In Texas, a Bastrop physician and an Austin doctor were among the over 60 physicians that were disciplined y the Texas Medical Board. are among the 64 doctors the Texas Medical Board recently disciplined.

The Internalist that was disciplined, Dr. Rajeev Gupta, was disciplined because five patients were improperly billed and the radiology equipment was operated by a staff member that was unlicensed. Dr. Gupta was fined $1000 and required to take a course in medical billing.

Another doctor was disciplined because of overzealous advertising of services. Dr. Marci Roy, an Austin neurologist, must pay a $1,000 fine because of Web site advertising that suggests she has a superior ability to treat carpal tunnel syndrome at her clinic than other doctors who provide similar services, according to the board. Blaming the language on a typographical error, Roy said that it was not a violation of the board's advertising rules but that she changed the language after a complaint was filed, the order says.

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

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

When a patient reports to the ED and requires laceration repair, the medical billing claim needs to address the length of the wound in order to be a properly filed claim. If the wound length is either not addressed or addressed incorrectly, the claim may be either denied, rejected or only partially paid. Additional factors can include whether or not there was a separate evaluation and how the service was managed during the encounter. Make sure all of these factors are documented in your medical billing claim.

Laceration repairs are very common in the ED, in fact a nationwide survey showed that every one in fifteen patients presenting in the ED needed some sort of wound repair; knowing how to file them correctly to get the maximum allowable reimbursement for the procedure will make a big difference to your practice. This will bring you into delicate territory, you want to be sure you bundle all the procedures however you don't want to overcode the claim which will almost always cause a denial of the entire claim and you want to be careful not to undercode as the physician will wind up not getting properly reimbursed and this too will affect the bottom line of the practice.

There are three basic complexity levels: simple, intermediate and complex. First of all use the documentation to ascertain which level the wound is and then apply the proper coding from there. Use modifiers as necessary and always make sure that your medical documentation of the procedure is iron clad. Using these tips, your medical billing claims should always be accepted and reimbursed!

Labels: claims, medical-billing, medical-coding, medical-data, physician-credentialing

On October 17, 2007 - the Senate Finance Committee met to discuss ways to pay for a fix to physician payment rates in 2008 and 2009, according to press reports. The heart of the meeting was to talk about the

$30 billion in cuts needed to avert the doc pay cut and make other Medicare changes, and home care once again landed on the chopping block to have many home services radically reduced or have their funding cut all together.
Some of the specifics of the home care that were discussed to be directly affected were wheelchair suppliers and oxygen providers are under discussion for reimbursement reductions to pay for the fix. The parties involved were sharply divided. The Democrats presented their plan which would finance the physician pay hike by cutting payments to certain Medicare managed care plans. Republicans, however, insist that rural patients depend on Medicare HMOs which would be affected under the Dem's plan. The goal of the Democratic leaders was to mark up a Medicare bill by the end of October, but “they’re dreaming,” Sen. Trent Lott (R-MO) commented to reporters.

The end of October has come and gone and no firm decisions have been made as of yet, we'll update you as soon as we hear changes are agreed upon for Medicare funded home visits.

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

Want to know why your emphysema claims aren't being fully reimbursed? Often, the reason is that you're lacking two things when you submit your claim. You aren't being detailed enough with your coding and your don't have enough detailed medical documenation to back up your full diagnostic testing that is required to accurately diagnose emphysema and narrow the degree and type. When you're compiling the medical billing for an established patient with active emphysema (492.8, Other emphysema) and they present and are complaining of shortness of breath (786.05); the physician provides inhalation treatment, trains the patient on using the nebulizer at home, and provides an expanded problem-focused examination and medical decision-making of low complexity, how would you report this?

There will be multiple codes for this visit as the emphysema was the reason for the visit however the physician also provided services and consulted regarding the nebulizer so there will need to be additional codings on the medical billing to take all the services rendered into consideration.

Be sure and capture 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered-dose inhaler or intermittent positive pressure breathing (IPPB) device]) to cover the comprehensive service the physician provided regarding using the nebulizer. Additionally, add in 99213, and back it up with documentation to show that the physician performed an exam of an existing problem with low- complexity decision-making.

If your documentation shows that the physicians's primary intent was to treat the difficulty in breathing at the time of the visit, switch to 94640(Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device).

It's important to always show if the emphysema is currently active at the time so further claims can use that diagnosis as part of the history where applicable.

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

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

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

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.

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

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

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.

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

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.

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

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.

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

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.

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

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.

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

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.

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

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.

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

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.

Labels: audit, claims, consulting, denials, medical-billing, medical-coding, medical-data, modifiers, outsourcing, paper-trail

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.

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

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.

