Medical Billing Blog: Section - Claims
Archive of all Articles in the Claims Section
This is the archive containing links to all articles written in the Claims 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.
Definity Still Definitely a Problem in 2007
The injectable contract agent named Perflutren better known as Definity has caused a lot of confusion as many providers are billing the incorrect code and Medicare and most other large payors switched the code for this service in late 2005 and 2 years later it’s still showing up on medical billing and causing numerous delays and rejections on medical billing reimbursements. If you’re a service provider that is still billing A9700, you could face delays in getting paid–or even denials on your medical billing claims. If the carrier approves the main echocardiography procedure, then it will usually approve the use of Definity as contrast. If you are not sure of …
Wound Closure Medical Billing -Dermabond or Stitches?
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 …
Is Your ADL Coding Accurate?
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 at your facility to the other agencies in your state and 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 …
Medical Billing for TB Screenings Made Easy
TB is in the news more and more and if you aren’t already seeing an increase in TB screenings, it’s likely your practice could experience it in the future. If you have a medical billing claim involving a patient that is at an increased risk for tuberculosis (TB) infection or is already having symptoms, a TB screening can be performed. If your practice runs these tests, be aware that in many cases, you can get reimbursed for the test as a medical necessity. When processing the medical billing for a TB skin test (86580) or blood test (86480) due to pulmonary TB symptoms or known TB exposure or risk. The …
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 …
To Bundle or Not to Bundle?
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 to the services may be reimbursed. A good example is if a surgeon performed 64 minutes of critical care for a patient in …
Medicare Website Updated to Make Medical Billing Information Easier, Faster to Find
Due to high usage and informational usage by the medical billing community at large, the Medicare website has revamped certain areas to make their site easier to search and access. When a medical biller is looking up information, at the Medicare coverage site located at www.cms.hhs.gov/mcd/search.asp, it is now easier than ever to search for the coverage limitations and other required information that you need. The page is now set up to ask if the biller is asking for a local or national coverage determination to avoid confusion and misinformation that was previously disseminated as there are certain differences between local and national coverages for certain procedures. Medical billers may …
Are You Getting Maximum Reimbursements for ER Dislocation Procedures?
A common occurrence in the emergency is the dislocation of various joints. They are sometimes incorrectly handled as breaks but shouldn’t be and you could be setting your practice up for a denial at best and audit at worst if you report these procedures incorrectly on your medical billing. Even if the reduction of the dislocation fails, the attempt should be reported on not only the medical billing as a procedure but also in the documentation as another procedure will have to be tried to relocate the elbow to its proper placement and you can show the timeline for the necessity of other and more involved treatments. On the claim …
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 …
