it down and if you show that you have a vague claim that needs more exacting information to get a better reimbursement for the practice, putting the need for exact information in dollars and cents is usually a good way to get the proper information you need to process the claim for the best return on services for the physician.
Make sure that you and your staff are up to date on using Q Modifiers as these were updated in 2007. Make sure you are getting the best reimbursements by using the currently preferred modifiers to be reported when the physician is performing foot care.
Modifiers Q7 (One class A finding), Q8 (Two class B findings) or Q9 (One class B and two class C findings) tell insurers why your physician is performing foot care. To determine which modifier applies to your physician's claim, check out the following list of what Medicare and other payers include in each description:
Class A Finding: Nontraumatic amputation of foot or integral skeletal portion thereof
Class B Findings: Absent posterior tibial pulse
Advanced trophic changes such as (three of the following sub-categories qualify as one class finding): hair growth (decrease or absence), nail changes (thickening), pigmentary changes (discoloration), skin texture (thin, shiny), skin color (rubor or redness)
Class C Findings: Claudication
Temperature changes (e.g., cold feet) Edema Paresthesias (abnormal spontaneous sensations in the feet, e.g., numbness, prickling, or tingling) Burning
For proper use, be sure to place the Q modifiers to indicate class findings before modifiers LT (Left side) and RT (Right side). Additionally, not all carriers will require it but it is a good idea to include detailed documentation about the necessity of the foot care and tie in the use of the Q modifier.
Pediatrics is one of the most complex areas of medical billing. It has many medical billing codes that were created just for the use of describing procedures. However, there are other areas of medical billing that do not have these specific codes for children. This can make coding hit or miss unless you know the nuances of what the carrier wants in order to get the maximum reimbursements for procedures performed. A common dilemma is with CPT code 99293 and its use for outpatient emergency room exams for an infant or if code 99291 should be used.
The medical billing code 99291 means critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes. You would use this code if a patient came into the emergency room and was there for a half and hour up to 74 minutes. This is pretty straight forward in medical billing. The confusion comes in when using code 99293. This means Initial inpatient pediatric care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age. This code should only be used if the infant is admitted inpatient.
When doing medical billing it becomes confusing because there is no code specifically for outpatient emergency room visits for children. There is only a child specific medical billing code for inpatient visits. A simple rule of thumb in medical billing is that the location of service must match the CPT code. This is because inpatient evaluations get reimbursed at different levels then outpatient emergency room visits.
If your staff is getting overwhelmed at the paperchase of keeping up with the current codes or you're experiencing denials or partial payments of your medical billing claims; it may be time to consider outsourcing your medical billing to a partner that can make sure the latest coding regulations are followed and your practice receives the maximum reimbursements allowed for procedures performed.
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!
There have been questions regarding the use of carotid Doppler (93880) being performed on the same day as venous Doppler (93965, 93970, 93971); some insurance companies do not want to reimburse both procedures as it is unusual to perform both with one service period.
National Correct Coding Initiative edits don't prevent you from reporting these codes together, but the payer may be questioning the medical necessity of performing both services on the same day. Doctors don't usually order both of these exams for the same patient on the same date of service. If there was a reason and you can show hard documentation as to the necessity of having both procedures performed on the patient on the same day, then you can document the need for the request and show circumstances that required both procedures be performed.
The medical billing industry is non-stop unusual situations for coding and constant judgment calls are necessary. When you have an unusual situation arise with the services rendered to a patient - a good rule of thumb is to show all the documentation you can to show the request was necessary and when in doubt - contact the payer directly and document who you talk to if you were told to file your claim in a specific manner.
If you are tired of chasing the never ending updates and edits to the fast paced world of medical billing, you're most likely not being fully reimbursed for the services you perform either. It might be time to consider outsourcing your medical billing claims to a partner that will keep up with the changes, advise your office of any coming changes that will affect your practice as well as get you the best reimbursements for the services rendered to patients.
No one has to tell you that the world of pediatric medicine is fast paced and along with unpredictable kids come unpredictable medical billing situations. If you process medical billing for pediatric physicians, you may or may not have run across a situation for determining what diagnoses would apply when parents come in to discuss their child's health issues.
