Billing - Articles

Why You Should Be Looking Up Medical Codes Online
February 23rd, 2023 - Find-A-Code
Medical coders, billers, and auditors all rely on accurate codes to do their jobs. Unfortunately, none of them can get by with just one set of codes. There are multiple sets encompassing tens of thousands of codes covering just about everything in healthcare. That means constantly looking up codes – even among those with excellent memories. The important question is this: where are codes being looked up?
Three Things To Know When Reporting Prolonged Services in 2023
January 31st, 2023 - Aimee Wilcox
The Evaluation and Management (E/M) changes made in 2021 and again in 2023 brought about new CPT codes and guidelines for reporting prolonged services. Just as Medicare disagreed with CPT in the manner in which prolonged service times should be calculated, they did so again with the new 2023 changes. Here are three things you should know when reporting prolonged services for all E/M services.
Medical Billers: The First And Last Players In The Billing Game
January 25th, 2023 - Find-A-Code
When it comes to medical coding and billing, there are a lot of players in the game. From reception staff to clinical staff and the back office, there are quite a few people involved in generating billable services and then actually billing payers for them. The medical biller is the first and last player in that game.
5 Medical Billing Trends to Watch in 2023
January 20th, 2023 - Find-A-Code
No doubt the medical billing industry is changing at breakneck speed. As a medical billing specialist in 2023, you will need to keep up with emerging trends if you want to stay in the game. What should you be paying attention to in the coming year? Check out these five possibilities...
Outsourced Medical Billing: What's Driving the Recent Trend?
January 18th, 2023 - Find-A-Code
Medical billing in the U.S. has historically been kept in-house for the most part. Hospitals, private practices, etc. have hired their own medical coders and billers, preferring to maintain tight control over the process. But things are changing, and they are changing in a big way. Outsourcing is the latest trend.
Medical Coding: Why Is An 'Easier' System So Complicated?
January 16th, 2023 - Find-A-Code
Believe it or not, there was a time in this country when paying for medical care was fairly simple. Your doctor rendered services for which you paid at the time of the visit. Medical insurance only offered catastrophic coverage for major medical events. Those were simpler days.

Prior years:  (click bar to view articles)

Identifying the MEAT to Support Reporting Chronic Conditions in the Computer-Assisted-Coding (CAC) World
December 13th, 2022 - Aimee Wilcox
The benefits of computer-assisted-coding (CAC) are great and understanding how to engage with the engine to ensure maximum coding efficiency is vital to the program's success for your organization. But how do you know when to accept an autosuggested code and when to ignore it, especially when it has to do with historical patient data?
What Are The Differences Between CPT and ICD Medical Codes
September 9th, 2022 - Find-A-Code
To the medical coding specialist, getting it right is non-negotiable. Coders rely on multiple coding sets to do what they do. The two most commonly utilized sets are as follows: Current Procedural Terminology (CPT) codes and International Classification of Diseases (ICD) codes.
No Surprises Act Requires More Transparent Medical Billing
September 9th, 2022 - Find-A-Code
Congress passed the No Surprises Act as part of the 2021 Consolidated Appropriations Act. No Surprises was fully implemented as of the start of this year. With it now being the law of the land, healthcare providers are legally obligated to provide more transparent medical billing so that patients do not receive surprise bills for out-of-network care or in-network care provided by an out-of-network clinician.
Navigating Medical Billing's Training vs. Experience Conundrum
September 5th, 2022 - Find-A-Code
Imagine the following scenario: a young person goes to school to earn certification as a medical coder or billing specialist. Upon completion, every job the recent graduate applies for requires experience. But how is this person supposed to get experience without landing that first job? It is a conundrum faced by certificate holders around the country.
Medical Coding And Billing Not The Same Thing
September 3rd, 2022 - Find-A-Code
Medical coding and billing are two careers that relate to translating patient medical data into bills that are ultimately submitted to insurance companies for payment. The two careers overlap to a certain degree, but they are distinctly separate entities. Simply put, medical coding and billing are not the same thing.
How CMS Determines Which Telehealth Services are Risk Adjustable
August 9th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Medicare Advantage Organizations (MAOs) have gone back and forth on whether or not to use data collected from telehealth, virtual Care, and telephone (audio-only) encounters with Medicare beneficiaries for risk adjustment reporting, but the following published documents from CMS cleared that up once and for all by providing an answer to a question specifically related to this question.
How To Reduce The Friction Inherent To Medical Billing
August 4th, 2022 - Find-A-Code
There is a certain amount of friction inherent to the medical billing process. Between hundreds of thousands of codes, different billing platforms, and a system that seems to be continually in flux, getting through the day without friction is nearly impossible. But that doesn't mean medical billing...
Billing and Coding: Bone Mass Measurement
August 4th, 2022 - Amanda Ballif
Guidance for billing, coding, and other guidelines in relation to local coverage policy L36460-Bone Mass Measurement.
Q/A: Billing Over the Allowed Amount
June 1st, 2022 - Chris Woolstenhulme
Question: Is there a financial penalty for billing over the allowed amount? Answer: Yes, if you are submitting claims to a contracted provider, you cannot bill over the contracted amount of your fee schedule. This is called balanced billing. There is also the no-surprise rule that protects insured and non-insured or ...
