Archive for the Week of October 13, 2006
Archive for the Week of October 13, 2006
Welcome to the medical billing blog archive for the week of October 13, 2006.
Here you will find links to every article added to the Outsource Management Group web site during the week of October 13, 2006.
You can browse this week's archives by clicking the "More" button from any of the excerpts below.
Using an Extended History in Your Medical Billing
You can use the 1997 audit guidelines that state an extended history for a patient can be created by updating the status of at least three chronic or inactive conditions that the patient has or has had. It is not imperative that the information be placed in the history of present illness (HPI) section. However what is imperative is that your medical billing reflect the medical documentation of all illness that you choose to use – both past or present- to create an extended history of illness. For audit purposes it is helpful to have the notations in both the HPI section and the assessment section. Most physicians will make …
Medical Billing Dilemma – Billing Global
Babies are going to come when they are good and ready and when a baby is being born there is nothing that can be done to stop it in the event of a normal vaginal birth, a doctor may not be on hand to deliver the baby. A situation that isn’t uncommon is for a nurse to deliver a baby when the ob-gyn is in the next room doing a procedure on another patient such as an episiotomy; then the question arises, can the service still be billed globally? Fortunately in many cases you can. It is up to the individual payer and you can find out quickly by either …
When You Can Discard Modifier 25
Modifier 25 cuts a fine line in the medical billing world. Auditors tend to target medical billing claims with this modifier however CMS recently clarified again that they do indeed want this modifier used where appropriate in medical billing claims. The best rule for when to use modifier 25 is met when your physician provides a significant and separately identifiable E/M service on the same day as a procedure with a global period. If your services meet that requirement, you are free to use the modifier without worry in your medical billing claims. The CMS updated the usage language of the modifier in the release on August 20, 2006 and …
Medical Billing Dilemma – Medial Dislocation
A common occurrence in the emergency is the dislocation of various joints. They are sometimes incorrectly handled as breaks but shouldn’t be and you could be setting your practice up for a denial at best and audit at worst if you report these procedures incorrectly on your medical billing. Even if the reduction of the dislocation fails, the attempt should be reported on not only the medical billing as a procedure but also in the documentation as another procedure will have to be tried to relocate the elbow to its proper placement and you can show the timeline for the necessity of other and more involved treatments. On the claim …
Medical Billing Watch – CMS Watching Radiologist Billing
A two year study by Medicare showed that Radiology providers billed Medicare inappropriately for a staggering 100,034 radiology services according to HHS Office of Inspector General (OIG). This translated into Medicare overpayments to the tune of $20 million dollars where Medicare Part A covered radiology services but providers still billed Part B for the technical component of those services as if they were outpatient services according to the OIG report. In a nutshell, Medicare paid these claims twice. Prepayment edits are the proposed solution to this matter and would disallow the submission of any medical billing claim that had the same services under Part A and Part B claims. If …
