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.
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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 …
Can NPP Services Be Reimbursed?
Absolutely, as long as the services meet the minimum criteria and you’re medical billing documentation is ironclad. If you aren’t getting a reimbursement for the services rendered to patients by a nonphysician practitioner (NPP) affiliate with your practice, you’re leaving money on the table for the insurance company that rightfully belongs to your practice. Learn the rules of the carrier and take the time to bill under the NPP provider number and statistics how that over three-fourths of the health plans billed would reimburse at an average rate of 85%. While this isn’t a full reimbursement, it is far better than not receiving anything in return for your services rendered. …
Medical Billing for B-12 Injections
Have you updated your methods for billing for B-12 injections? To eliminate potential medical billing problems, there are five steps to follow to ensure smooth B-12 reimbursement. The first medical billing step is to replace the injection administration codes for the B-12. These codes include the current procedural terminology codes 90782, 90788, and G0351. These medical billing codes were deleted from the 2006 CPT list. The new policy is to use one CPT for the injection: 90772 (Therapeutic, prophylactic or diagnostic injection; subcutaneous or intramuscularly). The second step when doing medical billing for B-12 is to make sure a family physician is present during the entire administration. The medical billing …
Is The Same Day Admission and Discharge Myth Costing You Money?
There is a long held myth in the medical billing community that you can’t bill for an admission and discharge on the same day. However, the truth of the matter is that you can generally bill for a discharge from one facility and an admission to another, as long as the same physician is present for both events. This means that the attending physician will leave one facility and go to the next facility. This is a common occurence with transfers between rehab or psych facilities, or a transfer from a hospital to a nursing home. The dilemma is that since you cannot transfer the patient’s chart from one facility …
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 your facility to the other agencies in your state 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 C’s and far more A’s than the national or state average, than …
Wound Length Matters in Medical Billing
When a patient reports to the ED and requires laceration repair, the medical billing claim needs to address the length of the wound in order to be a properly filed claim. If the wound length is either not addressed or addressed incorrectly, the claim may be either denied, rejected or only partially paid. Additional factors can include whether or not there was a separate evaluation and how the service was managed during the encounter. Make sure all of these factors are documented in your medical billing claim. Laceration repairs are very common in the ED, in fact a nationwide survey showed that every one in fifteen patients presenting in the …
Make Sure Therapy Documentation is Iron Clad
The HHS Office of Inspector General (OIG) has released its 2007 work plan, and it’s drawing ample attention to therapy services. If you frequently bill for therapy services in your practice be sure that your documentation is iron clad to show the necessity of the therapy services. The general overview of the plan includes the OIG planned review of medical necessity, correct billing and proper documentation for Medicare rehab services. Regarding specific facilities, a sampling of hot items on the OIG’s checklist include the following items: *inpatient compliance with the 75% rule for admission criteria. *home health agency compliance with higher therapy paying threshold services. *the medical necessity of skilled …
More Audit Triggers in 2007
In 2007 the OIG is planning on zeroing in on incident to billing claims. In the update issued in October 2006, the HHS Office of Inspector General plans to issue a report on whether you are following all the requirements for incident -to billing, including direct physician supervision. 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 2007 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 …
Medical Billing for Subsequent Hospital Care
A confusing medical billing situation can occur when the ED physician provides subsequent hospital care to a patient. Interpreting the level of eval and management services provided can be a challenge when the coder only has the notes. Many medical billers often err on the side of caution and under-report subsequent hospital care services which results in a much lower reimbursement rate and that hurts the overall revenue flow of the practice. This could occur if a coder fails to realize that she need not satisfy all of the E/M components to report the subsequent care codes. Documentation in the code choices needs to be included as well to insure …
Tuberculosis Test Requires Special Handling
As tuberculosis becomes more prevalent; it’s showing up more often as a coding dilemma. One of the most common questions is if the PPD test should be charged separately and the answer is yes-sometimes. The reason is that when a skin test such as the one for tuberculosis is done, if the results are negative the test will be considered inconclusive for diagnosis; however if the results of the PPD test are positive, then you are opening the door for further visits from a physician and treatment for a condition. If you have no way of knowing the outcome of the test when you are compiling the medical billing, the …
