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.
Global Billing for Ob-Gyn Services
One of the common dilemmas in medical billing for Ob-Gyn services is how to report the birth of a baby when there was no doctor on hand to deliver the newborn. When the delivery is progressing trouble-free, it isn’t uncommon is for a nurse to deliver a baby when the ob-gyn is in the next room doing a procedure on another patient such as an episiotomy; then the question arises, can the service still be billed globally? Fortunately in many cases you can. It is up to the individual payer and you can find out quickly by either checking their guidelines or website to see if the service will be …
CCI Updates You Need to Know
In the most recent updated of the Correct Coding Initiative (CCI) there are a number of edits you won’t want to miss if the services to the patient include debridement and treatment on the same burn site. CCI version 13.1 outlaws reporting a pair of debridement codes with certain burn treatment codes in most situations. However, CCI now bundles 11000 (Debridement of extensive eczematous or infected skin; up to 10 percent of body surface) and 11040 (Debridement; skin, partial thickness) into 16020 (Dressings and/or debridement of partial thickness burns, initial or subsequent; small [less than 5 percent total body surface area]), 16025 (… medium [e.g., whole face or whole extremity, …
Held Up Medical Billing Claim? It Might Be the Zip Code
At the beginning of 2007; medical billing claims that are submitted to Medicare for reimbursement need to have a zip code or you can count on a delay. A National Provider Identifier requirement to include your zip code on all billing transactions took effect Jan. 1. This included all bills including RAPs, and providers must report a five or nine-digit zip code for their primary facility and its subparts. Claims without the zip codes will be returned to provider (RTP’d) with reason code 32114. This will affect any facility that does medical billing claims for Medicare reimbursement. Many providers were unaware of the new requirement and a large amount of …
When to Provide Family and PH V Codes
With all of the various codes that make up medical coding, it can be confusing when you’re separating out closely related codes to find the best fit for your medical billing claim. One situation is when it comes to figuring out the difference between both personal and family history V codes. Basically, what you need to remember is that the V codes are there to help give a window into past patient history. If there is an ongoing medical condition, the V codes can be used to tell the tale. When looking into personal history, you can find out more about any prior procedures, hospitalizations and operations, as well as …
Knowing When It is Time to Outsource Your Medical Billing
It’s hard to let go of what you might deem the financial control of your practice. Hiring a medical billing consultant can seem like you’re adding expenses instead of cutting them down, especially if you have never outsourced your billing. If you’ve always discounted outsourcing your medical billing claims because you feel as though you would be relinquishing control over your billing, read on – you’ll find that is not the case. Actually outsourcing your medical billing and coding needs through a consultant is one of the smartest business moves you can make. Don’t think you have to use a local company, many medical billing firms have branch offices in …
Medical Billing Basics – How it Starts
If you’re wondering how your medical billing gets to the outsourcing company, the answer is carefully and securely. The patients are seen as usual in your office, your staff creates the records for billing just as they always did. If you are still using paper files your claims will need to be scanned and hand entered into the medical billing system, if you transmit electronically your staff will need to only access the program and transmit the chosen claims to be processed by the medical billing company. The data will transmitted to the medical billing company who will code and double check your medical billing claims to insure they are …
Differentiate Between Facial and Dental Nerve Blocks in Your Medical Billing
When you have a procedure that can cover two close but distinctly different areas such as a facial and a dental nerve block, you need to make sure that your claim encompasses exactly the procedure that was done or you may wind up with a denial of your claim. A common situation would be if the ED physician performed a diagnostic nerve block on a patient complaining of pain in the floor of her mouth and her bottom set of teeth. You would want to be certain that you chose 64402 (Injection, anesthetic agent; facial nerve) for facial nerve blocks, not blocks in the mouth or jaw. The determining factor …
Afraid of Under-Reporting Neonatal Services?
Under-reporting medical billing claims is unfortunately common and it costs revenue as you’re not being fully reimbursed for services rendered. Learning the exceptions to the bundles will allow you to break out services that can be billed alone – once you start investigating neonatal services you’ll realize quickly that you may have very been missing legitimate reimbursements. A scenario that isn’t uncommon is when a doctor attends a delivery of a 28-week gestation baby. The infant received positive pressure ventilation (PPV) in the delivery room (DR) with mask and bag for absent respiratory effort at birth. The baby was then intubated in the delivery room and received PPV on transfer …
Tips to Get Your Consultation Medical Billing Reimbursed
Since consultation requirements have increased in the last year as far as criteria for getting them reimbursed in your medical billing claims, there are some criteria you must be certain that your claims meet in order to justify using codes 99241-99255. It used to be simple and medical billing consultant merely had to meet the three “R’s” in order to justify medical billing claims for consultations. However the criteria for what does and does not constitute a consultation has changed and in order to make sure that your medical billing claims are paid, you need to reacquaint yourself with the three R’s of medical billing for consultations. The three R’s …
Medial Dislocation – Billing it Right
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 …
