Archive for The Month of December, 2006
Archive for the Month of December, 2006
Welcome to the medical billing blog archive for the month of December, 2006.
Here you will find links to every article added to the Outsource Management Group web site during the month of December, 2006.
You can browse this month's archives by clicking the "More" button from any of the excerpts below.
A Good Solution for Colonoscopy Confusion
There has been growing confusion over exactly how to report the growing number of colonoscopies that become “diagnostic”. This procedure has become more and more commonplace and the debate continues. Sometimes the best answer is the most obvious, contact the carrier and ask them how they want the procedure reported on your medical billing. Colonoscopies are part of a check up for most individuals over the age of 50, however when the colonscopy finds a polyp, you should normally use the polyp diagnosis in your medical billing claim and not the screening V code. The exception to this rule would be if the physician discovers a polyp during the screening, …
Interesting Study About Doctor’s Charges
A recent study came up with a staggering conclusion, nearly three-fourths of U.S. consumers said they know little to nothing about how the fees of their doctors compared to other physicians in a similar practice. Furthermore the study concluded the most Americans actually underestimate what their providers charge. For example, most adults (65 percent) think that, in general, a high-priced doctor in the U.S. charges two or three times as much for the same procedure as a low-priced doctor. In fact, a review of HealthMarkets data for several selected procedures shows that some doctors charge nearly 10 times what others charge for the same procedure. Additional information gained in the …
Noting When Radiation Therapy Is Twice Daily?
The opinion released by The Centers for Medicare & Medicaid Services (CMS) has said you can bill for twice-daily radiation therapy as long as the treatments happened in “different sessions.” But you have to be careful to follow the rules and avoid getting into trouble by billing for “different sessions” that were really just parts of the same session. A procedure called “hyperfractionation” is defined as any technique of radiation treatment that delivers more than one treatment session per day. If you’re stumped how to make sure that a session is separate from another session, just know this: to be considered separate, two sessions should be at least six hours …
Medical Billing for Tissue Adhesives
One point that many medical billers find confusing is the correct procedure for coding the use of tissue adhesives when used for wound closures. The answer to this question will be different depending on which entity is paying the medical billing claim. When you code for the use of tissue adhesives, including Dermabond; Medicare has its own guidelines for reporting this procedure that you need to follow to be reimbursed. You should report G0168 for Medicare patients only. If you are reporting the procedure for a non-Medicare patient, you should use the CPT code that is the equivalent and that is 12001-12018 series (Simple repair of superficial wounds …). Another …
Medical Billing Claims for Tests That Are Normal
If you have a medical billing claim to file and the test that was performed on the patient comes back without any definite diagnosis, don’t discount the fact that you won’t be reimbursed for the medical billing, instead you need to determine whether the test result is normal, negative, or inconclusive and that final reading will determine how your medical billing claim should be handled. If your test comes back inconclusive, you shouldn’t report a diagnosis that the laboratory gives you after a pathology test. Many practices mistakenly report the lab’s diagnosis because they feel that claim will legitimately get paid. A good rule of thumb is to code the …
Wrong Place of Service Can Cause Denials
Check and double check your medical billing claims for the notorious wrong place-of-service (POS) code that can spell denials and delays in getting paid for your observation services. A good general guideline to follow is to use POS 22 (Outpatient hospital) only for observation codes 99217 (Observation care discharge day management …) and 99218-99220 (Initial observation care, per day …). Be sure not to use POS 21 unless the patient has been formally admitted. You will need to split out the time the patient was in observation before they were admitted and use codes 99211-99215 for any E/M services rendered on the second day and before the patient is discharged. …
The Three R’s of Medical Billing
If you’re seeing a lot of that other “R” word: rejection; in your medical billing claims – it might be a case of your medical billing claims not meeting the basic requirements for payment. Traditionally, to code a consultation (99241-99255), the encounter had to meet three requirements: *Request for opinion*Rendering of services*Report to the requesting source. Medicare’s new guidelines requires that a physician make the require or other appropriate source for ordering services and procedures. A good way to make sure that there is no denial of the claim, is to have a written reason and request showing a logical progression of the services from the necessity and nature of …
Correct Medical Billing for Parent Consultations
The world of pediatric medicine is fast paced and along with unpredictable kids come unpredictable medical billing situations. If you process medical billing for pediatric physicians, you may or may not have run across a situation for determining what diagnoses would apply when parents come in to discuss their child’s health issues. If you’re wondering if there is a single code, the answer is yes. A parent conference falls under V65.19 (Other persons seeking consultation; other person consulting on behalf of another person). In other words, the code describes a person seeking “advice or treatment for non-attending third party.” Since a parent has the right to discuss the treatment and …
Do You Report Separate Codes for Separate Excisions?
One daily dilemma that many in the medical billing industry face are when to bundle a claim for services rendered and group like services and when to report them separately. Ultimately you want fair reimbursement for all services rendered to patients and with the fee structures for repayment on medical billing claims, it can be confusing about when exactly to combine and when to split services out as individual procedures. A good example would be if a physician debrides two sites with infected decubiti, technically, it would be two procedures and in most cases could be reported as separate. A good rule of thumb would be to first look at …
Do You Know About the New Mandatory CMS-1500 Form?
Head’s up medical billers, by April 2007, it will be required that you start using the new CMS form that accommodates the new National Provider Identifier (NPI) numbers. “Because of the number and types of changes that the new CMS-1500 includes, you will need to update your billing software programs to print your claims correctly”, says Cyndee Weston, executive director of the American Medical Billing Association. That means now is the time to update your billing system software to ensure your office is ready. If you don’t already outsource your medical billing claims and you don’t want to spend the money for an upgrade – it may be time to …
