Archive for the Week of June 16, 2006
Archive for the Week of June 16, 2006
Welcome to the medical billing blog archive for the week of June 16, 2006.
Here you will find links to every article added to the Outsource Management Group web site during the week of June 16, 2006.
You can browse this week's archives by clicking the "More" button from any of the excerpts below.
Handling Denials Due to Limitations of Service
Getting a medical billing claim denied is one of the biggest problems you can have with your billing. One tricky medical billing claim that many practices get denied for is the service for counseling patients that smoke or seeking to quit smoking and received counseling for doing so. Many payers outright reject any claim that has anything to do with tobacco, including counseling for the stoppage of its use. The patients either have zero coverage for this service or they get a limited number of counseling visits and those are normally less than full reimbursements. If the patient has already seen another physician regarding these services, you will have just …
The Trouble with Disease Management Medical Billing
Medical billing for disease management is not working for many insurance companies. Disease management has been a trend in the recent years. However, model programs are being shut down all over the country. Lack of interest is the downfall of these disease management programs. Medical billing and revenue for the year will fall due to disease management closings. A model disease management program, HeartPartners will be closing ten months early. The payer, PacifiCare Health Systems, cannot take any more medical billing loss. They were severely short on beneficiaries. They anticipated 15,000 beneficiaries, however only 3750 people actually enrolled in the program. Disease management is intended to educate patients about their …
Getting the Best Reimbursements for Injection Medical Billing Claims
If an ED physician performs an injection, infusion or hydration on a patient, there is a way to secure maximum reimbursements for your medical billing claims by looking for additional claims for separate evaluation and management services on the op report to secure all of your deserved reimbursement on these claims, the reason is anytime there is a separately identifiable and significant E/M service is provided, you can charge for both the E/M and the injection/infusion/hydration codes. The use of modifier 25 will make the claims payable with almost all carriers but there must be medical documentation to back it up to ensure reimbursement. .A good example of this would …
Medical Billing Dilemma – Dental Pain Codes
Finding the correct pain code when you’re compiling your medical billing can be a tricky issue, especially when dealing with dental matters. The trick to billing these types of procedures correctly is to narrow down the chief complaint. If a patient comes into the ED and presents a complaint of a dental wire sticking into their lip or tongue, you have a very clear chief complaint. If nothing was actually done to treat the issue but the patient was given advice such as checking with the dentist or getting supplies to relieve the pain from a local store, you can probably still get a reimbursement for the consultation services. In …
Medical Billing Dilemma -Debridement Reimbursements
Lately debridement medical billing has brought up many questions in the healthcare industry. The medical billing CPT codes 97597-97598 can usually not be used by every provider. The American Medical Association recently released these new Current Procedural Terminology codes. Interpretation of these two medical billing codes varies from payer to payer. When the American Medical Association first released the codes 97597-97598 there was a lot of confusion. Shortly after that release the Centers for Medicare and Medicaid Services offered an explanation of the medical billing codes. 97597 (Removal of devitalized tissue from wounds, selective, debridement, without anesthesia, with or without topical applications, wound assessment, and instruction for ongoing care, may …
Changes in Mesh Placement Reimbursements
Changes in CPT coding can be a blessing or a curse. In some caes it can mean more reimbursement dollars and in others it can mean less. When dealing with mesh placement for hernia repairs, medical billing may bring you less reimbursement for your services. The medical billing policy that has been updated no longer allows mesh placement to be separately reimbursable in relation to certain hernia repair surgeries. The National Correct Coding Initiative now has the medical billing CPT code 49568 bundled with 49570-49651. 49570-49651 describes umbilical, epigastria, spieling, and inguinal hernia repairs. Now, you medical billing can no longer include both of these codes for separate reimbursement. A …
Medical Billing for Fractures
When performing medical billing for fractures, it is imperative to know if you are dealing with definitive care or restorative care. Not knowing the difference could cost your physician a lot of money. There are a couple scenarios to keep in mind when deciding if your medical billing should be claimed as definitive or restorative care. The first step in proper medical coding and medical billing is understanding the nature of definitive fracture care in medical billing. For example: a 33-year old woman is seen in the emergency room for a minor fracture of the radial head. The emergency room physician gives her a sling and a short arm splint. …
