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.
Modifier v57.1 to Get Close Examination
If you use V57.1 (Other Physical Therapy) in your medical billing claims, be prepared for some close scrutiny of all your submitted medical billing claims. These claims in particular will be closely monitored to ensure that they were medically necessary services actually done by the physician. This review will be taking place in Iowa and other states are slated to follow suit in the coming months. Currently, the review will affect Part B Medicare patients only who are part of the outpatient home healthcare program. The reviewers will select home health outpatient claims with type of bill 34X, revenue code 042X and V57.1 as primary. With the close examinations of …
Make Sure Your DME Deal Doesn’t Look Like a Kickback
Based on a recent deal in which a supplier of DME products would provide equipment to a physician in exchange for a prime space and fees, would directly violate the federal anti-kickback statute, according to the HHS Office of Inspector General latest advisory. The basis of this decision was based on the situation where the agreement would have allowed the physician to become a DME supplier for non-Medicare patients, and the DME supplier would have rented space in the physician’s office to supply DME directly to the physician’s Medicare patients. The reason that this arrangement raised eyebrows is because the in-house DME supply programs either together or individually, pose a …
Correctly Coding E/M in Medical Billing
New medical billing coding interpretation may add more reimbursement to your reimbursements. The Centers for Medicare & Medicaid Services clarified the rules for a new patient evaluation and management codes. In reality, there has been no real medical billing policy change to the language the policy is written in; it is simply going to be interpreted differently by the Centers for Medicare & Medicaid Services. Now, the definition of “new patient” means someone none of the physicians in the practice have seen in the last 36 months face-to-face. Some medical billing staff members may get confused when it comes to lab work and other non-face-to-face procedures. If a patient is …
Take Advantage of the Preventative Care Medical Billing Increases
The Centers for Medicare and Medicaid Services updated the healthcare payment amounts for certain medical procedures related to preventative care. The Outpatient Prospective Payment System (OPPS) has ruled in favor of the provider on a few financial issues. There are some medical billing changes implemented in the January 2006 update that will increase your revenue if you use them correctly. The main medical billing change issued by the Outpatient prospective payment system (OPPS) deals with preventative screening exams. Beginning in January 2006, Medicare will now reimburse at a higher rate for most preventative services provided. For instance: Many patients receive a “Welcome to Medicare” physical. Now, if hospitals provide this …
Medical Billing Guidelines Made Clear
The Centers for Medicare & Medicaid Services can sometime seem a little vague in their guidelines. It is common knowledge in the medical billing world that a physician or non-physician practitioner must perform the history of present illness portion of an evaluation and management exam. However, this medical billing rule is nowhere to be found in the CMS guidelines. After examining the Center for Medicare & Medicaid’s guidelines, many people wonder if an ancillary staff member instead of a physician can take the history of present illness. Nowhere in the documentation does it prohibit this to be done. Most medical billing policies are spelled out exactly how they should be …
Are You Using the "G" Codes in Your Medical Billing Claims?
The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services are in a medical billing dispute. According to the American Medical Association, new “G” codes will be an unnecessary hassle. The Centers for Medicare & Medicaid Services believe that these new medical billing codes are an improvement in the healthcare system. Administratively, the CMS- created “G” codes and this may become a headache for your medical practice. There is virtually no incentive to use these medical billing codes. 2006 is the requested Centers for Medicare & Medicaid Services implementation date, but no one is jumping up and down for this change. For many businesses, the bottom line …
Medical Billing Techniques That Will Get Your Practice Audited
Millions of dollars each year are lost through outright fraudulent medical billing claims. Unscrupulous individuals deliberately file some of these medical billing claims, others are the result of an inexperienced coder in an office just getting it wrong. Either way, it can cost your practice big time in the form of time spent gathering information to answer an audit and in the form of some very stiff fines if there are improprieties found in your medical billing practices. The most common fraudulent medical billing practice is when services that were never rendered to a patient are billed. Since all charges are listed on an explanation of benefits form that is …
Medicare Medical Billing Error Decrease
Medicare has released the stats for 2005 regarding The Comprehensive Error Rate Testing (CERT) program implemented last year and it is showing that in the initial stages it has done some good for medical billing. The Centers for Medicare & Medicaid Services heightened claim error awareness by initializing an error-testing program in 2005. In 2004, the error rate for medical billing was 10.1%. At the end of 2005, this year’s CMS error rate was 5.1%. This is nearly half the amount of errors this year than last year. The Centers for Medicare & Medicaid Services attribute this improvement to the new CERT program. They believe that providers are inherently more …
Documentation is the Key to Getting Reimbursed
There are two major medical billing elements for critical care patients. If these two elements are missing, no or partial reimbursement will be received. In order to collect all the money you are entitled to, your medical billing must be accurate. The two most important elements in medical billing for critical care are time services were rendered and medical necessity requirements. Let’s face it, during emergency situations documenting times of services rendered on a patient is not the most important factor when dealing with a critical care patient. Patients are quickly moved into the emergency room, are quickly examined and treated as fast as possible. There are two main critical …
Get Correctly Reimbursed For Your Discography
There are many different rules about bundling your medical billing claims. Some codes are included with others, while different codes can be separately reimbursed. A discography is a procedure that brings up a lot of questions. In medical billing, the question about whether or not to code per region or per disc. This is one instance in which you may get more reimbursement than expected. The AMA (American Medical Association) states that you can report per disk when doing medical billing for a diagnostic discography. The code 72295 (Discography, lumbar, radiological supervision and interpretation) should be billed for as many disks as you treat. Even if the discography is only …