If you're wondering if there is a single code, the answer is yes. A parent conference falls under V65.19 (Other persons seeking consultation; other person consulting on behalf of another person). In other words, the code describes a person seeking "advice or treatment for non-attending third party." Since a parent has the right to discuss the treatment and medical issues for their minor child it's permissible to bill for the consultation.
The counseling diagnosis code can be used when the patient is present or when counseling the parent/guardian(s) when the patient is not physically present as in over the telephone. Although carriers may require supporting documentation for coverage of the encounter, so make sure you indicate the discussion's topic and the documentation should be signed off on by the attending physician. In case of an as yet undiagnosed concern, you can also check if payers want a secondary diagnosis that indicates the topic.
There are numerous reasons for consultations that include these top four common reasons: * ADD/ADHD -- 314.00, Attention deficit disorder; without mention of hyperactivity; 314.01, Attention deficit disorder; with hyperactivity * anxiety -- e.g., 300.00, Anxiety state, unspecified * depression -- e.g., 311, Depressive disorder, not elsewhere classified * obesity -- 278.00, Obesity, unspecified.
Use the total face-to-face time that the pediatrician spends with the parents to select the service code. Careful supporting documentation of the time elements is critical and will result in reimbursement for your medical billing claim.
Patient history, or PHI is an aspect of medical billing that has a myth attached. Contrary to popular belief, it is safe practice to allow any permanent office member to take the review of systems and the family social history.
These two evaluation and management history elements can actually be taken by absolutely anyone that is employed by the practice. It is ok in medical billing for even a parent or a secretary to take down this information as long as the information is reviewed and signed off on by the acting pediatrician.
The only part of an evaluation and management visit that the physician or nurse practitioner must complete for medical billing purposes is the history of present illness or the reason for the visit. By allowing your administrative staff to complete some of the patient documentation, a practice can save time and money as it frees up the pediatricians and nurse practitioners to have more time for the actual servicing of the patients.
Another great way to save your practice time and money is to outsource your medical billing. Your medical billing partner will make sure your pediatric practice gets the maximum return and if you're not using a medical billing company, you could be losing almost 30% of your medical billing revenue by simply not knowing how to get the maximum reimbursements that your practice is allowed for services rendered and general errors that occur when practices file their own claims.
Confused about multi-day observations? Well, you're not along. Multi-day observation medical billing claims can cause a lot of confusion. In order to get the correct reimbursements on your medical billing claims, you need to be sure that your multi-day observation billings are reported correctly - otherwise you're practice isn't receiving the maximum reimbursements for the services rendered and you're in effect - losing money.
A main rule of thumb when doing medical billing for multi-day observation is to report per day of service. This means that if a patient is admitted late at night and isn't discharged until the next morning, you report both service dates. The two current procedural terminology codes to use would be 99218-99220 for the initial observation evaluation. The other code you should use is 99217 (observation care discharge day management).
A common medical billing mistake that is made is to bill code 99234-99236 instead. This is incorrect because it means "observation or inpatient hospital care". These medical billing codes includes the initial visit and the discharge costs. Reimbursement would be unfairly less then the services provided.
When using CPT code 99217 it is necessary to provide the necessary documentation to prove medical necessity. Documentation of an initial examination, hospital discussion with the patient, continued care instructions, and discharge preparation of records is required to validate the medical billing of the two CPT codes together. When billing Medicare for observation medical services you must know their rules. In order to report same day observation codes, the patient must be in the hospital for at least eight hours. Anything less does not warrant separate reimbursement. Usually private insurance payers are not this strict.
However, the best way is to record and submit the initial evaluation time and discharge time for medical billing purposes, this will ensure that you have your medical documentation right and the carrier should not have an issue reimbursing your practice for these services.
With all of the various codes that make up medical coding, it can be confusing when you're separating out closely related codes to find the best fit for your medical billing claim. One situation is when it comes to figuring out the difference between both personal and family history V codes. Basically, what you need to remember is that the V codes are there to help give a window into past patient history. If there is an ongoing medical condition, the V codes can be used to tell the tale.
When looking into personal history, you can find out more about any prior procedures, hospitalizations and operations, as well as any previous illnesses and injuries that the patient has endured. This can help to show the physician to easily see that there may have been occurrences in the past that could have an effect on the current diagnosis. Such codes can help to make diagnosis much quicker and easier for all of those involved.
