Are Your Using the Common Working Files With CMS?

The biggest medical billing problem is getting denied payment for a claim. A service for which many patients are denied is smoking or tobacco-use cessation counseling. Payers have a hard time paying for this service. The patient either has no coverage, or is only allowed a certain amount of counseling sessions for the smoking cessation purpose. What happens if another physician has already done medical billing for these counseling sessions? Chances are, you would not get paid. The centers for Medicare & Medicaid Services have come up with a medical billing solution to let you know how many sessions a patient has already used.

Let’s say you know your patient is allowed three counseling sessions for smoking cessation per year. How would you know if your patient has already had medical billing done by another doctor for that reason? By using the Common Working File (CWF). This is a database that will tell the provider just how many visits that patient has already used towards the tobacco cessation-counseling limit. It will, in essence, tell you if your medical billing will be denied for a frequency of service limitation.

You will be able to access this pertinent medical billing information by entering the health insurance claim number (HICN) of the patient. This number, along with the information retrieved by that number is to be used with confidentiality. Be sure to protect you patient’s medical billing PHI with your practice’s life. A good medical practice is one that upholds integrity with medicine, medical billing, and patient information. Be sure to keep the HICN numbers behind lock and key, or a password protected computer system.

The CWF database may help your practice improve medical billing reimbursement. If you see that a patient has used up all counseling sessions, you may deny service. The Common Working File is one effort CMS has made to create simpler medical billing.

View all Articles by: Melissa C. - OMG, LLC. CEO