Archive for the Week of May 12, 2006
Archive for the Week of May 12, 2006
Welcome to the medical billing blog archive for the week of May 12, 2006.
Here you will find links to every article added to the Outsource Management Group web site during the week of May 12, 2006.
You can browse this week's archives by clicking the "More" button from any of the excerpts below.
Proper Reporting for Medical Billing of Twins Delivery
If you have a medical billing claim to process that includes twins delivery and one was a traditional birth and the other a cesarean, you should report two codes. If both babies were delivered traditionally (vaginally), report only one code for both babies, as it will be considered one procedure. If there are no complications, the babies will both be born vaginally. You should report 59400 (Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care) for the first baby and 59409-51 (Vaginal delivery only [with or without episiotomy and/or forceps]; multiple procedures) for the second baby. Your diagnosis code will be 651.01 …
Special Medical Billing Dilemma
With multiple births becoming more and more commonplace, the reporting of twins on medical billing claims has become more routine and there are some special considerations when filing out your medical billing claims. If both babies are born by cesarean, bill only once. Remember, the doctor delivers all of the babies–whether twins, triplets, or more–by cesarean, you should submit 59510-22. Report 59510 with modifier 22 (Unusual procedural services) appended, because even though only one incision was made, the modifier will testify to the fact that multiple babies were delivered. Be sure and include your medical documentation as to the reason for the necessity of the cesarean. If the babies were …
Reasons to Outsource Your Medical Billing Functions
If you’ve been feeling the stress and strain of too much paperwork and time spent preparing medical billing for your practice and not enough time is left to service your patients to help your practice grow, it might be time to consider outsourcing your medical billing claims. There are some sobering facts about medical billing claims that might give you pause to consider it might be time to outsource your medical billing. When you consider that healthcare providers averaged spending $7 billion annually just submitting claims to carriers. Another jaw dropping fact about your medical billing claims, is you might be missing being reimbursed for nearly 1/3 of your legitimate …
Medical Billing for Nutritional Counseling
With obesity among patients rising at an alarming rate, the continuing counseling of patients who need nutritional information, especially for controlling their diabetic conditions is also on the rise and it is fast becoming a common coding in medical billing. If it can be reimbursed and how it can be reimbursed are two dilemmas that many physicians are finding confusing. If you’re not getting reimbursed for your patient counseling, you’re losing money for your practice. When an individual nutritionist consults with a patient in a non-certified physician setting, you’ll most likely report sessions with 97802-97804. But if your practice has an American Diabetes Association-approved program, you may also use Medicare-specific …
Getting New Patient Office Visits Paid by Medicare
If a new patient presents in your office and it is determined through evaluation that a pap smear is necessary – Medicare will probably deny the claim unless you can show medical necessity of the preventative measure. You will need to use pap and a pelvic code with 99203 is if the patient presents with a problem that needs to be evaluated. Using code 99203 (Office visit) is not a substitute for the rest of a preventive exam (which Medicare generally does not cover). Use modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the …
Medical Coding – The First Step to Medical Billing
Medical billing and medical coding go hand in hand and can seem very confusing until you learn how they work with each other. Medical coders take the procedures and services performed by doctors, hospitals and clinics and translate those services into a series of assigned medical codes that each carry a revenue amount that will be reimbursed when the form that the medical coder has filled out is completed, documented and submitted for reimbursement by the medical biller. There are codes for every conceivable type of encounter and even codes for having no code for the procedure. Whether it is a test, service, procedure, treatment or ongoing care, the service …
Medical Billing Explained
If you’re researching becoming a medical biller, it is a fantastic career with a great future. Basically a medical biller takes the documentation provided by their client (a doctor or hospital) that has rendered services to a patient and is looking to get reimbursement for those procedures and services from the patient’s insurance company. The medical biller’s job is to submit the claim to the carrier (insurance company) and get their client (the doctor or hospital) a reimbursement. The medical biller will have to make sure the claim is properly coded. This means that each procedure and service has a numerical code assigned to it. Those codes must be logical …
What’s So Great About Electronic Medical Billing Claims?
In short – everything. This is one of the few scenarios where there truly is no downside. Medicare alone receives more than 500 million claims on the average per year and they only accept electronic medical billing claims. Filing your medical billing claims or having them filed electronically by your medical billing partner will cut your turn around time on your reimbursements from an average of 90 days for paper or self filed claims to about 14 days for most claims. That alone should be enough to encourage you to outsource your medical billing. Electronic claims will enable you to create a revenue stream that you can count on and …
Have the Diagnosis In Your Documentation
One of the biggest ways that physicians lost out on reimbursements is through poor documentation. Offices get hectic, notes you intend to make don’t get made and sometimes your medical billing claims get submitted to the carriers for reimbursement without the proper documentation. First and foremost, there must be a diagnosis of the condition or disease for the patient. From that it must extend the services rendered in conjunction with the condition or disease and the medical documentation explaining why the services were performed. Only the physician can state the diagnosis for the patient, even with test results that clearly show for example a patient was diabetic, the person doing …
Avoid Fee Reductions in Your Medical Billing
If you have multiple endoscopic services that were rendered during one surgical session, make sure that you determine if the procedures were all part of a “parent” procedure. If that is the case, you can not bill for different endoscopes, you must put them together as one service or you run the risk of having the carrier impose a fee reduction on your medical billing claim. The parent code must be included in the medical billing and be sure to include your documentation of medical necessity to insure that your medical billing claim gets paid in full and not a reduced reimbursement or worse, an outright rejection. If other endoscopic …
