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.
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 …
Medical Billing for Type A Medicare Claims
Type A Medicare claims are not uncommon, however making one medical billing mistake with a Part A claim can cost thousands of dollars. Type A claims should almost always be consolidated billing. Here are some basic tips you should follow when doing consolidated medical billing for Type A claims. There are several medical billing charges that should be excluded when it is a hospital providing the service to the patient. The Centers for Medicare & Medicaid Services gives this list to exclude: computerized axial tomography scans, ambulatory surgery in the operating room, MRI, cardiac catheterizations, radiation therapy, angiography, emergency room services, venous and lymphatic procedures and ambulance services related to …
Cost to Charge Ratio and How to Change Yours
Your provider number has a strong impact on your medical billing cost to charge ratio (CCR). If your hospital is merging with another hospital, it is important to figure in the possibly new Cost to Charge Ratio medical billing payments you will receive. There are two avenues merging hospitals can take. The first method is when two hospitals merge together while one of the existing provider numbers is kept in tact. In this instance, one hosptial keeps their medical billing number, while the other one drops theirs and joins the first. The hospital that drops their medical billing provider number will receive a new cost to charge ratio. The ratio …
Accuracy in E/M in Medical Billing
Medical billing largely depends on the accuracy of the physician’s records. Many times physicians have nothing to do with the medical billing aspect of their practice or facility. This can cause them to be haphazard with their documentation for their patients. It is important to educate physicians about the importance of accurate records that are utilized in the medical billing department. With rising healthcare costs; carriers are becoming much less lenient on treatments and procedures being covered. They also have become sticklers for accurate medical billing documentation submissions. If there is anything incorrect on a claim, it gets sent back to the provider without payment. There are many evaluation and …
