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.
Critical Care Medical Billing
Critical care is often confusing in the world of medical billing as a number of factors can come into play and whether you need to bundle services or not will also be an issue. Due to the nature of the critical care – notes are often made hurriedly and in many cases are incomplete and it is up to the medical billing professional to put it all together into a package that will be clear, concise and easy to read for the carrier so that the services may be reimbursed. A good example is if a surgeon performed 64 minutes of critical care for a patient in cardiac arrest. During …
Using an Extended History in Your Medical Billing
You can use the 1997 audit guidelines that state an extended history for a patient can be created by updating the status of at least three chronic or inactive conditions that the patient has or has had. It is not imperative that the information be placed in the history of present illness (HPI) section. However what is imperative is that your medical billing reflect the medical documentation of all illness that you choose to use – both past or present- to create an extended history of illness. For audit purposes it is helpful to have the notations in both the HPI section and the assessment section. Most physicians will make …
Medical Billing Dilemma – Billing Global
Babies are going to come when they are good and ready and when a baby is being born there is nothing that can be done to stop it in the event of a normal vaginal birth, a doctor may not be on hand to deliver the baby. A situation that 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 …
When You Can Discard Modifier 25
Modifier 25 cuts a fine line in the medical billing world. Auditors tend to target medical billing claims with this modifier however CMS recently clarified again that they do indeed want this modifier used where appropriate in medical billing claims. The best rule for when to use modifier 25 is met when your physician provides a significant and separately identifiable E/M service on the same day as a procedure with a global period. If your services meet that requirement, you are free to use the modifier without worry in your medical billing claims. The CMS updated the usage language of the modifier in the release on August 20, 2006 and …
Medical Billing Dilemma – Medial Dislocation
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 …
Medical Billing Watch – CMS Watching Radiologist Billing
A two year study by Medicare showed that Radiology providers billed Medicare inappropriately for a staggering 100,034 radiology services according to HHS Office of Inspector General (OIG). This translated into Medicare overpayments to the tune of $20 million dollars where Medicare Part A covered radiology services but providers still billed Part B for the technical component of those services as if they were outpatient services according to the OIG report. In a nutshell, Medicare paid these claims twice. Prepayment edits are the proposed solution to this matter and would disallow the submission of any medical billing claim that had the same services under Part A and Part B claims. If …
The Upcoming Changes to Power Mobility Devices are Clarified by CMS
Power mobility devices (PMD) have become a very big business and also given patients a new lease on life by being able to get around in an easier fashion. Previous reports had stated Medicare would no longer pay for PMD devices, however Medicare will still pay for a Group 2 power mobility device (PMD) when appropriate according to a memo released by the Centers for Medicare and Medicaid Services. A fact sheet released by CMS on Sept. 20 clarifies this as saying many facilities misinterpreted that medical billing claims for PMD devices would not be paid, however that is not correct. When the new statues went into effect on October …
Will Outsourcing Your Medical Billing Get Your Claims Paid Faster?
You bet it will. Outsourcing your medical billing is a big decision but it is also a very smart one. You are not only freeing up your staff to help run your busy practice, you are allowing the professionals whose sole business is to keep up with the fast paced and ever changing coding and regulation changes in our industry, take care of all of your billing and coding needs. You have a busy practice, your staff is busy servicing patients and generally doesn’t have the free time to devote to seeing what claims were paid and only partially paid. Your medical billing outsourcing partner has the knowledge, experience and …
Medical Billing Dilemma – Break Out Services for Medicare
Did you know that you might be missing a full reimbursement for well-woman care if you’re not breaking out the breast exam and pap smear? If the medical billing claim is for a well woman exam; in almost every instance, Medicare will allow you to break out the claims and get reimbursement for both services. If the physician provides a complete well-woman exam for a Medicare patient, you should report G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination) for the breast and pelvic exams. When the physician also obtains a Pap smear, use Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to …
Elements to Get Your Ob-Gyn Ultrasounds Paid
A type of medical billing claim that prompts a lot of confusion, is the ultrasound. Nearly three-quarters of women will undergo at least one ultrasound during their pregnancies, normally between 18 to 20 weeks gestation. In fact, the American College of Obstetricians and Gynecologists (ACOG) maintains that one complete ultrasound should be included as a part of routine obstetric care. Knowing whether to code as a routine ultrasound or detailed ultrasound – check the reasons why it was done. One confusing point is when a patient is suspected of having abnormalities of the uterus or placenta; an ultrasound can determine whether or not further medical intervention is necessary during the …
