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