Continuous Glucose Monitors (CGMs) -- New Codes
May 2nd, 2022 - Wyn Staheli, Director of Content
New codes for continuous glucose monitors (CGMs) became effective on April 1, 2022. The following information is excerpted from MLN Matters MM12564 regarding CGMs. Be sure to review this information and implement policies to ensure accurate reporting/billing. On December 28, 2021, we published the Medicare DMEPOS final rule in the Federal Register. This addressed the ...
Early Studies Show Promise of ICD-11
April 13th, 2022 - Mary H. Stanfill
Two studies are extremely encouraging, in terms of the content coverage and feasibility of replacing ICD-10-CM with ICD-11. In February, the World Health Organization (WHO) released the official version of ICD-11. With this, the newest edition of the International Classification of Diseases (ICD) officially came into effect, and...
Monitoring Surgical Patients for VTE May Result in Higher RAFs
January 3rd, 2022 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT
A news release published in the American Association for the Advancement of Science (AAAS) included findings of a global surgery study identifying patients with either a current, recent, or previous COVID-19 infection have up to a five-times increased risk of death from venous thromboembolism (VTE) when undergoing a surgical procedure.
Are You Keeping up with the Official ICD-10-CM Guideline Changes for COVID-19?
October 25th, 2021 - Wyn Staheli, Director of Research
The COVID-19 public health emergency (PHE) has made it interesting and challenging for organizations to keep an eye on the evolving changes to the ICD-10-CM Official Guidelines for Coding and Reporting. Have you been keeping up with these changes?
Medicare's ABN Booklet Revised
July 29th, 2021 - Wyn Staheli, Director of Research
The “Medicare Advance Written Notices of Non-coverage” booklet, published by CMS’s Medicare Learning Network, was updated. This article discusses the changes to this booklet regarding the use of the ABN.
Identifying Risk-Adjusted Services During the Opioid Crisis
May 6th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Between June 2019 and June 2020, the United States saw a total of 107,750 deaths from COVID-19. The spread of this virus was so extraordinary that it led President Trump to declare a public health emergency, and we watched as individual states began implementing laws and regulations to limit social interaction ...
New Communication Technology-Based Services (CTBS) Codes for Nonphysicians
May 3rd, 2021 - Wyn Staheli, Director of Research
Medicare continues to expand the number of services provided via technology. There are some interesting new codes for nonphysician practitioners (NPPs) (e.g., psychologists, physical therapists) that became effective on January 1, 2021. Communication Technology-Based Services (CTBS), also known as virtual check-ins, describe specific short provider-patient communications which are initiated by the patient.
UB-04 Claim Form
May 3rd, 2021 - Wyn Staheli, Director of Research
The UB-04 Claim Form, also known as CMS-1450, is used for submitting claims for reimbursement for specially designated facilities. The 837i is the electronic version of the form. Much like the 1500 Claim Form, maintained by the National Uniform Claim Committee, the UB-04 Claim Form is maintained by the National Uniform Billing Committee (NUBC) which maintains lists of approved codes used on various fields on the form (e.g., revenue codes, condition codes). Third-party payers, including Medicare, may have their own adaptations of the general instructions published by the NUBC.
58% of Improper Payments due to Medical Necessity for Ventilators
April 29th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Proper documentation not only protects the provider, the payer, and the patient, it protects the integrity of the entire healthcare system. When it comes to coverage and documentation for durable medical, the DMEPOS supplier and staff must be familiar with the National and Local Coverage Determinations (NCDs and LCDs) as these are ...
Failure to Follow Payer’s Clinical Staff Rules Costs Provider $273K
April 12th, 2021 - Wyn Staheli, Director of Research
Clinical staff (e.g., LPN, RN, MA) provide essential services which allow providers to leverage their time and improve reimbursement opportunities and run their practices more efficiently. There is, however, an ongoing question of how to appropriately bill for clinical staff time. This is really a complex question which comes down to code descriptions, federal or state licensure, AND payer policies. Failure to understand licensing and payer policies led a Connecticut provider organization down a path that ended in a $273,000 settlement with both federal and state governments.
Properly Reporting Imaging Overreads (Including X-Rays)
April 8th, 2021 - Aimee Wilcox CPMA, CCS-P, CST, MA, MT and Wyn Staheli, Director of Content Research
hile many provider groups offer some imaging services in their offices, others may rely on external imaging centers. When the provider reviews images performed by an external source (e.g., independent imaging center), that is typically referred to as an overread or a re-read. Properly reporting that work depends on a variety of factors as discussed in this article.
To Our Codapedia Friends!
July 30th, 2020 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Codapedia friends, come and join us at Find-A-Code - a core product of innoviHealth! The information found on Codapedia comes from our sister company, Find-A-Code. If you do not already have a subscription with the greatest online coding encyclopedia, call us and get signed up today. We are offering a ...
Use the Correct Diagnosis Codes and Revenue Codes to Get Paid for PAD Rehab
July 15th, 2020 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
The initial treatment in rehabilitation for patients suffering from Intermittent Claudication (IC) is Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD).  Rehabilitation using SET involves the use of intermittent walking exercise, which alternates periods of walking to moderate-to-maximum claudication, with rest.   When reporting 93668 for peripheral arterial disease rehabilitation the following ...