Labels: audit, claims, consulting, hipaa, medical-billing, medical-coding, medical-data, outsourcing, security

If you haven't taken the time to evaluate your data; both the data that you actively send as well as the data at rest. If you don't you could be in violation of the new HIPAA violations. The last security rule made by HIPAA (and while the final ruling does not mandate that you encrypt all of your email transmission)it does require that you examine how all of your data is transferred on an overall scale.

There are two key items that will help you evaluate how your data is transmitted. (1)integrity controls and
(2)encryption.

Integrity control sounds a little confusing, but it really just means proper access controls and login procedures, password restriction and other user authorizations; which are the basics of most companies' e-mail policies. Integrity control is also a policy approach to e-mail security; that is, making sure your staff members know what e-mail procedures are permitted within your organization. It's important to keep in mind that your organization may not need to encrypt e-mail. But it's a good security measure if you do.

A good strategy to adopt would be for provider-to-patient e-mail messaging, encrypt all data. After giving the patient cautionary information about e-mail security, the provider must obtain a signed patient authorization to permit e-mail communications. Keep this in the patient's file and you will have no questions about whether or not the patient authorized e-mail communications in case a problem or question arises in the future.

Here are some good questions to ask yourself when accessing your data transfer security:
#1 How critical is the information being transmitted?

#2 What is the completeness of the information? That is, is this a complete medical record or is this just a snippet of information?

#3 How many individuals might be represented in the information? In other words, information about one person would have a different weight than information about a group of people;

#4 What is the level of the network's security? That's where you start to consider whether it's a local network or the Internet.

If you can not answer all these questions about your data transmission, it is likely that you will need to encrypt to ensure the integrity of your data and stay compliant with HIPAA.

Labels: claims, hipaa, medical-billing, medical-coding, medical-data, outsourcing, security

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!

Labels: audit, claims, consulting, medical-billing, medical-coding, medical-data, outsourcing, paper-trail

Foreign bodies as you are well aware present often as people get in all sorts of accidents at the home and on the job. From the splinter in the eye from the weekend warrior who decided he was too cool to wear safety glasses when he was building a table to the kid that came into the ER with multiple embeds under the skin; they are all reimbursable procedures and if you aren't getting half or better reimbursements, then you need to brush up on your coding and make sure your medical billing claims are airtight.

Generally, it is always best to use only one code for foreign body removal in each particular site on the body. Even if there are several foreign bodies that need to be removed from each particular spot, you can go ahead and list only one code. This will still need to be the case even though the physician at your office will have to undertake a bit more work.

Make sure and back up your FB removal with ironclad medical necessity for any additional procedures needed and note especially if the FB is elevated to a complex status as you can usually file those and realize a reimbursement for the necessary procedures to locate the FB or multiple FB's if absolutely necessary.

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

Medical billing for pregnant patients is a fairly cut and dried process. It's easy to create medical necessity for the visits and it's easy to show the reasons for the continued visits. That is, unless the patient transfers practices in the middle of her prenatal care. Pregnancy transfers scare many medical billing personnel, however you can use three easy tips and make your maternity patient transfers a breeze.

How you do medical billing for a maternity transfer all depends on how many times she was seen in the clinic. If she was seen 1-3 times you always want to code those visits as evaluation and management visits. One thing to keep in mind is that the first antepartum visit is not as straight forward as you may think. Always keep track of the level of service (level 4 or level 5) before doing medical billing for this date.

The next tip deals with visits 4-6. This means that the maternity patient was fairly established with your practice before transferring. It is quite simple to do medical billing for these visits. Simply use CPT code 59425. This code covers every antepartum care visit in your office. It is by far, the simplest way to do maternity transfer medical billing.

Last, if the pregnant patient is seen in your office seven or more times, there is a code that encompasses all of those visits as well. The CPT code is 59426. You should never bill for a global fee because a global fee in medical billing means that your physician also delivered the baby. This is coded with 59400-59622.

Some payers can also get confused when the initial transfer is made. In some cases they will ask for you to report separately. Most of the time, they still want you to code 59425 or 59426, but want all the dates listed in chronological order by date of service.

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

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.

Labels: claims, consulting, denials, medical-billing, medical-data, paper-trail

Patient history is valuable any time you're building up your documentation to show medical necessity for reimbursement of any procedure. Any time you are coding for problem visits that a patient has, it is important that you take into consideration any other office visits that they may have recently had. Basically, you are going to want to look to see if there is a connection between visits for preventative medicine as well as current health issues that may be in place, which also needs some attention.

Many times, a physician will end up seeing a patient that shows up in search of a visit to fall into the category of preventative medicine. Then, upon further evaluation, the doctor will then need to look at the patient further for some sort of significant problem that they have. As a coder, you may end up finding yourself in a situation where you are not sure if you are to code the visit under a new or established patient.

This type of a situation will call for a fast judgment call on your part. In order to make sure that the practice receives reimbursement and avoids denial, you can always go with a new patient code to begin with. Then, after you look through and take all of the medical documentation into account, you can see if there is a modifier that you can add on. A good rule of thumb is to always take the procedure, documentation and time lapse between visits into account before you record the code.

