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

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

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

Often, patients who are confined to beds for long periods of time develop pressure ulcers. They are painful and need to be treated as quickly as possible as infections can set up within them that can be life threatening when the patient is already in a weakened condition.

When a service is performed for a patient such as treatment of a pressure ulcer on an area of the body such as the lower back, the usual manner of treatment is to remove any devitalized tissue from the ulcer using a water jet and forceps. The area is then covered to allow it to not be rubbed on so the skin can begin to repair itself.

When you report this type of claim, read the description of the code carefully. You will notice the since the water jet is normally used, it is already bundled into the claim itself. If you report it additionally, you are setting yourself up for a total claim rejection.
You would want to report this claim as follows (make sure you know the measurements of the wound being treated):

* report 97597 (Removal of devitalized tissue from wound(s), selective debridement, without anesthesia (e.g., high-pressure water jet with/without suction, sharp selective debridement with scissors, scalpel and forceps), with or without topical application(s), wound assessment, and instruction(s) for ongoing care, may include use of a whirlpool, per session; total wound(s) surface area less than or equal to 20 square centimeters) for the debridement.
You will also want to link 707.03 (Decubitis ulcer; lower back) to 97597 for the pressure ulcer.

Labels: audit, claims, consulting, denials, medical-billing, medical-coding

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