Are NCCI Edits Just for Medicare?
July 14th, 2020 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
The National Correct Coding Initiative (NCCI) edits were developed by CMS to help promote proper coding and control improper coding that leads to incorrect payments with part B claims. It is important to understand that NCCI edits do not include every possible code combination or every type of un-bundling combination. With that ...
Payment Adjustment Rules for Multiple Procedures and CCI Edits
July 9th, 2020 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Surgical and medical services often include work that is required to be done prior to a procedure and post-procedure. When there are multiple procedures done by the same physician, group, or another qualified healthcare professional on the same day, the pre and post work is only required once. Therefore, CMS ...
HCPCS Codes Were NOT all Created for the Same Purpose
June 29th, 2020 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Have you ever wondered why you were unable to find a particular product/code with our DMEPOS search? When looking for HCPCS Level II codes, there are several kinds of codes and not all HCPCS codes were created for the same purpose. If you are searching for a certain HCPCS product ...
Proposed Risk Adjustment Changes
June 4th, 2020 - Wyn Staheli, Director of Research
On June 2, 2020, HHS published two proposed changes to the Risk Adjustment Data Validation (RADV) protocols for HHS-Operated Risk Adjustment Programs.
Packaging and Units for Billing Drugs
May 18th, 2020 - Christine Woolstenhulme, QCC, CMCS, CPC, CMRS
To determine the dosage, size, doses per package and how many billing units are in each package, refer to the NDC number. Take a look at the following J1071 - Injection, testosterone cypionate, 1mg For example; using NCD # 0009-0085-10 there are 10 doses of 100 mL (100 mg/mL = 1 mL and there are ...
New CPT® Codes Approved for COVID-19 Antibody Identification
April 15th, 2020 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
On April 10, 2020, the American Medical Association approved and published a revision of code 86318 and added two new codes 86328 and 86769 for reporting Coronavirus [COVID-19] antibody testing.
COVID-19: Cybercrime, Telehealth, and Coding
March 25th, 2020 - Wyn Staheli, Director of Research
Your inbox is probably like mine with all sorts of announcements about COVID-19. Here are just a few reminders of things we felt should be passed along. We have heard of several cases of cybercrime related to this outbreak. For example, there was a coronavirus map which loads malware onto your ...
A 2020 Radiology Coding Change You Need To Know
February 10th, 2020 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
The radiology section of the 2020 CPT© has 1 new, 18 revised, and 14 deleted codes. Interestingly, six of the 14 deleted codes were specific to reporting single-photon computerized tomographic (SPECT) imaging services of the brain, heart, liver, bladder, and others. If your organization reports radiology services, it is...
Regence: Dental Procedures Under The BlueCard Program?
December 9th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
This information can be found on Regence/Blue Cross Dental procedures explaining additional benefits for dental procedures. Regence currently does not offer dental benefits, however, there are times a patient can receive treatment with a Blue Cross provider and qualify under their medical benefits. In addition, Regence informs the providers to file these claims ...
VA: How UCR Charges are Determined
November 20th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
How does the VA determine charges billed to third party payers for Veterans with private health insurance? According to the VA. "38 C.F.R 17.101 stipulates the basic methodology by which VA bills third party insurance carriers. In order to generate a charge for medical services, VA establishes reasonable charges for five ...
Q/A: Q/A: How do I Code a Procedure for the Primary Insurance so the Secondary Can Get Billed?
November 19th, 2019 - Wyn Staheli, Director of Research
Question: How do you modify a code submitted to the primary insurance company to let them know it is not covered by them so you can bill to a secondary?
Medical Insurance Coverage for TMJ Disorders (TMD)
November 19th, 2019 - Christine Taxin
It is agreed that TMJ disorders should be covered by insurance. There are often questions whether it is covered by medical insurance or dental insurance and where the line is that separates coverage.Medical Insurance typically is the primary insurance for TMJ disorders. The reason is that joints are found anywhere ...
And Then There Were Fees...
November 11th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Find-A-Code offers fees and pricing for just about everything, this article will address two of some of the most common payment systems with CMS. (OPPS) -Outpatient Medicare Outpatient Prospective Payment System. (MPFS)- Medicare Physician Fee Schedule The Fees section on each code page is determined on the type of services...
Are you providing TMD treatment and having a hard time receiving payment from Medical? Take a look at the law for your state!
November 3rd, 2019 - Christine Taxin
TM TREATMENT AND THIRD PARTY INSURANCE COVERAGEMinnesota, in 1987, became the first state to adopt legislation requiring health insurance policies issued within the state to include coverage for the diagnosis and treatment of temporomandibular (TMD) joint disorders and craniomandibular (CMD) disorders on the same basis as other joint disorders. At ...
Medically Unlikely Edits (MUEs): Unlikely, But Not Always Impossible
October 18th, 2019 - Namas
Medically Unlikely Edits (MUEs) were created by the Centers for Medicare & Medicaid Services (CMS) to help lower the error rate for paid Part B claims. MUEs are the maximum units of a HCPCS or CPT code that a provider would bill under most circumstances for the same patient on ...
