Archive for The Month of October, 2006
Archive for the Month of October, 2006
Welcome to the medical billing blog archive for the month of October, 2006.
Here you will find links to every article added to the Outsource Management Group web site during the month of October, 2006.
You can browse this month's archives by clicking the "More" button from any of the excerpts below.
Medical Billing Reimbursements Will Increase for Home Care
Many states will be reaping the rewards of increased home care medical billing reimbursements, due to an experiement currently going on in a few states. A few states, such as Wisconsin and Missouri, have been working to come up with a solution for this big expense. Improved medical billing reimbursement and funding may be the answer to improving home care. Wisconsin is one of the few states implementing a program called the Family Care program. This provides assistance for low income senior citizens and disabled people for long term care. These folks already feel the hardship of medical billing costs. The program is designed to ease some of those expenses …
Is The Same Day Admission and Discharge Myth Costing You Money?
There is a long held myth in the medical billing community that you can’t bill for an admission and discharge on the same day. However, the truth of the matter is that you can generally bill for a discharge from one facility and an admission to another, as long as the same physician is present for both events. This means that the attending physician will leave one facility and go to the next facility. This is a common occurence with transfers between rehab or psych facilities, or a transfer from a hospital to a nursing home. The dilemma is that since you cannot transfer the patient’s chart from one facility …
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 …
More Audit Triggers in 2007
In 2007 the OIG is planning on zeroing in on incident to billing claims. In the update issued in October 2006, the HHS Office of Inspector General plans to issue a report on whether you are following all the requirements for incident -to billing, including direct physician supervision. The OIG wants to know whether these services met the Medicare standards for medical necessity, documentation and quality of care, according to the OIG’s 2007 Work Plan. Other topics include: Other things that will be closely studied in the report include global periods and how they are determined in the medical billing. The agency will also be in the lookout for assignment …
Medical Billing for Subsequent Hospital Care
A confusing medical billing situation can occur when the ED physician provides subsequent hospital care to a patient. Interpreting the level of eval and management services provided can be a challenge when the coder only has the notes. Many medical billers often err on the side of caution and under-report subsequent hospital care services which results in a much lower reimbursement rate and that hurts the overall revenue flow of the practice. This could occur if a coder fails to realize that she need not satisfy all of the E/M components to report the subsequent care codes. Documentation in the code choices needs to be included as well to insure …
Tuberculosis Test Requires Special Handling
As tuberculosis becomes more prevalent; it’s showing up more often as a coding dilemma. One of the most common questions is if the PPD test should be charged separately and the answer is yes-sometimes. The reason is that when a skin test such as the one for tuberculosis is done, if the results are negative the test will be considered inconclusive for diagnosis; however if the results of the PPD test are positive, then you are opening the door for further visits from a physician and treatment for a condition. If you have no way of knowing the outcome of the test when you are compiling the medical billing, the …
Critical Care Medical Billing
Critical care is often confusing in the world of medical billing as a number of factors can come into play and whether you need to bundle services or not will also be an issue. Due to the nature of the critical care – notes are often made hurriedly and in many cases are incomplete and it is up to the medical billing professional to put it all together into a package that will be clear, concise and easy to read for the carrier so that the services may be reimbursed. A good example is if a surgeon performed 64 minutes of critical care for a patient in cardiac arrest. During …
