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.
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 …
Filing Locum Tenens Claims and When to Use Modifier Q6
Locum tenens is a confusing situation in the case where a physician takes a vacation or otherwise isn’t available and hires a physician to see patients on site, Medicare can deny the claim unless it is properly documented. The reason is that Medicare is very strict about seeing specific modifiers on medical billing claims that involve a substitute or locum tenens physician. Further, your medical billing claim must have the time limits observed for locum tenens doctors. Otherwise, Medicare won’t pay for their services rendered to patients. Also, you can’t hire a locum tenens as extra staff. This includes situations where the regular attending physician goes on vacation, has an …
Are Your Sick Visit Claims Costing You?
If you don’t properly meet certain requirements for the use of Modifier 25 in your sick visit bundled medical billing claims, you could very well be losing money and not know it. There are some simple rules to follow to ensure that you’re getting the best reimbursements for your claims. First of all, make sure that you know exactly what the payer requires for reimbursement on these claims. Next, make sure you document exactly what caused the encounter and what the outcome was. This shows a logical flow of information and will better help the payer see that the services rendered will qualify for full reimbursements. Additionally, be aware that …
Separate Charges for Separate Procedures
Neonatal patients seem to present confusing scenarios for many medical billers. It could be due to the fact the patient is so tiny that many of the procedures seem related to split out but in many cases, claims for neonatal services are incorrectly bundled together. A good case in point would be if a neonatal patient presented with a fever. The physician then did a urine catheterization (51701) and a spinal tap (62270) in the office. In many cases, the medical biller might have bundled these claims together but that would be incorrect as they are two distinctly different procedures even though they were performed at the same visit. Also, …
You’re Coding Modifier 59 Correctly With These Tips
Using a modifier incorrectly can cost you in terms of reimbursements and time. Carriers are closely scrutinizing medical billing claims for incorrect usage of modified 59. There are two main areas that you can concentrate on to avoid getting his with denials or pay backs and insure that you use the modifier correctly. A study of the OIG found a 40% error rate for modifier 59 and you can double check your billing. First of all, in order to use modifier 59 there must be services performed at separate regions. Fifteen percent of the OIG’s audited claims using modifier 59 had procedures that weren’t distinct because “they were performed at …
Avoid Reductions By Properly Reporting Modifier 52
Avoid Fee Reductions By Reporting Modifier 52 Properly If it has become a habit to append modifier 52 every time your medical billing has a service that doesn’t exactly meet a CPT code description, you could be unknowingly cutting your compensation on your submitted claims. AMA CPT guidelines state that modifier 52 should be used when the physician partially reduces or eliminates a service or procedure at his own discretion. The CMS guide lines state as follows: “when a procedure/service performed is significantly less than usually required”. What you should do is report the code as usual for the procedure and then append modifier 52 to show that the services …
Oh No! Medicare Computer Glitch!
The software switch is over at Medicare, but keep your eyes peeled for medical billing mistakes coming from the Centers for Medicare & Medicaid Services. Medicare Part B carriers have switched software systems over to a new billing software that is part of a multi-carrier system. Some carriers have already switched to the system, some are in the process of switching and some will change in the near future, many providers are implementing this switch in January 2007. During the Centers for Medicare & Medicaid Services software switch, there were many medical billing claim errors. Errors that have occurred or could possibly occur again in the future include: missing updated …
Critical Care Evaluation and Management Reimbursements Made Easy
Pediatrics has many medical billing codes that were created just for the use of describing procedures. However, there are other areas of medical billing that do not have these specific codes for children. This can make coding hit or miss unless you know the nuances of what the carrier wants in order to get the maximum reimbursements for procedures performed. A common dilemma is with CPT code 99293 and its use for outpatient emergency room exams for an infant or if code 99291 should be used. The medical billing code 99291 means critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes. You would …
Are Your Arteriogram Claims Getting Paid?
This article will make you a bilateral renal arteriogram medical billing pro. There are many code confusions with this increasingly common surgical procedure. Some payers will not pay a cent if you submit your medical billing with the wrong code combinations. However, doing medical billing for renal arteriograms can be quite simple. There are two codes one should report when doing medical billing for a renal bilateral arteriogram. The current procedural terminology code 36245 should be reported twice. Then the Current Procedural Terminology code 75724-26 should be reported. Do not make the mistake in adding a G0275 to your claim because the renal arteriography already includes that service. If you …
Is Sloppy Coding and Lack of Time to Follow Up Hurting Your Bottom Line?
In a word: yes. If your staff has gotten sloppy in their compilation of your medical billing claims and your office is so busy that no one has time to follow up on medical billing claims; it is costing your practice in the form of real dollars. If you’re not already outsourcing your medical billing, your practice is most likely part of the statistic that shows that nearly one fourth of all medical practice income is lost due to under pricing, under coding, missed billing and claims that go unreimbursed. Imagine if you could add up to one extra fourth of your business income; would you expand your practice? Add …
