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

As more research is done regarding the relationship between varicose veins, blood clots and other complications; more and more patients are having the simple surgery and as a result there has been confusion about exactly how to code this procedure to get the fairest reimbursement for this service. Once you know the basics for setting it up - it's easy!

A good example would be if a patient with varicose veins in her left lower leg presents to the ED and is stating she has severe pain in her leg. One of the veins is clearly bleeding so the doctor will use a standard suture ligation to stem the bleeding and winds up removing one of the veins in the procedure. Suture ligation isn't an uncommon way to treat a bleeding varicose vein, however there is currently no specific CPT code for it. The answer? Break it down!

A good way to report this on your medical billing would be to use code 37785 (Ligation, division and/or excision of varicose vein cluster[s], one leg) for the ligation. Be sure to attach ICD-9 code 454.8 (Varicose veins of lower extremities; with other complications) to 37785 to prove medical necessity for the procedure. You should be aware that 37785 has high RVUs and may be considered by some carriers to be more indepth of a procedure than was actually performed. A good rule of thumb would be to verify directly with the specific carrier that you are reporting to and make sure they will cover the procedure as such. If they won't a good alternative reporting method on the medical billing would be to report 12002 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities which includes hands and feet]; 2.6 cm to 7.5 cm) for the repair and attach ICD-9 code 454.8 to 12002 to prove medical necessity for the procedure.

Include all your documentation and be as detailed as possible, especially in the case of not being certain what the carrier will cover - simply ask and document the time, date and full name of whoever you speak with - this will insure all bases on your claim are covered.

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

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

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 u