2020 Official ICD-10-CM Coding Guideline Changes Are Here!
October 1st, 2019 - Wyn Staheli, Director of Research
It’s that time of year for offices to get ready for the ICD-10-CM code revisions. As part of that process, it’s also good to know what is going on with the ICD-10-CM Official Guidelines for Coding and Reporting. In the examples listed below, strikeout text is deleted and highlighted text ...
Medical ID Theft
August 16th, 2019 - Namas
Medical ID Theft "So, do you guys think you can do something with that?" John asked angrily at our first meeting with him in August 2017 as he slammed a stack of medical bills, EOBs and collection letters - three inches high - down in front of my partner and I. ...
The Slippery Slope For CDI Specialists
August 2nd, 2019 - Namas
Who knew that when Jack & Jill when up the hill to fetch a pail of water, they would have to ensure that in order to keep the level of water the same on the way back down, they would need to both support the pail. Many of you in this industry are ...
Q/A: How do I Bill Mobile Clinic Services?
July 29th, 2019 - Evan Gwilliam DC, MBA, BS, CPC, CCPC, CPC-I, QCC, MCS-P, CPMA, CMHP, AAPC Fellow
Question: I have a part time mobile clinic. I travel to treat patients at their homes. Are there special considerations when billing for these encounters?
The Facts of Critical Care
July 19th, 2019 - Namas
Critical care services remain to not only be an area of confusion for providers, coders, and auditors, but also a constant target for the carriers for audit. We can sit back and look at critical care and think of all of the ways the code descriptor and/or use could be ...
Act Now on CMS Proposal to Cover Acupuncture for Chronic Low Back Pain
July 17th, 2019 - Wyn Staheli, Director of Research
Now is the time to comment on a proposal to cover acupuncture for chronic low back pain. This comment period is the part of the HHS response to the opioid crisis. You only have until August 14th to officially comment.
5 Ways to Minimize HIPAA Liabilities
July 12th, 2019 - BC Advantage
Last year was historic for HIPAA enforcement. The HHS Office of Civil Rights collected a record $23.5 million in settlements and judgments against providers guilty of HIPAA violations. To avoid becoming part of that unwanted statistic, it’s important to pay extra close attention to five key areas of HIPAA vulnerability. Take ...
The Importance of Medical Necessity
July 9th, 2019 - Marge McQuade, CMSCS, CHCI, CPOM
ICD-10-CM codes represent the first line of defense when it comes to medical necessity. Correctly chosen diagnosis codes support the reason for the visit as well as the level of the E/M services provided. The issue of medical necessity is one of definitions and communication. What is obvious to the ...
Q/A: Can I Put the DC’s NPI in Item Number 24J for Massage Services?
July 8th, 2019 - Wyn Staheli, Director of Research
Question: Are there scenarios in which it is acceptable to put the DC's NPI in box 24j for massage services? Answer: While the answer to this is yes, it is essential to understand that there are very limited scenarios. In most cases, Item Number 24J is only for the NPI of the individual ...
Don't Let Your QPro Certification(s) Expire! Your Certifications Matter!
June 20th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Hello QPro Members, Just a friendly reminder!                                                                                        ...
How to Properly Report Monitoring Patients Taking Blood-thinning Medications
June 18th, 2019 - Wyn Staheli, Director of Research
Codes 93792 and 93792, which were added effective January 1, 2019, have specific guidelines that need to be followed. This article provides some guidance and tips on properly reporting these services.
A United Approach
June 14th, 2019 - Namas
A United Approach As auditors, we all have a different perspective when evaluating documentation. It would be unreasonable to think that we all view things the same way. In my opinion, differing perspectives are what makes a great team because you can coalesce on a particular chart, work it through and ...
What Medical Necessity Tools Does Find-A-Code Offer?
June 13th, 2019 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Find-A-Code is a great resource for individuals working in all aspects of healthcare, from providers and ancillary staff to the attorneys and payers who assess and critique the documentation supporting the services performed. When recently asked what tools Find-A-Code has to help support medical necessity, our response was, "We provide many resources ...
How to Code Ophthalmologic Services Accurately
June 6th, 2019 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Have you ever tried to quickly recall the elements required to support a comprehensive ophthalmologic exam versus an intermediate one? Make coding decisions quickly by creating a cheat sheet containing vital information that allows you to quickly select the right code. According to Article A19881 which was published in 2004 and ...
Auditing Hospitalist Services
May 31st, 2019 - Namas
Auditing Hospitalist Services The inpatient side of coding and auditing can be enormously complex, with many more moving parts than are typically found in the outpatient setting. In this audit tip, we will discuss a few of the challenges that come with auditing one of the most important players in the ...
Noting "Noncontributory" for Past Medical, Family, Social History - Is It Acceptable?
May 29th, 2019 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Is "noncontributory" really an unacceptable word to describe a patient whose family history doesn't have any bearing on the condition being evaluated and treated today?
