Medical Billing Blog with Medical Billing & Coding Info & Articles
Our blog contains news and articles relating to numerous healthcare sectors including revenue cycle management, medical billing, medical coding, ICD, HIPAA, practice management functions and more.
The Dermabond Dilemma
When a wound needs closing and a tissue adhesive is used the medical billing coding can be different than when sutures or stitches are used. There are specific guidelines for medical billing when tissue adhesives are used. All adhesives including Dermabond have their own unique way of being reported on medical billing. Consult with Medicare or the carrier to ensure that you are meeting those guidelines prior to submitting your medical billing. There are five basic guidelines that Medicare requires in order to reimburse for this service and many carriers follow the same criteria for laceration closures utilizing Dermabond. You should report G0168 for Medicare patients only; the CPT code …
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 …
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 …
