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.
Pregnant Patient Transfer Easy On Your Medical Billing
Pregnancy medical billing is a rather straightforward process. That is, unless the patient transfers practices in the middle of her prenatal care. Pregnancy transfers scare many medical billing personnel, however if you can remember three tips, maternity transfers will be a snap. How you do medical billing for a maternity transfer all depends on how many times she was seen in the clinic. If she was seen 1-3 times you always want to code those visits as evaluation and management visits. One thing to keep in mind is that the first antipartum visit is not as straightforward as you may think. Always keep track of the level of service (level …
Universal Injection Code
As of January 1, 2006; changes were made regarding therapeutic and antibiotic injections medical billing claims that will affect your medical billing claims if you don’t update your filing methods. In the past there were separate injection administration codes for a therapeutic, prophylactic, diagnostic injection and an antibiotic injection. Instead of choosing to report administration of a prophylactic Synagis treatment (90378) with a 90782 (Therapeutic, prophylactic or diagnostic injection , you now simply use 90772 as a universal injection code. On E/M coding, you will generally still need to attach modifier 25 to insure you’re your claim is handled. Modifier 25 states that this procedure or other service was performed …
Can You Bill Medicare – When the Patient Has Died
A confusing medical billing situation can arise when a patient dies en route or shortly after being admitted to a hospital. Many medical billers struggle with what to report or amount of procedures to report that were performed prior to the patient expiring. A good example would be a patient that presented in the ED for CPR direction. The ED physician tells EMS to perform defibrillation and administer medications. When EMS brings the patient into the ED, the doctor examines the patient and decides there isn’t cause to continue CPR and pronounces the patient dead. How should this be reported? Normally, on your medical billing form, you would usually bill …
The Removal of Sutures
Medical billing allows for very little wiggle room in your descriptions and documentation. Almost all surgeries, whether performed in the doctor’s office, or in the operating room have a follow-up period. This means that during that particular 15-day, 30-day, 60-day, etc. period, any treatment the surgeon does for that surgery is included in the medical billing of the surgery itself. However, there is an exception to this rule. An example of an exception to this medical billing rule deals with mentally handicapped patients. The removal of sutures is usually a procedure performed within the postoperative follow-up period. Medical billing is usually done only for the surgery. However, if a mentally …
Get Your Therapy Medical Billing Claims Paid
No type of medical billing claim raises more eyebrows with Carriers more than therapy bases medical billing claims. Most therapy claims are 100% legitimate but because of the amount of fraud that has been perpetrated by a few unscrupulous individuals all of these types of claims get closer looks than ever. One way to insure your claims are submitted correctly is to make sure the documentation is done absolutely accurately in your therapy department. In a recent audit of claims, the CMS found that the number one error in reporting therapy medical billing claims is with the minutes billed. Make sure the amount of therapy given to the patient is …
Using Care When Using Modifier 24
If you are a practitioner or medical biller that has a client who sees patients in need of services for post operative complications and you are bundling the services into the global period of surgery, you could possibly be missing thousands of dollars in reimbursements yearly using this method of doing your medical billing. In many cases you can legitimately report patient evals made during the post-op period, according to the individual carrier’s rules. A good rule of thumb for most carriers is if the post operative complication evaluation is unrelated to the original procedure and this can usually be distinguished by medical necessity and date alone, then you can …
Correct Billing for Same Day Services
Medical billing for same day services can sometimes be confusing. Only skilled professionals can tell the difference between same day services and code them correctly. A good example of same day services that can be confuses involve fine needle aspiration (FNA). If a FNA is performed on the same day as a more extensive procedure, the Centers for Medicare & Medicaid Services will only pay for the procedure that is more invasive. This is called the “sequential procedures policy” in medical billing. This usually occurs when a physician decides to do a FNA, but later after the procedure, decides it did not accomplish what it was supposed to. That same …
Correct Medical Billing Reimbursements for Power Mobility Devices
Due to the unfortunate incidence of fraud, there are some strict medical billing requirements for getting reimbursed for power mobility devices. Additionally, the time the physician spends working on the extra documentation is also billed at the current rate of an extra $21.60 for the extra time spent on power mobility medical billing. Recently there was an increase in the amount of documentation that is needed to do medical billing for power mobility devices. Medicare requires the prescription, patient’s medical records and any other supporting information. Instead of lowering the amount of medical billing documentation for power mobility devices, Medicare decided to properly compensate for the extra time it creates. …
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 …