An Update on the DHS OIG's Effort to Combat Fraud & Abuse
May 17th, 2019 - Namas
An Update on the DHS OIG's Effort to Combat Fraud & Abuse Every year, the Department of Health and Human Services (DHS) Office of Inspector General (OIG) is required by law to release a report detailing the amounts deposited and appropriated to the Medicare Trust Fund, and the source of such ...
Spotlight: QPro Blogs
May 14th, 2019 - Brittney Murdock, QCC, CMCS, CPC
Look for important tips and updates for the medical industry on the QPro Blog! The link to the blog is available from the Medical page under the Industries tab. Use the search bar to look up topics and specialties. View the blogs page here. ...
Prioritize Your Patient's Financial Experience
May 13th, 2019 - Wyn Staheli, Director of Research
For many years, the ChiroCode DeskBook has emphasized the need for providers to firmly establish the patient’s financial responsibility through clear communication. We even created a “Patient Financial Responsibility Acknowledgment Form” to help providers with this process. Lately, the lack of pricing transparency has been in the news and even ...
Q/A: Two Payers Both Paid the Claim. Who Gets the Refund?
May 13th, 2019 - Wyn Staheli, Director of Research
Question We have a personal injury situation where we submitted a claim was sent to the patient's auto policy carrier who refused payment. We then submitted it to her other insurance. Eventually, both companies paid her claims. Her auto paid at full value, and her secondary paid at a reduced rate ...
Spotlight: UCR and Workers Comp Fees
May 1st, 2019 - Brittney Murdock, QCC, CMCS, CPC
Access Usual, Customary, and Reasonable (UCR) rates and National Unadjusted Workers Compensation rates for your geographic area! Rates are displayed in a table as well as a graph for comparison with Medicare billed and Medicare allowed. UCR and Workers Comp Fees are available as an add on to any subscription...
Medicare Revises Their Appeals Process
April 29th, 2019 - Wyn Staheli, Director of Research
On April 12, 2019, Medicare announced that there will be some changes to their appeals process effective June 13, 2019. According to the MLN Matters release (see References), the following policy revisions in the Medicare Claims Processing Manual (MCPM), Chapter 29 are taking place: The policy on use of electronic signatures Timing ...
Coverage for Hearing Aids and Auditory Implants
April 23rd, 2019 - Brandon Dee Leavitt QCC, CMCS, CPC, EMT
For hearing impairment, Medicare is firm in its stance on when it will and will not cover hearing correction. In the PUB 100-02 Medicare Benefit Policy Manual, Chapter 16, Medicare cites the Social Security Act by explaining:  "..."hearing aids or examination for the purpose of prescribing, fitting, or changing hearing aids" ...
Q/A: What’s Wrong with the Diagnoses on my Claim?
April 22nd, 2019 - Wyn Staheli, Director of Content
Question: I got a denial on my claim and it said the problem was with the diagnoses codes that I used. I used M54.15 and M79.2. I don’t understand why this is a problem.
Auditing Chiropractic Services
April 22nd, 2019 - By Evan M. Gwilliam, DC MBA BS CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow Clinical Director, PayDC Chiropractic EHR Software President, Gwilliam Consulting LLC drgwil@gmail.com
Chiropractic is unique from other types of health care and auditors need to be aware of the nuances of this field. Chiropractic has become the focus of more and more audits as doctors seem to struggle to create records that properly support the care provided to the patient throughout the entire episode.
Q/A: How Many Diagnosis Codes do I use?
April 15th, 2019 - Wyn Staheli, Director of Research
Question: My patient has a lot of chronic conditions. Do I need to include all these on the claim? I know that I can have up to 12 diagnoses codes on a single claim. What if I need more than that? Answer: More is not always better. You only need to ...
Prepayment Review Battle Plan
April 8th, 2019 - Wyn Staheli, Director of Research
Any type of payer review can create some headaches for providers and cause problems for a healthcare office. Even for a practice that has taken administrative steps to try and prevent a prepayment review, it can still happen. A prepayment review means that you must include documentation WITH your claim. ...
Prolonged Services
March 29th, 2019 - Namas
Prolonged Services I find in my own audit reviews that the prolonged service code set is often mistreated: they are avoided and not used even when the scenario supports them, or they get overused and improperly documented. Prolonged services are used in conjunction with all types of Evaluation and Management (E/M) ...
Q/A: How do we Know Which Codes a Payer Will Allow?
March 22nd, 2019 - Wyn Staheli, Director of Research
How do we know which codes a payer will allow? The best way to determine the codes (CPT, ICD-10-CM and HCPCS) allowed by a payer is to review their payer policy. While it is good to know the official guidelines (e.g., ICD-10-CM Official Guidelines for Coding and Reporting, AMA Guidelines, Medicare ...
The Impact of Medical Necessity on High Level E/M Services
March 21st, 2019 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
I was recently asked the question, "Does 99233 require documentation of a past medical, family, and/or social history (PFSH)?" The quick answer is, "it depends." Code 99233 has the following minimal component requirement: Subsequent inpatient E/M encounters can meet the code level requirement either by component scoring & medical necessity or time & medical necessity. ...
Type of Bill Code Structure (2018-08-30)
March 20th, 2019 - Find-A-Code
The UB-04 claim form (also known as CMS 1450) is the standard facility and residential claim form used to report health claims. The Type of Bill is reported in Block No. 4 of the UB04 claim form. Type of bill codes are four-digit codes that describe the type of bill a ...
