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.
Medicare to Conduct Reviews for Medical Billing Overpayments
The states of New York, California, and Florida are involved in a pilot demonstration led by the Centers for Medicare & Medicaid Services. The Centers for Medicare & Medicaid Services has hired a Recovery Audit Contractor (RAC) to do extensive evaluation of medical billing claims for three years. You may be asking: What does this medical billing audit mean to your practice if you don’t reside in one of those states? If the demonstration in these three states is successful and the Centers for Medicare & Medicaid Services are able to recover money in medical billing overpayments, it could mean a lot to your practice. It would mean that the …
Correct Medical Billing for Endoscopy Procedures
Endoscopic procedures are getting a closer look by Medicare and Medicaid. The University of Rochester’s Strong Memorial Hospital submitted claims from September 2001 to December 2003 for endoscopic procedures that were found in an audit conducted by both agencies to be billed incorrectly. In total costs, the hospital repaid over $500,000 combined to these organizations. There were two main reasons the medical billing was incorrect. Many of the procedures claimed that the head of surgeon, Ma Sundaram, performed the surgeries. In all actuality, most of the time, the head surgeon was not even present. The other reason the medical billing was incorrect was because medical necessity was not substantiated for …
Using Disaster Related Codes in Medical Billing
Disasters such as 9/11 and natural disasters like Hurricane Katrina have made it apparent that medical billing needs to be able to reflect these unfortunate situations. The Centers for Medicare & Medicaid Services issued new codes to reflect these conditions. Not all medical billers are aware of them and how to use them. The new condition code that should be used in medical billing for coding disaster related service claims is DR (disaster related). The new medical billing modifier is CR (Catastrophic/disaster related). Any institution can use either one of these codes, no matter what the location of the facility is. There is one exception to this rule. Suppliers and …
Protection of PHI-Patients That Use DME Services
Perhaps one of the most important aspects of medical billing is protecting your patients’ PHI. Durable medical equipment (DME) companies can have just as much of a problem with confidentiality as any other medical facility or practice. There are four main tips for DME businesses to protect the medical billing PHI information. The first rule is medical equipment tracking. Some medical devices contain personal medical billing PHI information. When these devices are used by a patient, they could potentially breach that confidentiality if the information was not properly stored or disposed. It is much easier to track the device itself than to track the information the device gathers. Tracking devices …
Accurate Medical Billing For Incision Codes
A common medical billing question is: When is it appropriate to use an incision code. This question comes up many times when the removal of foreign bodies occur. In only certain instances would you report an incision code in medical billing. When removing a foreign body, if the physician makes an actual incision to remove the object, then the proper incision medical billing code should be used. The two main incision codes are 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) and 10121 ( Incision and removal of foreign body, subcutaneous tissues; complicated.) This seems fairly simple, however, there are certain medical billing qualifications incisions must meet. If …
Determining One MD or Two in Billing Procedures
In the following scenario, how would you code it? A child presents to the ED with a very high fever and enough symptoms that the physician on duty suspects meningitis. A spinal tap is performed under moderate sedation. If the same doctor performed the sedation and the spinal tap, you would report it as 99143-99145 (moderate sedations services….performed by the same physician), however if two separate physicians performed the sedation, then you would need to identify the procedures as two separate procedures by two different physicians and use 99148-99150 (moderate sedation services …provided by a physician other than the health care professional performing the diagnostic or therapeutic service). You will …
Understanding Medical Billing and Revenue Codes
Not all medical billing is generated from physician’s services. Sometimes services are rendered to patients and the medical billing created from those procedures need to be submitted to the various insurance carriers, but they also need three things: a price, a procedure code, and a revenue code. Revenue codes indicate to the type of service that you are billing for; revenue codes are 3-digit codes, and those revenue codes must match up with specific procedure codes to designate what services were rendered. For instance, if you are using a 360 revenue code, you’re stating that the services rendered were performed in the operating room, and therefore, the procedure codes that …
Changes Coming to Follow Up Care in September 2006
If your practice routinely provides burn or laceration follow up care, head’s up because after September of this year, there will be three new post-op codes added that will better detail the services rendered during the patient’s visit and should improve your reimbursement rate. Be sure and alert your staff that V58.3 will no longer be a valid code to use and the new three designations should be chosen from when coding the patient’s visit. The three new designations are as follows: * nonsurgical wound dressing change or removal, V58.30* surgical wound dressing change or removal, V58.31* suture removal, V58.32. Having more exact coding designations to go with the ICD-9 …
Undercoding Your Medical Billing Can Cost Your Practice
A well-known secret in the medical billing industry is that many physicians purposefully undercode because they are fearful of the penalties for overcoding or unbundling their medical billing claims. Another big mistake some physicians make is to leave their coding to their staff, which is guaranteed to have errors because the staff has no way of knowing exactly which services occurred in the exam room and which did not. In capitated care issues, physicians who don’t code for supplies reimbursement on their medical billing claims lose a lot of money. Imagine if every patient that you provided services to was worth an extra $50, imagine how that revenue would add …
Get Reimbursed for Tests
Diagnostic testing causes a lot of confusion in medical billing. One rule of thumb when doing the billing is to only report what your documentation will support. It is tempting to report a diagnosis that comes after a pathology test because common sense would tell you that it is more likely to be paid. Instead report the reason for test and use your medical necessity such as patient complaints and symptoms to back up the reasons for the test. Use your judgment when reporting testing and don’t use presumed diagnosis where an illness or condition is trying to be “ruled out”. Instead code the signs and symptoms the patient is …
