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.
Documenting E/M On Your Medical Billing
Guidelines for Documenting E/M On Your Medical Billing Evaluation and management services are some of the most common charges medical billing companies charge today. Since evaluation and management claims are so abundant, it is important to methodically document the occurrences. There are several documentation guidelines for E&M that can improve your medical billing accuracy. The first guideline, and possibly them most important, is insuring your ICD-9 codes and CPT codes correctly match with the documentation in the medical records. This may seem obvious. However, there have been many times when medical billing has been performed incorrectly in this manner. Medical records are very important in substantiating procedures and tests billed. …
Medical Billing and EOB
Medical Billing and EOB The goal of any medical billing firm is to receive a correct check and correct explanation of benefits (EOB) from an insurance company. Sometimes this is easier said then done. Many times the EOB goes one place and the check goes another. What is the easiest and most productive method for posting payments for medical billing? The first method is an example of a practice that does their own medical billing. In this case, it is beneficial to make sure a check and EOB are sent to the practice and a duplicate is sent to the patient. This prevents future problems with remainders owed. It also …
How Does a CPT Become a Code?
How Does a CPT Become a Code? Some of the most integral components of medical billing are current procedural terminology codes (CPT codes). In order to understand correct coding practices for medical billing, it is important to understand how a CPT code becomes a code. The first step in issuing a code for CPT comes in the form of a suggestion. Medical personnel, physicians, and state associations regularly make suggestions to the American Medial Association. After a staff member from the AMA reviews the suggestion, that staff member determines if the issue has already been addressed or if it is a new one that needs to be resolved for medical …
Medical Billing For Breast Biopsies To Avoid Denials
Medical Billing For Breast Biopsies To Avoid Denials When performing medical billing on a breast biopsy, it is necessary to follow correct protocol. Failure to do so could result in a returned claim or a denial of payment. The key to any question of medical necessity lies in the diagnosis code (ICD-9 code). Many medical billers have gotten into the lazy habit of only using a 3 digit ICD-9 code. This is because the only payer who seemed to care what the diagnosis code was, happened to be Medicare. Now-a-days most payers require an accurate and complete diagnosis in order to pay a claim. If you are doing medical billing …
Reporting the Right HCPCS Codes For Devices
Reporting the Right HCPCS Codes For Devices When doing medical billing it is very important to report the correct HCPCS codes. Failure to do so could result in a returned claim or partial payment. Both of these outcomes are unacceptable for medical billing companies. Businesses cannot run without begin paid. HCPCS stands for Healthcare Common Procedure Coding System. These codes, similar to Current Procedural Terminology codes, report what medical devices are used for health care when doing medical billing. If the hospital submits a claim that supports a device code or two, that hospital is required to report at least one of the HCPCS codes on a medical billing claim. …
When To Use Modifier -91
When To Use Modifier -91 Medical billing has certain nuances that billers should be aware of when submitting claims to insurance companies. One nuance is a modifier. A modifier adds additional information to a current procedural terminology code that the code itself does not present. Modifier 91 is frequently misused when doing medical billing. Modifier 91 is used to report when multiple diagnostic tests are done during the same day. For example: If a patient is rushed into the emergency room and is given a stat glucose test which determines he has hypoglycemia, he will be given glucose gel. Then the emergency staff will need to test him fifteen to …
How Proper Use of 99231 For Medical Billing Claims Can Boost Your Earnings
How Proper Use of 99231 For Medical Billing Claims Can Boost Your Earnings Unsure of the correct medical billing procedures, physicians frequently downcode 99231 for quick payment. There are so many rules and regulations associated with medical billing, physicians tend to downcode whenever there is a questionable decision. A frequent downcode is 99231. Properly billing 99231 can save practices thousands of dollars. There are three codes that are often misused: 99231, 99232, and 99233. 99231 means problem-focused interval history and exam, straightforward or low-complexity medical decision making. 99232 means expanded problem-focused interval history and exam, moderate-complexity medical decision making. 99233 means detailed interval history and exam, high-complexity medical decision making. …
Medical Billing For Multiple Same Day ED Visits
Medical Billing For Multiple Same Day ED Visits Double-dipping is a medical billing myth that is costing many physicians money each year. This double-dipping myth directly relates to a patient having two emergency department visits on the same day. Here I will try to discredit that medical billing myth. The medical billing double-dipping myth states that one physician statement should account for two elements. In the case of an emergency department visit, it means that one physician statement should apply towards two visits on the same day, even if they were at separate times. This should not be the case. If a patient is seen in the emergency department on …
What Is The Difference Between Modifier -25 and -57 When Filing Medicare Medical Billing Claims?
What Is The Difference Between Modifier -25 and -57 When Filing Medicare Medical Billing Claims? Modifier 25 and modifier 57 are sometimes difficult to differentiate between when doing medical billing. It is important to understand the differences between these two modifiers to ensure correct medical billing practices. In medical billing Modifier 25 means when doing an evaluation and management, a physician decides a MINOR surgical procedure needs to be done on the same day. It means the evaluation and management should be paid for separately and not bundled with the surgical reimbursement. In medical billing, Modifier 57 means when doing an evaluation and management, a physician decides a MAJOR surgical …
What is a Late Bill Override Date?
A term you will hear from time to time, especially if your practice is still filing your own claims and you haven’t outsourced your medical billing yet, is LBOD. LBOD stands for Late Bill Override Date and it’s fairly cut and dried. Basically the provider uses the LBOD to document compliance with timely filing requirements which insures that you get reimbursed for services rendered. Generally, you should only use the LBOD if you are filing a claim with dates of service older than 120 days and you must have all documentation on file for these addendums to your medical billing claims. The LBOD is permissible to use on either paper …
