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.
Medical Billing Caps for Therapy Addressed
New treatment methods and less surgical procedures has made therapy medical billing dramatically rise. Not only are there more physical therapy claims, but there are also many more speech therapy and rehab claims sent in to payers. To decrease the deficit, the House of Representatives recently passed an act that puts a cap on therapy medical billing. The Deficit Reduction Act of 2005 was passed on December 21,2005 with a very narrow vote by the Senate. Senators were split in a 51-50 vote to cap therapy medical billing reimbursements. As a matter of fact, the vice president of the senate cast the tie breaking vote for the act. Although there …
Indirect Supervision Codes in 3 Easy Steps
Care Plan oversight services can be slightly confusing for medical billing staff members. In order to correctly bill services, there are certain rules that should be followed. There are three medical billing steps for correctly billing indirect supervision codes. The medical billing current procedural terminology codes 99375-99380 should only be used in certain instances. These codes represent non face-to-face visits by pediatricians for special needs children. There are certain instances when it is acceptable to do medical billing for this care plan oversight (CPO): revision of care plans, review of patient status, review of lab work, and phone calls to assess condition with guardians. The second step to correct medical …
No Time For Credentialing?
Did you know your medical billing partner can do far more than handling the flawless transactions of your medical coding and billing – they can also help you get credentialed with various carriers to insure that the services rendered by your practice are covered by various insurers that require a physician be part of their network in order to recognize claims submitted. If you have a busy practice, you may be putting off getting credentialed with additional insurance companies because you just don’t have the time to fill out the forms, questionnaires and other information in order to get approved with additional carriers. You know from previously getting credentialed that …
Common Medical Billing Coding Confusion
A common confusing coding dilemma concerns the diagnostic investigation of the swallowing function with a few different methods. The two codes that cause the most confusion are 70371 and 74230 and knowing when to use them will make the difference between a paid medical billing claim and a denial or delayed claim. Here is a breakdown of the basics for the two codes : 70371: Code 70371 (Complex dynamic pharyngeal and speech evaluation by cineradiography or video recording) describes a radiologic study using cineradiography or video recording for pharyngeal and speech evaluation. Typically, although not necessarily, a speech pathologist is present, and the patient repeats sounds to allow for evaluation …
Perinatal Billing Code Additions Coming Soon
Head’s up! There are ICD-9 code additions that will most likely impact OB/GYN’s. They haven’t been solidified yet, but here’s a sneak peak at what could be included in the coming changes. These codes are slated to be four new ICD-9 code changes that will become available in October. The four new codes will be in the perinatal sector of care and are : * 768.7 new code for hypoxia and birth asphyxia — , Hypoxic-ischemic encephalopathy (HIE)* two new codes describing other respiratory problems after birth:* 770.87 — Respiratory arrest of newborn* 770.88 — Hypoxemia of newborn Another slated change may be the addition of a fifth-digit subclassification under …
How to Avoid Fraud and Abuse Charges In Your Medical Billing
Gainsharing in medical billing is highly scrutinized. The HHC Office of Inspector General is very suspicious about gainsharing activities with healthcare providers. There are three areas hospital providers should focus on in order to prevent medical billing fraud allegations. Improper gainsharing agreements are borderline fraud in medical billings. The three things hospitals can do to prevent any fraud charges are having sufficient quality controls implemented, promoting accountability, and limiting payments that lead to referral pattern changes. If all three of these elements are satisfied, your hospital will have no problem providing trustworthy medical billing. In order to run a hospital successfully, two things are necessary: quality of care, and profitability. …
Bulletproof Your Medical Billing Claims
Documentation is the Kevlar jacket for the medical billing industry. When you’re compiling your medical billing claim make sure that your documentation is detailed and exact in nature. Never submit a medical billing claim without documentation as it will only deny or delay your reimbursement on your claim. A good example is if a patient presents in an ED twice in one day. Generally most carriers will deny a medical billing claim showing duplicate visits. However if medical documentation shows the necessity of those visits were for two different services such as a critical care code (99291-99292) or reports prolonged care (99354-99355) in addition to the E/M code, the carrier …
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 …
