Archive for the Week of October 27, 2006
Archive for the Week of October 27, 2006
Welcome to the medical billing blog archive for the week of October 27, 2006.
Here you will find links to every article added to the Outsource Management Group web site during the week of October 27, 2006.
You can browse this week's archives by clicking the "More" button from any of the excerpts below.
The Dermabond Dilemma
When a wound needs closing and a tissue adhesive is used the medical billing coding can be different than when sutures or stitches are used. There are specific guidelines for medical billing when tissue adhesives are used. All adhesives including Dermabond have their own unique way of being reported on medical billing. Consult with Medicare or the carrier to ensure that you are meeting those guidelines prior to submitting your medical billing. There are five basic guidelines that Medicare requires in order to reimburse for this service and many carriers follow the same criteria for laceration closures utilizing Dermabond. You should report G0168 for Medicare patients only; the CPT code …
Will Inaccurate Activities of Daily Living Scores Hurt You?
You bet. ADL coding is something that auditors will be watching heavily and if you’re not calculating yours correctly, you’ll penalized and fined. One way to make sure your facility is well within the guidelines of billing permissibly and ethically is to do a RUG profile of your residents and compare your facility to the state and national averages. You can compare your facility to the other agencies in your state against the national averages at the Centers for Medicare & Medicaid Services Web site:(http://www.cms.hhs.gov/www.cms.hhs.gov/apps/mds). If you find that your facility has far fewer rehab RUGs ending in C’s and far more A’s than the national or state average, than …
Wound Length Matters in Medical Billing
When a patient reports to the ED and requires laceration repair, the medical billing claim needs to address the length of the wound in order to be a properly filed claim. If the wound length is either not addressed or addressed incorrectly, the claim may be either denied, rejected or only partially paid. Additional factors can include whether or not there was a separate evaluation and how the service was managed during the encounter. Make sure all of these factors are documented in your medical billing claim. Laceration repairs are very common in the ED, in fact a nationwide survey showed that every one in fifteen patients presenting in the …
Make Sure Therapy Documentation is Iron Clad
The HHS Office of Inspector General (OIG) has released its 2007 work plan, and it’s drawing ample attention to therapy services. If you frequently bill for therapy services in your practice be sure that your documentation is iron clad to show the necessity of the therapy services. The general overview of the plan includes the OIG planned review of medical necessity, correct billing and proper documentation for Medicare rehab services. Regarding specific facilities, a sampling of hot items on the OIG’s checklist include the following items: *inpatient compliance with the 75% rule for admission criteria. *home health agency compliance with higher therapy paying threshold services. *the medical necessity of skilled …