Voluntary Repayments
March 8th, 2019 - Namas
Should you volunteer to repay money from Medicare or other federal healthcare programs if you believe they were the result of errors on your end? The penalties for not doing so could be severe. Under the Federal False Claims Act, if retained overpayments can be shown to be to false ...
Q/A: Can you Help me Understand the New Medicare Insurance Cards?
March 7th, 2019 - Wyn Staheli, Director of Research
As many of you are aware, CMS began issuing new Medicare identification cards last year which required the replacement of social security numbers with a new Medicare Beneficiary Identifier (MBI). All cards have now been mailed out and patient's should have the new cards when they come in. Currently, we are in the transition period until January 2020.
UnitedHealthcare to Discontinue Coverage of Consultations
March 4th, 2019 - Wyn Staheli, Director of Research
In United Healthcare's March provider bulletin, they announced that beginning on June 1, 2019, they will be phasing out coverage of consultation services (99241-99255).
Medicare Physician Fee Schedule Indicators
March 4th, 2019 - Brittney Murdock, QCC, CMCS, CPC
Many denials can be avoided when you understand how a payer looks at a code. Find-A-Code puts a lot of this information all on one page. Under Additional Code Information on CPT codes you will find a lot of questions can be answered. In addition to the global policy, uniform...
Comprehensive Search
March 4th, 2019 - Brittney Murdock, QCC, CMCS, CPC
There are several ways to search a diagnosis code, however the comprehensive search is the easiest and quickest way to find the ICD-10-CM you are looking for. Typing a word or keyword into the comprehensive search, many terms have a Click-A-Search solution to help you drill down to the nearest...
Spotlight: Click-A-Dex Tool
March 4th, 2019 - Brittney Murdock, QCC, CMCS, CPC
Another popular search tool is our index system Click-A-Dex Tool. Click-A-Dex is formatted like the indexing in a code book, this is a quick and easy tool for an enhanced index search. Simply start typing in the desired search, once you type in your desired condition, the results will show...
Medicare Supplemental Policies (MediGap) and Extremity Adjustments
February 25th, 2019 - Wyn Staheli, Director of Research
The nice thing about MediGap policies is that they pay for some of the healthcare costs that an original Medicare plan (Part B) does not cover. So when a patient has Medicare and a Medicare supplement (MediGap) and their condition is related to an extremity (a noncovered service), Medicare must ...
Separately Report a "Separate Procedure" with Confidence
February 22nd, 2019 - Namas
Many procedures in the CPT® code book are designated "separate procedures," but that doesn't mean you can report those procedures separately in every case. First, you must consider other procedures performed during the same encounter. "Separate" Might Not Mean What You Think It Does You can always identify a designated separate procedure by the inclusion of "(separate ...
Q/A: What's the Difference Between Q5 and Q6 for a Substitute Provider?
February 22nd, 2019 - Wyn Staheli, Director of Research
It is important to understand that modifiers Q5 and Q6 are not interchangeable. So when do you use each of them?
Understanding NCCI Edits
February 20th, 2019 - Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT
Medicare creates and maintains the National Correct Coding Initiative (NCCI) edits and NCCI Policy Manual, which identify code pair edits. When performed on the same patient, on the same day, and by the same provider, the secondary code is considered an integral part of the primary code, and payment for ...
Consent for CT Scan - Women
February 19th, 2019 - Christine Taxin
The ADA has forms in over 26 lanuages available to purchase. You also need specific forms for all of the procedures. Even working with patients who are pregnant needs to have a consent with a specialty and collaboration with medical providers. I am showing you one of the forms...
Coding Medicare Initial Preventive Physical Exams (IPPE)
February 12th, 2019 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
The Medicare Initial Preventive Physical Exam (IPPE), also commonly referred to as the “Welcome to Medicare Physical”, may seem daunting to many, but when broken out to identify the requirements is fairly straightforward. Purpose An IPPE helps the Medicare beneficiary (the patient) get to know their healthcare provider at a time when they ...
BC Advantage Now Offering Q-Pro CEUs!
February 5th, 2019 - Find-A-Code
We are excited to announce BC Advantage is now offering Q-Pro CEUs! It is now even easier to get your QPro CEUs and stay current with BC Advantage: offering news, CEUs, webinars and more. BC Advantage is the largest independent resource provider in the industry for Medical Coders, Medical Billers,...
QPro - Medical Certifications
January 23rd, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
QPro (Qualified Professionals) is a member support system dedicated to enhancing coding and management through certification for healthcare coders and managers. Through increased knowledge of coding principles, changes in coding policies, and the experiences of fellow coders and managers in resolving office challenges, QPro members confidently code for maximum and ...
Check out our New Topic Pages!
January 17th, 2019 - Kristy Richie
We have created subject-specific landing pages with tools and resources for your convenience.  We understand how important your time is so we added another layer of organization to our site.  Check out our State pages for information on Workers Comp, Medicare, Medicaid and more... TOPIC pages are accessible at the top of every page on the ...
