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

Remember when medical billing used to be a simple affair of matching the procedure done with a couple of medical billing codes to describe what was done, attaching your documentation and then submitting your medical billing claim for reimbursement?

Now we have codes for codes and modifiers and the need to when to bundle and when to not bundle with the goal being fair reimbursement for procedures done. Modifiers cause a lot of confusion for many medical billers. One such confusing modifier that is worth clarifying is Q6.

This applies to Medicare medical billing claims only, but in a nutshell when one of your staff physicians takes a leave of absence for any reason and a substitute physician fills in, you need to add the Q6 modifier to Medicare claims the sub handles if you want to ensure reimbursement for the services that the sub provides.

If you're wondering why, the reason is that when a substitute or locum tenens physician handles patients, Medicare wants to see specific modifiers on claims. This is to make sure that the time limits on locum tenens doctors are strictly observed. In order to be reimbursed, make sure that modifier Q6 (Service furnished by a locum tenens physician) is attached to all codes for procedures performed by the substitute physician. This lets the Medicare carrier know that you are coding for a locum tenens physician. Without the modifier, you’ll likely receive a denial for the claim.

Since many private carriers are adopting more and more of Medicare's standards for payment on services; before filing a locum tenens claim with a private insurer, verify with the plans as to their requirements for locum tenens billing -- and whether or not they even recognize it. Some good questions to ask are
* Do you recognize modifier Q6?
* Which provider’s ID should be reported for the services?
* Does the locum tenens provider need to be credentialed with the payer, even if only temporary privileges?
As always - write down the full name and position of whomever you speak with and the time and date of your call in case you need to track that person down again.

Labels: medical-billing, medical-coding, modifiers

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

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.

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