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blog contains information regarding Medical
billing outsourcing news, HIPAA news,
recent information and changes to
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coding industry, as well as the thoughts
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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!
For correct payment amount, accurate place of service codes are required. The failure to provide the correct place of service code with the correct current procedural terminology code for E/M services will cause your claim to get denied. One of the most important elements of medical billing is the place of service code.
In medical billing, the place of service codes for an evaluation and management are commonly misused. There are several current procedural terminology codes for an evaluation and management session that correspond to different medical billing place of service codes. When using CPT 99341 (Home visit for the evaluation and management of a new patient) through 99350 (which means the same as 99341 except with an established patient), the only POS code available for use is 12. This means home.
Many billers get confused with these medical place of service codes. If a patient is in an assisted care center, many people consider this a home and bill with place of service code 12. This would be incorrect. POS 12 is reserved for house, apartments, etc visits. There is actually a more specific code for an assisted care center in medical billing, the correct POS code would be Medicare Contracting Changes Could Bring Reimbursement Delays When billing to Medicare, expect some medical reimbursement delays in the upcoming years. The Centers for Medicare & Medicaid Services is currently reforming contractor workload for medical billing claims that come in. The speedy implementation of this medical billing reform may lead to reimbursement delays and errors.
Congress mandated that the Centers for Medicare & Medicaid Services reform their contracting system. This needs to be completed by October of 2011. However, since estimates of huge savings have been made, the Centers for Medicare & Medicaid Services wants to speed up this medical billing contractor reform. Their goal is to have it completed by 2009, which is two years earlier.
This change to the contractor method will take many Part A and Part B contractor work loads and transfer the loads over to the Medicare Administrative Contractor. Unfortunately, by making this reform too soon it is very likely that medical bills will be reimbursed incorrectly or with much delay. It seems as though the Centers for Medicare & Medicaid Services has not thought of possible medical billing and reimbursement problems of implementing this system too soon. The Government Accountability Office has suggested to CMS to wait until 2011, but they have refused.
If your practice is planning on billing Medicare in the coming years, it would be wise to keep close track of those medical claims. Make sure they are not lost in the cracks. Also be sure they are reimbursed at the correct rate. This extra effort could become a headache for your practice. Medical Billing firms can alleviate this stress. Their job is to make sure your claims are paid on time and accurately. They know how to deal with payers. Medical billing companies can save your practice much headache once Medicare makes contracting reforms.13.
Basically, for every current procedural terminology code, there is a correct place of service code that corresponds to it. if these medical codes are used incorrectly in billing, it will cost your practice time and money. Insurance companies will deny the claims and your office will have to correct the problem. With the use of an outside medical billing company, you can erase this problem from your mind. Medical billing companies are versed in the correct billing procedures for every medical service. They check claims for accuracy before they are submitted and take care of any claims that come back unprocessed. Correct medical billing POS codes are essential for maximum practice profitability.
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.
Medical billing changes occur throughout each and every year and keeping up with those changes can be confusing. Aural Rehabilitation has become one major area of confusion since the 2006 update. The medical billing changes to Aural Rehab CPT codes has wrongly caused many people to believe Aural Rehabilitation is no longer a reimbursable service.
Medicare actually assigned status code "I" to all new medical billing codes for auditory rehabilitation. These codes are 92630 and 92633. This means that the Centers for Medicare and Medicaid Services will not pay for auditory rehabilitation, only diagnostic audiology. However, this is only true if an audiologist performs the service and the medical billing.
There are several other medical professionals that could possibly perform medical billing for aural rehabilitation. A speech language pathologist is one example of a provider who could get reimbursed by CMS for aural rehab.
It is important when reviewing new medical billing changes not to jump to any conclusions. If you did this, you could be missing out on money. For example, there may still be speech pathologists who perform aural rehabilitation, but don't perform medical billing for the service. Having a partner firm to help your staff review and alert you of any coming changes that will affect your reimbursements is invaluable.
Not to mention that hiring a medical billing firm to review new coding changes and to handle your claims will take a lot of the paper-chase and workload off your in-house office staff. Get a free consultation and find out exactly how much of your reimbursements you've been missing through handling your own medical billing, most practices are astounded to learn they are losing up to 25% of their revenue through unpaid claims that are simply filed incorrectly or procedures that could be billed separately.