As far as family history goes, these codes are made to help to report any possible problems that may run within their family that can attribute to their current illness or symptoms. These codes may tell whether or not certain family members have died due to certain illnesses or diseases as well as tell the physician if there seems to be anything that the patient may be at risk of contracting later on in life. When it comes to these codes, it is easy to see just how valuable they can be when it comes to being able to pinpoint certain problems while being able to rule out others that are not relevant to the patient's family history.
It's hard to let go of what you might deem the financial control of your practice. Hiring a medical billing consultant can seem like you're adding expenses instead of cutting them down, especially if you have never outsourced your billing. If you've always discounted outsourcing your medical billing claims because you feel as though you would be relinquishing control over your billing, read on - you'll find that is not the case.
Actually outsourcing your medical billing and coding needs through a consultant is one of the smartest business moves you can make. Don't think you have to use a local company, many medical billing firms have branch offices in an area near you, but others may be miles to hundreds of miles away, and thanks to the power of the internet with secure connections and software advances that allow you to transfer your patient billing records while upholding the utmost in privacy standards, with just a click of your mouse, makes the job of shopping for a medical billing consultant to hand the billing paperwork for your busy practice all the easier.
Your staff won't have to spend long hours at the copy machine when you outsource, most records can be transferred via computer to computer using secure, encrypted technology. Many medical billing consultants offer real time updates of patient accounts, so if information is needed on where a particular claim stands, your staff can click and see!
Outsourcing to a medical billing consultant will insure that your claims are coded and submitted properly because that's their business! There are no interruptions, patients asking questions, and general day to day running of your practice. A medical billing consultant can devote 100% of their time to handling your coding and claims. That way your cash flow is steady and your practice will grow!
Time is money in your practice and if you outsource your medical billing through a consultant you are definitely making the most of your time and because of your smart choices, you'll see an increase in your revenue flow for your practice.
If you're wondering how your medical billing gets to the outsourcing company, the answer is carefully and securely. The patients are seen as usual in your office, your staff creates the records for billing just as they always did. If you are still using paper files your claims will need to be scanned and hand entered into the medical billing system, if you transmit electronically your staff will need to only access the program and transmit the chosen claims to be processed by the medical billing company.
The data will transmitted to the medical billing company who will code and double check your medical billing claims to insure they are error free and then transmit them either directly to the carrier or to a clearinghouse. A clearinghouse is just a another check and balance in the system of medical billing. Your claims are formatted in a standard way so they can be transmitted to the various carriers. Once received, the carriers will normally send back a verification of receipt for the electronic claim filing, and then you can begin the countdown until your medical billing claim is reimbursed and you have a check in your office. Normal time until reimbursement is about 2 weeks and in some cases even less.
The simple act of outsourcing your medical billing claims will free up your staff to do so much more within your practice. If they are free from entering, checking and double checking and following up on claims, they can do what they do best - service your patients and help you practice grow and thrive. If there are problems or issues with a particular medical billing claim, your medical billing partner will handle any denials or partial payments.
Since consultation requirements have increased in the last year as far as criteria for getting them reimbursed in your medical billing claims, there are some criteria you must be certain that your claims meet in order to justify using codes 99241-99255.
It used to be simple and medical billing consultant merely had to meet the three "R's" in order to justify medical billing claims for consultations. However the criteria for what does and does not constitute a consultation has changed and in order to make sure that your medical billing claims are paid, you need to reacquaint yourself with the three R's of medical billing for consultations.
The three R's are (1) Request for opinion; (2)Rendering of services; and (3) Report to the requesting source. The first big change in late 2006 applied to the qualifying requesters. The new CMS guidelines that were issued now require that a physician make the request. It's easy to meet this requirement by simply getting a written request; but that's not all. CMS officials still insist that the requesting physician has to document the request for a consult. The only change is that the consultant doesn't have to verify that the initiating doctor has done so.
If you don't have the medical documentation to back up the consultation, chances are good your claim won't be reimbursed or at the very best only partially so. The best advice you can follow is to let your documentation guide your medical billing and coding. If you can't meet the three R's criteria prior to billing, attempt to get the proper documentation to do so, it will mean a little extra leg work, but the practice will reap the rewards in the form of accepted medical billing and reimbursements.
Outsourcing a Dirty Word toYou?