Labels: claims, medical-coding, medical-data, outsourcing, paper-trail

B-12 injections are a very common procedure. If you're only receiving partial payments or experiencing rejections of your claims, you may need to tighten up your handling of these claims as the codes and procedures for filing criteria have undergone changes in the past year. To eliminate potential medical billing problems, there are five steps to follow to ensure smooth B-12 reimbursement for your claim.

The first medical billing step is to replace the injection administration codes for the B-12. These codes include the current procedural terminology codes 90782, 90788, and G0351. These medical billing codes were deleted from the 2006 CPT list and should no longer be used. The new policy is to use one CPT for the injection: 90772 (Therapeutic, prophylactic or diagnostic injection; subcutaneous or intramuscularly).

The second step when doing medical billing for B-12 is to make sure a family physician is present during the entire administration. The medical billing CPT 90772 clearly requires direct physician supervision.

Third, it is very important to check on the insurance company’s incident-to policies. The medical billing current procedural terminology code 99211 is usually allowed without direct physician supervision, but the Centers for Medicare and Medicaid Services requires the service to be incident-to.

The fourth medical billing step is important. Since direct supervision is required for the CPT 90772, make sure you make it perfectly clear that there was a physician present. One tip is to create a stamp that clearly states “Physician supervision”, and attach this to your medical billing claims. This way, your medical billing will not be denied for such reasons.

The fifth, and final step to ensure B-12 medical billing reimbursement is to forget CMS issued G codes. The Centers for Medicare and Medicaid Services needed prescription drug codes in 2005, however, there were no CPT codes available at that time. For this reason, G codes were introduced for medical billing purposes. Once the newer CPT codes were introduced -the G codes were no longer valid.

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

When the surgeon removes lymph nodes during a partial mastectomy, it may be confusing as to how to the mastectomy and the lymph excision. A common point of confusion is whether they should be bundled or reported separately.

The answer is pretty cut and dried. In most cases, with partial mastectomy, the surgeon will perform an axillary lymphadenectomy to remove the lymph nodes between the pectoralis major and the pectoralis minor muscles. The surgeon may also remove the nodes in the axilla through a separate incision at the same time.

When this occurs, you should not report the mastectomy and lymphadenectomy (38745, Axillary lymphadenectomy; complete) separately. Instead, you should use a single, combined code to report the work of both procedures. CPT eliminated partial mastectomy with lymphadenectomy code 19162 for 2007 and has replaced it with 19302 (Mastectomy, partial [e.g., lumpectomy, tylectomy, quadrant-ectomy, segmentectomy]; with axillary lymphadenectomy).

With the updated CPT codes that went into effect on Jan. 1, 2007, you should report 19302 only for most combined partial mastectomy lymphadenectomy procedures. The exception to that rule will be if there is a "staged" exception: Following some partial mastectomies (19301), the surgeon may return during the postoperative period to see if there has been any lymph node involvement and, if so, may choose to remove the nodes at that time. You will want to add the lymphadenectomy as a staged procedure using 38745 with modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) appended to the claim.

Labels: mastectomy, medical-billing, medical-coding, medical-data

If you haven't taken the time to evaluate your data; both the data that you actively send as well as the data at rest. If you don't you could be in violation of the new HIPAA violations.

Recently, HIPAA made a final security rule and while the final ruling does not mandate that you encrypt all of your email transmission but it does require that you examine how all of your data is transferred on an overall scale.

There are two key items that will help you evaluate how your data is transmitted. (1)integrity controls and (2)encryption.

Integrity control sounds a little confusing, but it really just means proper access controls and login procedures, password restriction and other user authorizations; which are the basics of most companies' e-mail policies. Integrity control is also a policy approach to e-mail security; that is, making sure your staff members know what e-mail procedures are permitted within your organization. It's important to keep in mind that your organization may not need to encrypt e-mail. But it's a good security measure if you do.

A good strategy to adopt would be for provider-to-patient e-mail messaging, encrypt all data. After giving the patient cautionary information about e-mail security, the provider must obtain a signed patient authorization to permit e-mail communications. Keep this in the patient's file and you will have no questions about whether or not the patient authorized e-mail communications in case a problem or question arises in the future.

Here are some good questions to ask yourself when accessing your data transfer security:#1 How critical is the information being transmitted?

#2 What is the completeness of the information? That is, is this a complete medical record or is this just a snippet of information?

#3 How many individuals might be represented in the information? In other words, information about one person would have a different weight than information about a group of people.

#4 What is the level of the network's security? That's where you start to consider whether it's a local network or the Internet.

If you can not answer all these questions about your data transmission, it is likely that you will need to encrypt to ensure the integrity of your data and stay compliant with HIPAA.

Labels: hipaa, medical-coding, medical-data, security