Reporting Unilateral or Bilateral Codes
December 18th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Generally, Audiology tests are coded as if they were performed on both ears, if the testing was performed only on one ear, you are required to append a modifier to acknowledge there was a reduced service or a unilateral assessment, using modifier 52 - Reduced Services. (Be sure to read...
Errors Billing Outpatient Services When Patient is also Inpatient
November 29th, 2018 - Wyn Staheli, Director of Research
The OIG recently reported that Medicare inappropriately paid acute-care hospitals for outpatient services provided to patients who were inpatients of another facility including long term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, and critical access hospitals. CMS suggests using the following resources to ensure compliance: Medicare Inappropriately Paid Acute-Care Hospitals for ...
No Good Deed Goes Unpunished
November 28th, 2018 - Dr. Ray Foxworth, MCS-P, President of ChiroHealthUSA
You simply need to read the headlines, posts, and tweets, about providers across the healthcare profession being audited, fined, and some even convicted, to see that the costs of non-compliance are real. We tell ourselves, “It won’t happen to me.” The reality is that it easily could. Your license is your livelihood.
Reciprocal Billing and Locum Tenens Arrangements Changes
November 26th, 2018 - Wyn Staheli, Director of Research
CMS has made changes to their payment policies for reciprocal billing arrangements and Fee-For-Time compensation arrangements (formerly referred to as locum tenens arrangements). Providers need to be aware of these changes and update their policies as appropriate.
Q/A: What do I do When my State Doesn't Require Pre-certifications for PI, but the Payer in Another State Does?
November 7th, 2018 - Wyn Staheli, Director of Research
Question:  In Pennsylvania for Personal Injury cases we do not need to go through specific care paths or get precertification in order to treat patients, however, in New Jersey (NJ), doctors that practice there are required to get that precertification. Our question is that when we bill a New Jersey auto ...
Medi-Cal Coverage Criteria for Hospital Beds and Accessories
November 7th, 2018 - Raquel Shumway
Medi-Cal coverage of child and adult hospital beds and accessaries. What is covered and what documentation is required.
Q/A: Does My LMT need an NPI? How do I Bill Her Services?
October 22nd, 2018 - Wyn Staheli, Director of Research
Question: I am setting up an LMT to work as employee under Dr. Clifton, DC. i need to know several things - hoping they are related and can be grouped into this one question.... does she need her own NPI? where does that NPI # go? what box #? if not, ...
Type of Bill Codes
October 11th, 2018 - Find-A-Code
Type of bill codes identifies the type of bill being submitted to a payer. Type of bill codes are four-digit alphanumeric codes that specify different pieces of information on claim form UB-04 or form CMS-1450 and is reported in box 4 on line 1. First Digit = Leading zero. Ignored by CMSSecond ...
HCC - Acceptable Provider Interpretation for Diagnostic Testing
October 1st, 2018 - Wyn Staheli, Director of Research
The following table is taken from the Contract-Level Risk Adjustment Data Validation Medical Record Reviewer Guidance dated 2017-09-27 (see References). It is a listing of acceptable provider interpretation of diagnostic testing. Acceptable Examples include: Cardiology and Vascular Surgeons Echocardiogram (including Doppler, Duplex, Color flow of the heart vessels) EKG (electrocardiogram) – Stress test, Cardiac ...
Q/A: Do I Have to Accept Any New Patient?
September 24th, 2018 - Wyn Staheli, Director of Research
Question: Is it legal for us to not allow a patient to be seen in our office if their parents have bad debt with us?
Join QPro Today and Get Certified
September 12th, 2018 - Find a Code
Join QPro Today and Get Certified! To have a credential in the medical profession shows you have met a minimum standard for professional and ethical standards. Often employers prefer to hire staff that will be involved with any type of patient information such as coding, to show proof they have met certain ...
Pricing for ASC’s and APC’s
August 27th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
For Medicare purposes, an Ambulatory Surgical Center Resources (ASC) is a distinct entity that operates exclusively to furnish surgical services to patients who do not require hospitalization and in which the expected duration of services does not exceed 24 hours following admission. ASC payment groups determine the amount that...
Importance of Depression Screenings
August 16th, 2018 - Wyn Staheli, Director of Research
Why would a chiropractor be concerned about depression screenings when you aren’t trained to be a mental health provider? The answer lies in patient outcomes. Many quality care organizations recommend depression screenings for patients with a chronic condition. According to The National Institute of Mental Health, “People with other chronic ...
Q/A: Can I Bill Mechanical Massage?
August 16th, 2018 - Wyn Staheli, Director of Research
Are there any alternative procedure codes for billing mechanical massage (e.g., muscle master vibromassage, genie rub, etc)? I know that 'by the book' mechanical devices are not covered under 97124, but wondered if you have suggested a go-around code.
Using Modifiers
August 13th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Modifiers offer supplemental information and provide additional details without changing the procedure codes definition and are always two digits. Modifiers are required for proper billing and at times used with NCCI edits, however, two or more NCCI -associated modifiers on the same line will be denied. In addition, NCCI modifiers ...
Q/A: Can I Bill Spinal Decompression Table to Insurance?