"Chronic pain syndrome" can be considered as a vague description of a vague diagnosis by your carrier and unless you back up your medical billing with the reasons for using this catchall term for several pain conditions, you may be seeing only partial reimbursements to denials for this condition. Traditionally, ICD-9 directs you to code 338.4 (Chronic pain syndrome) for the condition.
However, you may need to couple this diagnosis with other probable causes backed up by symptoms and doctor's notes. Other diagnosis possibilities for chronic pain syndrome include fibromyalgia/muscular pain (729.1, Myalgia and myositis, unspecified); reflex sympathetic dystrophy/regional pain syndrome (337.2x, Reflex sympathetic dystrophy) or peripheral neuropathy (337.0, Idiopathic peripheral autonomic neuropathy) caused by either diabetes (250.6x, Diabetes with neurological manifestations) or amyloidosis (277.30, Amyloidosis, unspecified). Among the listed alternatives for 338.4, coders choose 729.1 most commonly as a substitute for the generic chronic pain syndrome diagnosis code.
The best route to getting a better reimbursement on a vague diagnosis is to check with your physician to clarify what type of pain the patient has. The patient might initially report pain "everywhere" but he may be able to pinpoint his worst pain sites, such as the lower back (724.2, Lumbago) or the hip (719.45, Pain in joint; pelvic region and thigh).
Also it's a good practice to verify any of the patient's pain-related symptoms before reporting the physician's final diagnosis. Good examples of those would be back muscle spasms (724.8, Other symptoms referable to back) or derangement of joint (718.95, Unspecified derangement of joint; pelvic region and thigh).
When in doubt, ask the attending physician which diagnosis in their opinion best suits the claim. Using the notes can help you also pin it down and if you show that you have a vague claim that needs more exacting information to get a better reimbursement for the practice, putting the need for exact information in dollars and cents is usually a good way to get the proper information you need to process the claim for the best return on services for the physician.
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!
No one has to tell you that the world of pediatric medicine is fast paced and along with unpredictable kids come unpredictable medical billing situations. If you process medical billing for pediatric physicians, you may or may not have run across a situation for determining what diagnoses would apply when parents come in to discuss their child's health issues.
If you're wondering if there is a single code, the answer is yes. A parent conference falls under V65.19 (Other persons seeking consultation; other person consulting on behalf of another person). In other words, the code describes a person seeking "advice or treatment for non-attending third party." Since a parent has the right to discuss the treatment and medical issues for their minor child it's permissible to bill for the consultation.
The counseling diagnosis code can be used when the patient is present or when counseling the parent/guardian(s) when the patient is not physically present as in over the telephone. Although carriers may require supporting documentation for coverage of the encounter, so make sure you indicate the discussion's topic and the documentation should be signed off on by the attending physician. In case of an as yet undiagnosed concern, you can also check if payers want a secondary diagnosis that indicates the topic.
There are numerous reasons for consultations that include these top four common reasons: * ADD/ADHD -- 314.00, Attention deficit disorder; without mention of hyperactivity; 314.01, Attention deficit disorder; with hyperactivity * anxiety -- e.g., 300.00, Anxiety state, unspecified * depression -- e.g., 311, Depressive disorder, not elsewhere classified * obesity -- 278.00, Obesity, unspecified.
Use the total face-to-face time that the pediatrician spends with the parents to select the service code. Careful supporting documentation of the time elements is critical and will result in reimbursement for your medical billing claim.
Did you know you might have a cash flow leak and not know it? It's not uncommon for practices to file medical billing claims without meeting requirements for the use of Modifier 25 in bundled sick claims and doing so could very well be costing your practice valuable reimbursement revenue.
Fortunately, there are some simple rules to follow to ensure that you're getting the best reimbursements for your claims. First of all, make sure that you know exactly what the payer requires for reimbursement on these claims. Next, make sure you document exactly what caused the encounter and what the outcome was. This shows a logical flow of information and will better help the payer see that the services rendered will qualify for full reimbursements.
Additionally, be aware that the RVU system makes no adjustment for codes with modifier 25. Although a plan may pay such claims as the policy allows, insurers that follow CPT rules should generally be paying each CPT code in full in this instance as long as a distinct entry is made on the medical billing form. Additionally, make sure that your charges are consistent and reflect real pricings for services rendered.
