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

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.

Labels: claims, consulting, denials, medical-billing, medical-coding, medical-data, outsourcing

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.

Labels: claims, consulting, medical-billing, medical-coding, medical-data, modifiers, outsourcing