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.
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 …
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 …
