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

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.

Labels: audit, claims, consulting, medical-billing, medical-coding, modifier-51, outsourcing

The multiple procedure code Modifier 51, causes some confusion among medical billing professionals because it relates to multiple procedures performed but what many medical coders miss is the fact it only applies to multiple procedures performed by physicians and imaging centers. Using this modifier can get your claim denied and cause a large delay in receiving reimbursements.

Carriers already assume during a hospital stay that multiple procedures will already be performed therefore designation of the exact nature and type of services rendered by the attending physician will still suffice for hospital medical billing claims. The CPT manual designates modifier 51 (Multiple procedures) exempt codes with a "circle with a slash" symbol to the left of the code.

Pay close attention to those codes which don't need modifier 51. Certain types of services don't require the use of the modifier for add on services. Sarterial catheterization code 36620 (Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous) and you'll see a symbol to the left of the code. That means when a radiologist performs this service on a patient along with another procedure, you should report only 36620 without modifier 51.

Medicare is especially sticky about the use of modifier 51. Your medical billing claim will automatically be sorted by procedure performed on your medical billing claim from highest to lowest RVUs. The highest ranking service performed will normally reimburse at 100% and all remaining services at around 50%.

If your practice is suffering from multiple cases of medical billing denial or rejection; it most likely isn't your carrier but the use of outdated coding or weak documentation. If your medical billing isn't bringing in the revenue flow it should, it's time to consult with a medical billing partner and get fully reimbursed for the procedures you perform.

Labels: medical-billing, medical-coding, modifier-51