Medical Billing Blog: Section - General Info
Archive of all Articles in the General Info Section
This is the archive containing links to all articles written in the General Info 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.
Wrong Place of Service Can Cause Denials
Check and double check your medical billing claims for the notorious wrong place-of-service (POS) code that can spell denials and delays in getting paid for your observation services. A good general guideline to follow is to use POS 22 (Outpatient hospital) only for observation codes 99217 (Observation care discharge day management …) and 99218-99220 (Initial observation care, per day …). Be sure not to use POS 21 unless the patient has been formally admitted. You will need to split out the time the patient was in observation before they were admitted and use codes 99211-99215 for any E/M services rendered on the second day and before the patient is discharged. …
The Three R’s of Medical Billing
If you’re seeing a lot of that other “R” word: rejection; in your medical billing claims – it might be a case of your medical billing claims not meeting the basic requirements for payment. Traditionally, to code a consultation (99241-99255), the encounter had to meet three requirements: *Request for opinion*Rendering of services*Report to the requesting source. Medicare’s new guidelines requires that a physician make the require or other appropriate source for ordering services and procedures. A good way to make sure that there is no denial of the claim, is to have a written reason and request showing a logical progression of the services from the necessity and nature of …
Do You Report Separate Codes for Separate Excisions?
One daily dilemma that many in the medical billing industry face are when to bundle a claim for services rendered and group like services and when to report them separately. Ultimately you want fair reimbursement for all services rendered to patients and with the fee structures for repayment on medical billing claims, it can be confusing about when exactly to combine and when to split services out as individual procedures. A good example would be if a physician debrides two sites with infected decubiti, technically, it would be two procedures and in most cases could be reported as separate. A good rule of thumb would be to first look at …
Do You Know About the New Mandatory CMS-1500 Form?
Head’s up medical billers, by April 2007, it will be required that you start using the new CMS form that accommodates the new National Provider Identifier (NPI) numbers. “Because of the number and types of changes that the new CMS-1500 includes, you will need to update your billing software programs to print your claims correctly”, says Cyndee Weston, executive director of the American Medical Billing Association. That means now is the time to update your billing system software to ensure your office is ready. If you don’t already outsource your medical billing claims and you don’t want to spend the money for an upgrade – it may be time to …
Medical Coding for Estrogen Withdrawal
Put yourself in this medical biller’s shoes and see if you would file this claim correctly. A patient that recently had a hysterectomy presented to the ED with symptoms needing treatment. The physician noted that the patient was suffering from “estrogen withdrawal with menopausal symptoms.” A level three evaluation and management service was performed on the patient; what diagnosis code would you use? There’s no specific code for estrogen withdrawal. Stumped? In this case you should use more than one code as there is no specific code for this service. Break out the claim to show the patient’s main complaint and reason for the ED visit and then to show …
Thinking About Outsourcing Your Medical Billing?
Outsourcing has become a dirty word in many industries due to the substandard nature of the work that is produced in many niche markets. However, with a little due diligence and making a smart choice with the company that you choose to partner with for your medical billing – it can be a rewarding experience for your practice. A medical billing partner like Outsource Management Group can not only process your medical billing, they also have practice management services that can help you keep tabs on your accounts receivable so you have a steady influx of revenue at all times. Another great feature of outsourcing is that OMG can get …
Are You Properly Handling PHI?
In medical billing, PHI is personal patient information that should only be shared with covered entities. It is not only unethical to release a patient’s medical billing PHI to outside sources but it can ruin your business as well. An example of wrongly shared PHI is at the University of Missouri Health Care. Currently over 800 patients have a class-action lawsuit filed against them. The patients claim their confidential medical billing records were released to a home health provider called Option Care. Option Care apparently used the information and contacted the patients trying to sell them pricey medications. They also tried to convince them that their doctor, Dr. Paul King, …
Rejected Claims Hurt Revenue
In the fast paced world of medical billing, it can be difficult for your staff to keep up with not only a busy practice, patient phone calls, needs that crop up and then the medical billing too. If a member of your staff misses a line item on your medical billing or uses an out of date code, it can directly affect your revenue in the form of a claim that isn’t fully paid or worse a rejected item that requires your staff to pull the file, review the documentation and then resubmit the claim to the carrier. This takes valuable time away from your practice and has your staff …
Proper Reporting for Varicose Vein Repair
Varicose vein treatments are becoming more and more frequent as more patients are urged to get them treated to stave off the possibility of blood clots and other issues that can crop up later if they are left unaddressed by the patient. However reporting the varicose vein treatment procedure on the medical billing may be a little confusion for some; once you know the basics for setting it up – it’s easy! A good example would be if a patient with varicose veins in her left lower leg presents to the ED and is stating she has severe pain in her leg. One of the veins is clearly bleeding so …
Want to Outsource Your Medical Billing But Hesitate?
The word “outsourcing” has become a dirty word for many physicians that have been burned by medical billing companies that either outsourced their claims to medical billing companies that use neither secure networks nor adhere to HIPAA regulation in order to maximize their profits; or the outsourcing company just turned out to not be reliable and it wound up costing the practice money to utilize their services. Don’t let a bad experience keep you from partnering with a legitimate medical billing company that can not only help you get your reimbursements faster but also realize great profits by maximizing every single medical billing claim that is filed to make sure …
