Medical Billing Blog with Medical Billing & Coding Info & Articles
Our blog contains news and articles relating to numerous healthcare sectors including revenue cycle management, medical billing, medical coding, ICD, HIPAA, practice management functions and more.
When To Use 58661 and 49322-59 in Your Medical Billing
Sometimes in medical billing it is difficult to decide when to use current procedural terminology codes 58661 and 49322-59. These codes, like many others seem similar, but in actuality, are quite different. When performing medical billing it is necessary to know when to use current procedural terminology code 58661 versus 49322-59. There are several instances in medical billing where it seems as though several codes would fit the description. The truth is that most of the time there is only one possible current procedural terminology code that would explain a procedure best. It is important that the personnel that perform medical billing for your practice are educated on these slight …
What Exactly is Medical Practice Management?
Along with outsourcing your medical billing to a third party partner, you will also find it very beneficial to outsource your practice management to your medical billing partner. Most medical practice management involves four basic categories 1- Medical coding services2- Medical billing services3- Physician credentialing4- Consulting services Outsourcing your medical coding will be very beneficial to the day-to-day operations of your practice. Allowing an experienced company to handle your medical coding will not ensure that the proper codings will be used, but the latest changes and information to make sure you always get a maximum reimbursement on your medical billing claims will be assured. Along with proper coding go good …
How to Avoid "Medically Unnecessary" Medical Billing Denials
There is very little more frustrating in the realm of medical care than to receive a medical billing claim returned and notated with the words of doom for any medical billing claim: “Medically Unnecessary Procedure”. This is frustrating because it essentially means the services were performed for free and won’t be reimbursed by the insurance carrier or Medicare. There’s little you can do in your practice to ensure that your medical billing claims have proper documentation to show medical necessity of the procedure. ECGs get regular scrutiny for the necessity of the procedure. If your staff is too overwhelmed by the day-to-day business of keeping your patients happy and your …
Modifier v57.1 to Get Close Examination
If you use V57.1 (Other Physical Therapy) in your medical billing claims, be prepared for some close scrutiny of all your submitted medical billing claims. These claims in particular will be closely monitored to ensure that they were medically necessary services actually done by the physician. This review will be taking place in Iowa and other states are slated to follow suit in the coming months. Currently, the review will affect Part B Medicare patients only who are part of the outpatient home healthcare program. The reviewers will select home health outpatient claims with type of bill 34X, revenue code 042X and V57.1 as primary. With the close examinations of …
Make Sure Your DME Deal Doesn’t Look Like a Kickback
Based on a recent deal in which a supplier of DME products would provide equipment to a physician in exchange for a prime space and fees, would directly violate the federal anti-kickback statute, according to the HHS Office of Inspector General latest advisory. The basis of this decision was based on the situation where the agreement would have allowed the physician to become a DME supplier for non-Medicare patients, and the DME supplier would have rented space in the physician’s office to supply DME directly to the physician’s Medicare patients. The reason that this arrangement raised eyebrows is because the in-house DME supply programs either together or individually, pose a …
Correctly Coding E/M in Medical Billing
New medical billing coding interpretation may add more reimbursement to your reimbursements. The Centers for Medicare & Medicaid Services clarified the rules for a new patient evaluation and management codes. In reality, there has been no real medical billing policy change to the language the policy is written in; it is simply going to be interpreted differently by the Centers for Medicare & Medicaid Services. Now, the definition of “new patient” means someone none of the physicians in the practice have seen in the last 36 months face-to-face. Some medical billing staff members may get confused when it comes to lab work and other non-face-to-face procedures. If a patient is …
Take Advantage of the Preventative Care Medical Billing Increases
The Centers for Medicare and Medicaid Services updated the healthcare payment amounts for certain medical procedures related to preventative care. The Outpatient Prospective Payment System (OPPS) has ruled in favor of the provider on a few financial issues. There are some medical billing changes implemented in the January 2006 update that will increase your revenue if you use them correctly. The main medical billing change issued by the Outpatient prospective payment system (OPPS) deals with preventative screening exams. Beginning in January 2006, Medicare will now reimburse at a higher rate for most preventative services provided. For instance: Many patients receive a “Welcome to Medicare” physical. Now, if hospitals provide this …
Medical Billing Guidelines Made Clear
The Centers for Medicare & Medicaid Services can sometime seem a little vague in their guidelines. It is common knowledge in the medical billing world that a physician or non-physician practitioner must perform the history of present illness portion of an evaluation and management exam. However, this medical billing rule is nowhere to be found in the CMS guidelines. After examining the Center for Medicare & Medicaid’s guidelines, many people wonder if an ancillary staff member instead of a physician can take the history of present illness. Nowhere in the documentation does it prohibit this to be done. Most medical billing policies are spelled out exactly how they should be …
Are You Using the "G" Codes in Your Medical Billing Claims?
The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services are in a medical billing dispute. According to the American Medical Association, new “G” codes will be an unnecessary hassle. The Centers for Medicare & Medicaid Services believe that these new medical billing codes are an improvement in the healthcare system. Administratively, the CMS- created “G” codes and this may become a headache for your medical practice. There is virtually no incentive to use these medical billing codes. 2006 is the requested Centers for Medicare & Medicaid Services implementation date, but no one is jumping up and down for this change. For many businesses, the bottom line …
Medical Billing Techniques That Will Get Your Practice Audited
Millions of dollars each year are lost through outright fraudulent medical billing claims. Unscrupulous individuals deliberately file some of these medical billing claims, others are the result of an inexperienced coder in an office just getting it wrong. Either way, it can cost your practice big time in the form of time spent gathering information to answer an audit and in the form of some very stiff fines if there are improprieties found in your medical billing practices. The most common fraudulent medical billing practice is when services that were never rendered to a patient are billed. Since all charges are listed on an explanation of benefits form that is …
