Medical Billing Blog: Section - Audit
Archive of all Articles in the Audit Section
This is the archive containing links to all articles written in the Audit section of our blog.
Click any of the article links below to read the entire article or browse another section to the right to read articles on another subject.
Outsourcing a Dirty Word toYou?
The word “outsourcing” has become a dirty word for many physicians that have been burned by medical billing companies that either outsourced their claims to medical billing companies that use neither secure networks nor adhere to HIPAA regulation in order to maximize their profits; or the outsourcing company just turned out to not be reliable and it wound up costing the practice money to utilize their services. Don’t let a bad experience keep you from partnering with a legitimate medical billing company that can not only help you get your reimbursements faster but also realize great profits by maximizing every single medical billing claim that is filed to make sure …
October Updates Are In Effect!
If you haven’t already, make sure that your staff is using the updated CPT codes that were released in October 2008. Not doing so can lead to kick backs that will require more staff hours to research, redo and resubmit and if this happens on a number of claims it can seriously affect your reimbursements and in turn – slow your revenue flow to a mere trickle. One way to avoid this dilemma is to outsource your medical billing and yes, there are some horror stories out there about outsource companies that threw away patient billing, had lax attitudes towards billing submissions and wound up costing the physician a lot …
Tips for Getting Maximum Reimbursements for Ulcer Claims
Often, patients who are confined to beds for long periods of time develop pressure ulcers. They are painful and need to be treated as quickly as possible as infections can set up within them that can be life threatening when the patient is already in a weakened condition. When a service is performed for a patient such as treatment of a pressure ulcer on an area of the body such as the lower back, the usual manner of treatment is to remove any devitalized tissue from the ulcer using a water jet and forceps. The area is then covered to allow it to not be rubbed on so the skin …
Report – HHA’s and Hospices Are Billing Medicare Accurately
A recent report showed that HHA’s (home health agencies) and hospices are billing Medicare on an accurate level according to a report compiled by the CMS’ Comprehensive Error Rate Testing. The report showed that HHAs had a 1.4 percent error rate and hospices a 1.0 percent error rate in the November CERT report, which covers claims from April 2006 to March 2007. DME (durable medical equipment) suppliers had a wide range of error rates broken out by supplier type. The lowest was 0.6 percent for a medical supply company with prosthetic/orthotic personnel certified by an accrediting organization while the highest was a whopping 51 percent for “unknown supplier/provider” where it …
Home Care Payments Will Be Getting Close Scrutiny in 2008
On October 17, 2007 – the Senate Finance Committee met to discuss ways to pay for a fix to physician payment rates in 2008 and 2009, according to press reports. The heart of the meeting was to talk about the $30 billion in cuts needed to avert the doc pay cut and make other Medicare changes, and home care once again landed on the chopping block to have many home services radically reduced or have their funding cut all together.Some of the specifics of the home care that were discussed to be directly affected were wheelchair suppliers and oxygen providers are under discussion for reimbursement reductions to pay for the …
Emphysema Diagnosis Coding Tips
Want to know why your emphysema claims aren’t being fully reimbursed? Often, the reason is that you’re lacking two things when you submit your claim. You aren’t being detailed enough with your coding and your don’t have enough detailed medical documenation to back up your full diagnostic testing that is required to accurately diagnose emphysema and narrow the degree and type. When you’re compiling the medical billing for an established patient with active emphysema (492.8, Other emphysema) and they present and are complaining of shortness of breath (786.05); the physician provides inhalation treatment, trains the patient on using the nebulizer at home, and provides an expanded problem-focused examination and medical …
Common Varicose Vein Treatments
As more research is done regarding the relationship between varicose veins, blood clots and other complications; more and more patients are having the simple surgery and as a result there has been confusion about exactly how to code this procedure to get the fairest reimbursement for this service. Once you know the basics for setting it up – it’s easy! A good example would be if a patient with varicose veins in her left lower leg presents to the ED and is stating she has severe pain in her leg. One of the veins is clearly bleeding so the doctor will use a standard suture ligation to stem the bleeding …
RVUs Made Easy!
RVUs (relative value units) cause a lot of confusion in the medical billing world when you’re dealing with imaging procedures. It’s really just a matter of listing your services rendered logically then tallying them up from largest to smallest. For example, imaging codes aren’t discounted under the multiple-surgery payment reduction, so you typically list surgical codes first, in order by RVU, then the imaging codes. Your final coding report should look like this in order : * 35471 main coding * 36245 main coding * 75722-26-59 procedure with modifier * 75966-26. procedure with modifier Just remember to list the “heavier” codes at the top of your list and the lighter …
Audit Triggers to Watch Out For in 2008
In 2007 the OIG zeroed in on incident to billing claims. The HHS Office of Inspector General plans to issue a report on whether all the requirements for incident-to billing, including direct physician supervision are being followed. 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 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 violations where the physician has billed the patient more than Medicare co-pays …
Getting Place of Service (POS) Codes Right
For correct payment amount, accurate place of service codes are required. The failure to provide the correct place of service code with the correct current procedural terminology code for E/M services will cause your claim to get denied. One of the most important elements of medical billing is the place of service code. In medical billing, the place of service codes for an evaluation and management are commonly misused. There are several current procedural terminology codes for an evaluation and management session that correspond to different medical billing place of service codes. When using CPT 99341 (Home visit for the evaluation and management of a new patient) through 99350 (which …
