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.
9-Day Delay May Turn Into 12 Days
No doubt you’ve heard about Medicare holding all claims from Sept. 22 through Sept. 30, as required by the Medicare Modernization Act. The Centers for Medicare & Medicaid Services had claimed that all of those claims would be paid promptly on Oct. 2. But now it turns out that may not be strictly true. Some larger carriers have reported they may have been notified that there may be a delay in mailing out checks, so this may turn into a 12 day holding. Make sure your office staff knows about the September delays in medical billing so they don’t waste time tracking claims. Additionally, make sure on your Medicare claims, …
Avoid Denials with Proper NCCI Edits
July 2007 will bring more NCCI edits that you need to know in order to avoid denials and get maximum reimbursements on your medical billing claims. This group of edits will mainly affect emergency room practitioners and physicians and nurses that treat patients in nursing homes. The codes that were changed in the upcoming release were codes 99281-99285 (Emergency department services) are considered component codes of the more global 99304-99306 codes (Initial nursing facility care). This means if a single physician provides a level-two ED service along with a level-two initial nursing home service, you should only report 99305 (Initial nursing facility care, per day, for the evaluation and management …
More Information About Medical Billing Modifiers
Many medical billing claims get rejected for the smallest of mistakes. In many cases it can be something as simple as an incorrectly used modifier causing your claim to be rejected by the carrier. Modifier 25 which reads , “Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service” is kind of a catch all modifier for procedures that may not have an exact coding you can assign. In the previous wording for Modifier 57 it caused some confusion with Modifier 25. If you haven’t updated your CMS coding, be sure you have the latest as 57 now simply …
Chronic Bronchitis Medical Billing Claims
If your medical billing claims for patients who present and are diagnosed with chronic bronchitis are getting denied payment by the carrier; take a very close look at the code you’re using to report this condition. One of the biggest reasons chronic bronchitis isn’t paid on a claim is because it is reported as a general chronic code using 491.9, Unspecified chronic bronchitis. The trick is to forego choosing the 491.9 as the ICD-9 will lead you to do. Instead look for the diagnosis of the possible cause of the chronic bronchitis such as chronic asthma which has its own specific code. If procedures were performed on the patient, note …
Getting Your Medical Billing For Soft Tissue FBR Right
Foreign body removal (FBR) is a very common procedure that emergency department physicians wind up performing on a regular basis. However this particular procedure causes a lot of confusion in the medical billing department. To insure that maximum reimbursements are met, you need to know how to code it accurately. The reporting of soft tissue FBRs will involve more than one choice in which code to use on the superform and knowing exactly what makes and FBR an FBR procedure will help you narrow down exactly which code to use to avoid unnecessary delays in payment or rejections. The confusion often arises when coders look at the notes from the …
Things to Consider About Outsourcing
It can seem daunting to hire a medical billing consultant. Especially if you have never outsourced your billing or you feel as though you would be relinquishing control over your billing which is not the case. In reality, outsourcing your medical billing and coding needs through a consultant is one of the smartest business moves you can make. Don’t think you have to use a local company, many medical billing firms have branch offices in an area near you, but others may be miles to hundreds of miles away, and thanks to the power of the internet with secure connections and software advances that allow you to transfer your patient …
Well-Woman Exam Claims Squeaky-Clean
To code a well-woman exam correctly, you’ve got to know two key concepts: how Medicare and private-payer guidelines differ, and when you should separately code breast/pelvic exams and Pap smears. Best bet: Use these two quick tips for accurate well-woman coding. 1. Break Out Services for Medicare:If the family 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 laboratory), says Carol Pohlig, BSN, RN, CPC, senior …
Medical Billing Is Not Just Data Entry
Many physicians are reluctant to outsource their medical billing because they are under the misconception they are simply paying someone else to do what can be done within their offices and there are also concerns they won’t have control over reimbursements if the process leaves their premises. They couldn’t be more incorrect. Your medical billing partner not only enters the claims for submission to the various carriers and insurances, they also handle payment posting to patient accounts so they will no longer be outstanding and those monies come from several sources, insurance companies, patient, Medicare, etc. This requires knowledge of insurances, adjustments and knowing how to properly apply money to …
Rates For Home Health Agencies Going Up In 2007
Good news coming in 2007 for home health agencies, your rates of reimbursement are going to increase and there is further coming additions for cases that are a mix of high therapy and adjustment. Earlier this year, the CMS proposed a 3.1 increase, which applies to the base rate for each 60-day episode and reflects the estimated home health market basket inflationary rate. The currently proposed base episode rate by CMS for 2007 is at $2,334 (before case-mix adjustment occurs). Also, a “high-therapy case-mix adjustment” of approximately $2,500 will occur if a patient receives at least 10 therapy visits within a 60 day episode. The rates of various services are …
Changes to DME Products
The CMS eases quality standards for small DME suppliers. Originally released earlier this year, the new standards were difficult to understand and even more difficult to comply to. Numerous complaints and comments were made regarding the changes and the CMS responded by releasing a “greatly simplified” version of quality standards for suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). Some of the items that were rewritten to be easier to comply with include: * Bringing the standards to meet from 104 pages to 14; * Focusing the standards more specifically on the issues affecting quality service for Medicare beneficiaries; * Clarifying the requirements for performance management to allow …