A red flag for many payers is two of the following scenarios: * Enter a $0 charge for the sick visit service (99201-99215), and bill the preventive medicine service (99381-99397) above the contracted rate
* Split the well care charge in half and apply it to the sick visit.
Final point, raising your price on a single visit may get your entire claim denied. The best way to file your sick claims is to charge the usual amount for services rendered and then back up your claim with strong documentation. Filing this way will give your practice the best chance at reimbursements for sick visits.
As you know in processing medical billing for hospital based claims, location of services is everything and you must be certain that the correct place of service coding is used. That is where code 21 comes in handy. Place of service code 21 is used in medical billing for all inpatient hospital care. Code 23 is a lesser used code, but also useful.
Admittance of a patient to the hospital will make it necessary to use the inpatient hospital POS code 21. Many medical billers get confused when the emergency department comes into play. They question whether or not they should use place of service code 23 for emergency room-hospital, or place of service 21 for inpatient hospital if a patient is admitted from the emergency department. This becomes confusing when a patient is brought into the emergency room, taken into surgery, and then admitted after surgery. It is obvious the location after surgery should be POS code 21, but what about before the patient was admitted?
Fortunately the answer is simple. Medical billing hospital admission codes include absolutely everything that was done on that particular date of service. This means anything a physician does to a patient in the emergency room is included with everything a physician does once a patient is admitted on that day. So, Place of service code 21 should be used in medical billing for the entire day that a person is admitted.
The only time POS 23 is used is if the patient is not admitted to the hospital. POS 23 would be used for all services rendered on that day in the ED, including surgery as long as the patient wasn't formally admitted. Make sure you use the proper POS code and reap the benefits on your reimbursements.
Make sure documenting your POS correctly in your medical billing and attach code 21 and 23 as necessary and you'll see your reimbursements go up in a healthy fashion.
Make sure that you're using the proper medical billing codes when reporting CVA services, if you're not using CPT codes 76937 and 75998, you may not be getting the full reimbursement for this service.
If a physician performs an ultrasound guided procedure, the code 76937 will give additional money for the procedure. This code means: ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent real-time ultrasound visualization of vascular needle entry. This means 76937 can be billed separately from the CVA placement code. One thing to note is that this code is only allowed one time per session in medical billing no matter how many sites were examined for the best entry. The CPT code 76937 should not be used if an ultrasound is used to only identify a vein to mark on the skin. The ultrasound must be used for medical billing purposes to guide a needle into the vein.
The other code used in medical billing to provide additional CVA payment is 75998. This is used for fluoroscopic guidance. This code is used when fluoroscopic guidance is needed to assist catheter placement or manipulation. It is reimbursed separately from the placement itself. It is important to note that any injection used to contrast the catheter's path is included in the CPT 75998.
Both of these CPT codes in medical billing require the use of modifier 26. Modifier 26 is only necessary when a surgeon is reporting in a facility. 26 means professional component. This allows the facility to medically bill separately for the equipment itself.
Most foreign body removal procedures are pretty black and white. Only on the rarest of occasions is there a complication and most of the claims can be handled in a similar manner. However in the even the physician is called on to perform soft tissue removal in a FBR procedure, you need to know how to code your medical billing claim s so your reimbursement won't be paid only partially or denied. Make sure in this event you code the service with 10121 (Incision and removal of foreign body, subcutaneous tissues; complicated).
Some giveaways that the FBR procedure was more complex than normal will be found in notes and procedurs that show radiographic guidance was used. A complex soft-tissue FBR may also have localization techniques including use of a C-arm fluoroscopy device, ultrasound, or x-rays with radiographic markers and extensive dissection. All of these procedures are clues the FBR was more complex.
Consider this example: A patient presents to the ER and says it feels as though "something is stuck" in his forearm. The ED physician performs a level-three ED E/M service and finds and attempt s to localize the found foreign body. On exam she can palpate something beneath the skin, but attempts to exact the location of the foreign body (including making an incision) fail. Under C-arm fluoroscopy guidance, the physician localizes a 1-cm foreign body, makes a small incision and removes the FB. The wound is left open and the patient is placed on antibiotics.
