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.
Better Reimbursements With Central Venous Access Billing
Make sure that you’re using the proper medical billing codes when reporting CVA services, if you’re not using CPT codes 76937 and 75998, you may not be getting the full reimbursement for this service. If a physician performs an ultrasound guided procedure, the code 76937 will give additional money for the procedure. This code means: ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent real-time ultrasound visualization of vascular needle entry. This means 76937 can be billed separately from the CVA placement code. One thing to note is that this code is only allowed one time per session in medical billing …
Busting the Pediatric Patient History Myth
Patient history, or PHI is an aspect of medical billing that has a myth attached. Contrary to popular belief, it is safe practice to allow any office member to take the review of systems and the family social history. These two evaluation and management history elements can actually be taken by absolutely anyone that is employed by the practice. It is ok in medical billing for even a parent or a secretary to take down this information as long as the information is reviewed and signed off on by the acting pediatrician. The only part of an evaluation and management visit that the physician or nurse practitioner must complete for …
Don’t Sweat "No Fever" Medical Billing
When a patient presents for emergency management services with various symptoms pertaining to the flu and no fever is found, you may be questioning exactly what should be noted in the medical necessity and other medical documentation sections of your medical billing form. You will not want to use this information under the history element. The 1997 “Documentation Guidelines for E/M Services” does not reference pertinent negatives in the context of the history of present illness (HPI). Instead, it references pertinent negatives in the context of the review of systems (ROS). Be certain not to check the associated signs and symptoms box of HPI. Instead, you should count the statement …
Understanding Locum Tenens for Your Medical Billing
Locum tenens is simply when one physician substitutes temporarily for another in the same capacity. There are some differences in billing for services performed by a locum tenens professional, however the 60-day time frame will apply. First and foremost, be sure you are appending modifiers Q5 (Service furnished by a substitute physician under a reciprocal billing arrangement) and Q6 (Service furnished by a locum tenens physician) as appropriate to use. The 60-day rule causes a lot of confusion. Basically, the clock starts ticking from the beginning of service and then runs for 60 consecutive days. It doesn’t matter whether the locum tenens or reciprocal billing physician provides services every day …
Are You Submitting Your DME Claims to the Right Region?
The Centers for Medicare and Medicaid Services are making improvements in their durable medical equipment handling of medical billing departments. Very soon, they plan on implementing new Durable Medical Equipment Regional Carrier (DMERC) responsibilities. The durable medical equipment changes are designed to improve costs, quality of care, and medical billing efficiency. The medical billing regions A and D will replace their DMERCs with Durable Medical Equipment Medicare Affiliated Contractors (DME MACs). This department will handle all the medical billing, and day to day operations such as customer service. A second program, called Program Safeguard Contractors (PSCs) will have the responsibilities of handling any medical billing fraud cases and reviews for …
Getting The Best Myomectomy Medical Billing Reimbursements
If you work in the billing department of a gynecologist’s office, myomectomy coding won’t be unknown to you, but in order to reap the maximum benefits of this procedure, there are a few key components you should keep in mind when doing medical billing for a myomectomy procedure. First of all, there are two major ways to perform a myomectomy: open and laparoscopic. Likewise, there are two sets of current procedural terminology codes that are acceptable to use for myomectomies in medical billing. If you perform a laparoscopic myomectomy, you should either use the medical billing code 58545 (Laparoscopy surgical, myomectomy, excision; 1 to 4 intramural myomas with total weight …
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 …
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 …
Proper Coding for Cervical Vertebroplasty
Some of the confusion about preparing medical billing is that the CPT does not always provide an exact code for a particular procedure, in this case we’ll use percutaneous vertebroplasty of cervical vertebra(e). It’s not a common procedure but it does occur and until recent years did not have its own designation and even today, some payers aren’t up to date on the proper coding to use to report this procedure. Before CPT added percutaneous vertebroplasty codes 22520-22522 in 2001, most payers recommended that coders report all vertebroplasty procedures using 22899 (Unlisted procedure, spine). Most payers still recommend using 22899 code for cervical vertebroplasties, as many carriers aren’t aware of …
Choosing A Medical Billing Company
Deciding to outsource your medical billing is not a decision to be taken lightly, and in the beginning you may not even need to outsource your billing in the beginning. But soon, you will find that your staff is so busy servicing your patients and running your office with its day-to-day goings on, finally you have to look at outsourcing. There have been some horror stories out there about physicians outsourcing their medical billing or practice management to a company and then finding out it cost them even more money because the company just wasn’t up to date on their coding books or simply not experienced enough to handle the …
