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.
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 …
Getting Rid Of Denial Claims For Well Visits
You should always pay good attention to what payers are perceiving when looking at your medical billing. Even though your practice may view the coding procedures a certain way, it is not always the case that your payer will understand them in the same fashion. It has recently been shown that there is a major discrepancy when it comes to dealing with the billing of the procedure code 96110. The fact is that this procedure code should never be lumped in with well exam codes, except for special circumstances. What can actually happen to cause problems is that the miscommunication between medical billing for your practice and the payers are …
History of Present Illness and Your Medical Billing
When to combine history of present illness and review of systems causes a lot of confusion among many practices. However it is possible to do and is perfectly acceptable to document an element once to account for HPI and ROS. In many instances, a physician will leave a medical billing company with tons of documentation for a review of systems, but not enough information for the history of present illness. The physician is missing out on some additional revenue by not documenting the ROS. The CMS states that physicians do not need to document an element two times for medical billing purposes. It is perfectly acceptable to use one element …
ADD/ADHD Medical Billing Reimbursements
Attention providers, are you getting reimbursed for your medical billing ADD medication rechecks? With the rise of ADD/ADHD in America, it is very important to medical practices to understand how to get paid. When dealing with mental health diagnoses, you walk a fine line with most insurance companies. There is one way most payers will reimburse your ADD/ADHD medical billing. Most physicians like to code ADD medication rechecks with the 90862 medical billing code. This code means, pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy. Although there is no problem using this CPT code with the diagnosis 314. (Hyperkinetic syndrome of childhood), …
Medical Billing Codes 70551-70553
Using Medical Billing Codes 70551-70553 for MRI and IAC Properly There are many times in medical billing when a patient receives both an IAC and brain MRI. The question is, can the medical biller be reimbursed for both of these services separately? If the medical billing personnel asked the American Medical Association this question, the answer would be simple. They would say that you can absolutely get separately reimbursed for an IAC and brain MRI in the same session. Realistically, however, this is not exactly true. The requirement to code for both x-rays is that they need two separate and distinct exams. Each exam is required to have distinct findings. …