On the claim, you should: * report 10121 for the complex FBR. * append 913.6 (Superficial foreign body [splinter] without major open wound and without mention of infection; elbow, forearm and wrist) to 10121 to represent the FB. * report 99283 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; moderate-complexity medical decision-making) for the E/M. * append 959.3 (Injury; elbow, forearm, and wrist) to 99283 to represent the forearm injury. * attach modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99283 to show that the E/M and FBR were separate services.
Meeting these requirements for a more complex service and showing the proper documentation will ensure that your complex FBR claims are reimbursed without question.
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.
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.
At the beginning of 2007; medical billing claims that are submitted to Medicare for reimbursement need to have a zip code or you can count on a delay. A National Provider Identifier requirement to include your zip code on all billing transactions took effect Jan. 1. This included all bills including RAPs, and providers must report a five or nine-digit zip code for their primary facility and its subparts.
Claims without the zip codes will be returned to provider (RTP'd) with reason code 32114. This will affect any facility that does medical billing claims for Medicare reimbursement. Many providers were unaware of the new requirement and a large amount of medical billing claims have already been rejected with reason code 32114 in the first 2 weeks of January.
If you handle your own inhouse medical billing claims,make sure your staff knows to double check that the zip code is included or you'll be part of the large number of facilities receiving rejected claims with reason code 32114. If you're tired of keeping up with the little changes like this that can cause you revenue flow to slow to a trickle; it may be time to consider outsourcing your medical billing claims.
It's hard to let go of what you might deem the financial control of your practice. Hiring a medical billing consultant can seem like you're adding expenses instead of cutting them down, especially if you have never outsourced your billing. If you've always discounted outsourcing your medical billing claims because you feel as though you would be relinquishing control over your billing, read on - you'll find that is not the case.
Actually outsourcing your medical billing and coding needs through a consultant is one of the smartest business moves you can make. Don't think you have to use a local company, many medical billing firms have branch offices in an area near you, but others may be miles to hundreds of miles away, and thanks to the power of the internet with secure connections and software advances that allow you to transfer your patient billing records while upholding the utmost in privacy standards, with just a click of your mouse, makes the job of shopping for a medical billing consultant to hand the billing paperwork for your busy practice all the easier.
Your staff won't have to spend long hours at the copy machine when you outsource, most records can be transferred via computer to computer using secure, encrypted technology. Many medical billing consultants offer real time updates of patient accounts, so if information is needed on where a particular claim stands, your staff can click and see!
Outsourcing to a medical billing consultant will insure that your claims are coded and submitted properly because that's their business! There are no interruptions, patients asking questions, and general day to day running of your practice. A medical billing consultant can devote 100% of their time to handling your coding and claims. That way your cash flow is steady and your practice will grow!
Time is money in your practice and if you outsource your medical billing through a consultant you are definitely making the most of your time and because of your smart choices, you'll see an increase in your revenue flow for your practice.
When you have a procedure that can cover two close but distinctly different areas such as a facial and a dental nerve block, you need to make sure that your claim encompasses exactly the procedure that was done or you may wind up with a denial of your claim.
A common situation would be if the ED physician performed a diagnostic nerve block on a patient complaining of pain in the floor of her mouth and her bottom set of teeth. You would want to be certain that you chose 64402 (Injection, anesthetic agent; facial nerve) for facial nerve blocks, not blocks in the mouth or jaw. The determining factor is that the surgeon treated a branch of the trigeminal nerve, not the facial nerve.
On the claim, report 64400 (... trigeminal nerve, any division or branch) for the nerve block. Other 64400 scenarios: Areas affected by the trigeminal nerve and its branches, and therefore coded with 64400 for nerve blocks, include: * the body of the mandible and the lower portion of the ramus * upper and lower teeth * floor of the mouth * anterior two-thirds of the tongue * gingiva on the lingual surface of the mandible * gingiva on the labial surface of the mandible * mucosa and skin of the lower lip and chin.
To ensure proper payment, back up your medical billing claim with the proper documentation to show the reason for the facial or dental block and that will allow the carrier to see why this code was chosen along with the necessity of the procedure. This will enable you to realize reimbursements instead of rejections on these type of claims.
A question that comes up periodically is 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 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.
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.
Outsourcing a Dirty Word toYou?
