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

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.

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

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

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.

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

"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.

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

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,