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.
Borrowing Provider Numbers Can Bring Big Trouble
Borrowing Provider Numbers Can Bring Big Trouble When performing medical billing, using your own provider number is a requirement. Failure to do so is considered fraud and is not tolerated. Using another provider’s tax identification number for medical billing can cost you big money and even jail time. Fraud costs Americans billions of dollars a year. (yes I said BILLIONS). One of the may variations of medical insurance fraud is using another provider’s Tax identification number. There are several reasons why providers would want to do this. A doctor without a contract with a provider network may want to use a TIN of a provider inside that network. Some people …
Avoid Denials With Proper Billing For 99293
Avoid Denials With Proper Medical Billing For 99293 There are many medical billing codes that were created specifically for pediatrics. However, there are other areas of medical billing that do not have these specific codes for children. This makes coding very difficult and inconsistent. Many people wonder if the CPT code 99293 should be billed for an outpatient emergency room exam for a baby instead of using code 99291. The medical billing code 99291 means critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes. You would use this code if a patient came into the emergency room and was there for a half …
Proper Coding For Dry Eye
Proper Coding For Dry Eye Medical billing for dry eye syndrome can be pretty complicated. There are several different ways to code for this syndrome. The different methods of medical billing for DES all depend on the documentation and treatment given by the physician. Dry eye syndrome is when patients have a decrease in their tear gland function. Their tears also begin to evaporate more quickly. If dry eye syndrome goes untreated, it can lead to thickening of the cornea which, in time, will impair vision. When doctors see a patient for this reason, medical billing claims should not be submitted to vision insurance. Vision insurance is for routine eye …
Correct Medical Billing For Group Visits
Correct Medical Billing For Group Visits With the emergence of more and more group doctor appointments, medical billing processes have had to adjust. A group visit is when patients with similar diagnoses or background have a medical appointment for educational reasons. In these visits usually full history is taken and physicians may individually take out patients for decision making and treatment. There are several medical billing options for this type of visit. Since group visits are fairly new, many medical billing staff members code it incorrectly. This miscoding can lead to payment denials. There are two main ways to code group visits. One way to do medical billing for a …
Demonstrating Medical Necessity For Foot Orthotics
Demonstrating Medical Necessity For Foot Orthotics Along with medical a billing claim, many insurance companies require a letter of medical necessity to be sent along with the claim for orthotics. A letter of medical necessity could mean the difference between getting your claim paid or getting it denied. The letter of medical necessity for orthotics needs to have several elements to be sent along with a medical billing. The first necessary element of an orthotic letter of medical necessity is patient information. Along with the medical billing, the letter of medical necessity should always include the patient’s name, insurance information, and date of birth. This section should also include the …
Getting Your Ob-Gyn Claims Paid With Correct Coding
Getting Your Ob-Gyn Medical Billing Claims Paid With Correct Coding There was a medical billing study done at the University of Illinois Hospital from 1999-2001. This was a study to see how many coding errors occurred in patients admitted for eclampsia and preeclampsia during this time. The study was astonishing. There were 67 total errors in this one study. Medical billing coding errors frequently happen with ob-gyn patients. Surprisingly, in this medical billing ob-gyn study, over 80% of the coding errors happened with clinicians. That means actual doctors were, and are, incorrectly coding ICD-9 codes and CPT codes. Most of the time people blame the actual coder instead of the …
Not Coding Correctly, You’re Not Getting Paid
If You’re Not Coding Correctly, You’re Not Getting Paid The coding process is the most complicated element of medical billing. Instead of having one coding system governed by one body, there are two. ICD-9-CM is governed by the Federal government. This is used to do medical billing for diagnoses and inpatient procedures. The other major medical billing coding system is CPT (current procedural terminology). This is governed by the American Medical Association. It is used to code physician office and outpatient services. Differencing maintaining bodies for coding systems makes it difficult for correct medical billing. If you do not have correct coding in medical billing, claims will not get paid. …
Correct Medical Billing For Sleep Apnea
Correct Medical Billing For Sleep Apnea With the increasing number of patients with obstructive sleep apnea, the DMERC recently changed it’s requirements for the medical billing of a CPAP machine. A CPAP machine is a continuous positive airway pressure device. It is used to assist patient in breathing at night. Recently, the DMERC has made the restrictions less harsh when it comes to doing medical billing for these devices. In 2002 new requirements were set for the purchase of CPAP machines. A patient now has to meet one of the two criteria. The first criteria for medical billing is that the patient’s AHI is greater than or equal to 15 …
Getting Your DME Billing Claims Paid
Getting Your DME Billing Claims Paid Many times medical billing questions arise about how to get DME claims paid. Some companies bill for durable medical equipment all the time, while others only do it a few times a year. Following simple medical billing tips will get your Durable medical equipment claims paid as accurately as possible. It is very important before a product is dispersed to see if the patient needs precertification from their insurance company. If medical billing is performed on a piece of durable medical equipment that needed precertification, but precertification was not obtained, many insurance companies will deny the claim. This may seem like a time consuming …
DME Fraud Claims Settled
DME Fraud Claims Settled AdminaStar Federal Inc. agreed to pay six million dollars to the federal government due to medical billing fraud allegations. This durable medical equipment company allegedly overcharged Medicare and intervened with their Medicare evaluations. The Centers for Medicare & Medicaid Services hopes this settlement gives the warning to all that medical billing fraud is not acceptable among their contractors. AdminaStar Federal Inc. was uncovered by two whistle blower medical billing lawsuits. They were in Indianapolis and fell under the False Claims Act. Apparently from 1991-1998, the medical billing employees at AdminaStar knowingly changed claim information. They also would hang up on customers just to appear to have …
