Archive for the Week of August 11, 2006
Archive for the Week of August 11, 2006
Welcome to the medical billing blog archive for the week of August 11, 2006.
Here you will find links to every article added to the Outsource Management Group web site during the week of August 11, 2006.
You can browse this week's archives by clicking the "More" button from any of the excerpts below.
Why Use OMG?
Medical billing is a complex process that if not done correctly, can lead to a loss of revenue and underpayment on your claims. Outsourcing your medical billing can help eliminate some of these losses. There are several benefits to using a medical billing company. Studies have shown that nearly one-third of all medical services are never reimbursed to the health care provider. This is due to poor follow-up to insurance companies and to patients themselves for medical practices. Too often, medical office personnel are stretched to their limits. They are responsible for medical billing, advertising, scheduling, and customer service. Medical billing companies can alleviate some of this stress by taking …
Real World Rehabilitation Medical Billing Reimbursements
The medical billing world has a new way of performing therapy for patients. Baton Rouge General Medical Center is changing the face of rehab therapy. The new rehab facility, “Around Town”, is helping patients adapt to the more practical aspects of life. While traditional therapy helps patients move their bodies again once again, this new therapy helps them adjust to real life situations. Payers may see a lot more of these types of medical billings come through their offices. The “Around Town” facility looks like the inside of a house or a home. It is equipped with a working kitchen, bedroom, living room with a chair and couch, and a …
Prior Authorization Can Get More Medical Billing Claims Paid
More and more often, medical billing claims that include saphenous vein ablation are getting very close scrutiny by carriers before reimbursements will be allotted. One of the biggest red flags is that most payers, including Medicare, will only cover payment for a very limited number of specific varicose-vein diagnoses. Samplings of the commonly and correctly reported procedures covered are as follows: * 454.0–Varicose veins of lower extremities; with ulcer* 454.1–… with inflammation* 454.2–… with ulcer and inflammation* 454.8–… with other complications. However, when these are reported correctly, you should have detailed documentation to why the procedure was needed and documentation of the failure of non-surgical treatments that were used previously …
Pregnant Patient Transfer Easy On Your Medical Billing
Pregnancy medical billing is a rather straightforward process. That is, unless the patient transfers practices in the middle of her prenatal care. Pregnancy transfers scare many medical billing personnel, however if you can remember three tips, maternity transfers will be a snap. How you do medical billing for a maternity transfer all depends on how many times she was seen in the clinic. If she was seen 1-3 times you always want to code those visits as evaluation and management visits. One thing to keep in mind is that the first antipartum visit is not as straightforward as you may think. Always keep track of the level of service (level …
Universal Injection Code
As of January 1, 2006; changes were made regarding therapeutic and antibiotic injections medical billing claims that will affect your medical billing claims if you don’t update your filing methods. In the past there were separate injection administration codes for a therapeutic, prophylactic, diagnostic injection and an antibiotic injection. Instead of choosing to report administration of a prophylactic Synagis treatment (90378) with a 90782 (Therapeutic, prophylactic or diagnostic injection , you now simply use 90772 as a universal injection code. On E/M coding, you will generally still need to attach modifier 25 to insure you’re your claim is handled. Modifier 25 states that this procedure or other service was performed …
Can You Bill Medicare – When the Patient Has Died
A confusing medical billing situation can arise when a patient dies en route or shortly after being admitted to a hospital. Many medical billers struggle with what to report or amount of procedures to report that were performed prior to the patient expiring. A good example would be a patient that presented in the ED for CPR direction. The ED physician tells EMS to perform defibrillation and administer medications. When EMS brings the patient into the ED, the doctor examines the patient and decides there isn’t cause to continue CPR and pronounces the patient dead. How should this be reported? Normally, on your medical billing form, you would usually bill …
The Removal of Sutures
Medical billing allows for very little wiggle room in your descriptions and documentation. Almost all surgeries, whether performed in the doctor’s office, or in the operating room have a follow-up period. This means that during that particular 15-day, 30-day, 60-day, etc. period, any treatment the surgeon does for that surgery is included in the medical billing of the surgery itself. However, there is an exception to this rule. An example of an exception to this medical billing rule deals with mentally handicapped patients. The removal of sutures is usually a procedure performed within the postoperative follow-up period. Medical billing is usually done only for the surgery. However, if a mentally …
Get Your Therapy Medical Billing Claims Paid
No type of medical billing claim raises more eyebrows with Carriers more than therapy bases medical billing claims. Most therapy claims are 100% legitimate but because of the amount of fraud that has been perpetrated by a few unscrupulous individuals all of these types of claims get closer looks than ever. One way to insure your claims are submitted correctly is to make sure the documentation is done absolutely accurately in your therapy department. In a recent audit of claims, the CMS found that the number one error in reporting therapy medical billing claims is with the minutes billed. Make sure the amount of therapy given to the patient is …
Using Care When Using Modifier 24
If you are a practitioner or medical biller that has a client who sees patients in need of services for post operative complications and you are bundling the services into the global period of surgery, you could possibly be missing thousands of dollars in reimbursements yearly using this method of doing your medical billing. In many cases you can legitimately report patient evals made during the post-op period, according to the individual carrier’s rules. A good rule of thumb for most carriers is if the post operative complication evaluation is unrelated to the original procedure and this can usually be distinguished by medical necessity and date alone, then you can …