July 25th, 2018 - Wyn Staheli, Director of Research
Are visits when a Chiropractor just uses a spinal decompression table billable to insurance? If so, what code is recommended?
Q/A: Can You Swap Out 97140 with 97530?
July 12th, 2018 - Wyn Staheli, Director of Research
Codes 97140 and 97530 are not interchangeable. See why.
Dual Medicare-Medicaid Billing Problems
July 12th, 2018 - Wyn Staheli, Director of Research
It is important to keep in mind that Medicaid is run at a state level so there can be some differences when it comes to coverage. However, the rules regarding balance billing of covered services is set at the federal level. The law states (emphasis added): A state plan must provide ...
Dual Medicare-Medicaid Billing Problems
July 12th, 2018 - Wyn Staheli, Director of Research
It is important to keep in mind that Medicaid is run at a state level so there can be some differences when it comes to coverage. However, the rules regarding balance billing of covered services is set at the federal level. The law states (emphasis added): A state plan must provide ...
WHO Said ICD-11 is Coming Soon
June 26th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Sooner or later ICD-11 will be released, and it sounds like it will be sooner than later. WHO released the news on June 18, 2018. The World Health Organization stated “ICD-11 will be presented at the World Health Assembly in May 2019 for adoption by Member States, and will come ...
Home Oxygen Therapy -- CMN for Oxygen
June 14th, 2018 - Raquel Shumway
The Certificate of Medical Necessity (CMN) for Oxygen is a required form that helps to document the medical necessity for oxygen therapy. It also documents other coverage criteria for the oxygen use. For payment on a home oxygen claim, the information in the supplier’s records or the patient’s medical record must be substantiated with the information in the CMN.
Inappropriate Use of Units Costs Practice Over $800,000
June 11th, 2018 - Wyn Staheli, Director of Research & Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT
A recent OIG enforcement action emphasizes the need to understand the proper use of units. A healthcare provider in Connecticut improperly submitted multiple units for drug screening urine tests. The proper billing of units has proven to be problematic for more than just lab tests. Is your billing of drugs & biologicals, injections and timed codes appropriate?
Provider-Based Facilities and Split Billing Is Your Facility Being Reimbursed for All Work Performed?
June 8th, 2018 - Sharon Hoglund, CPC, CPMA, CEMC, CEMA
Are you stumped by billing guidelines for provider-based facilities? Who bills for what and why? Read on to hear how a little extra time and effort spent on researching split billing coding guidelines can greatly impact your facility, and even your budget ensuring reimbursement for all services performed...
Three Ways Bundled Payments Can Be a Success
June 7th, 2018 - BC Advantage
Bundled payment models continue to attract interest for their potential benefits over traditional fee-for-service payment models. With bundled payments, also known as episode-based payments or packaged pricing, a group of providers is reimbursed based on a contracted price to cover all of the care and services related to a particular ...
Q/A: Coding for Lesion Removal and Repair
June 5th, 2018 - Chris Woolstenhulme QCC, CMCS, CPC, CMRS
The CPT book does not indicate repairs, measuring .5 cm and less, during lesion removal. Does this mean that...
Q/A: How Do I Respond to a Patient's Request to Not Submit the Claim to Their Insurance?
May 7th, 2018 - Wyn Staheli, Director of Research
A number of patients now have high deductible plans. Sometimes, deductibles can be $5000 or $10,000. My payer contract states that I must submit all claims to insurance for covered services. However, sometimes patients with these high deductibles come to my office and state that they would prefer to receive a modest discount for paying cash and in turn, not have their services submitted to insurance. As a doctor, this places me in a tough situation. Do I follow the patient's wishes or the payer contract?
Q/A: What Code do I Use for Supraspinatus and Infraspinatus Tendonitis?
May 7th, 2018 - Wyn Staheli, Director of Research
Is there a better code for supraspinatus and infraspinatus tendonitis than the one for a rotator cuff tear?
Medical to Dental Billing, Truth or Dare?
April 30th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Is it true that medical benefits are only accessible by physicians? This is NOT True! Perhaps you have been told it is illegal for a dentist to bill a patient’s medical insurance, this is erroneous information. In fact, the Accountable Care Organization’s objective is to provide better management of care ...
Proper Record Keeping and Documentation
April 19th, 2018 - Christine Taxin
Proper record keeping and documentation is not only essential for today’s dental practitioner, but is also required by law. Moreover, correct, current and accurate records directly enhance patient care by enabling the dentist to plan treatments, monitor progress, and provide essential notations. Clear and concise treatment plans, medical alerts, and ...
Q/A: Modifiers for Injections
April 17th, 2018 - Nicole Olsen QCC
I'm currently receiving a rejection for my billing with BCBS. We've entered 20550 and 20600 as services for the visit....
Avoiding D9 Denials
March 26th, 2018 - Nicole, QCC
The following is according to WPS. Please make sure what is bold below is entered verbatim on the second line of the "Remarks" section. This should be the only thing on the second line of remarks: Patient control nbr - If you are changing or adding a patient control number Admission hour - If you are changing or adding the admission ...
Documentation for Enteral Nutrition
March 9th, 2018 - Medicare Learning Network
The Medicare Learning Network provides guidance on required documentation for enteral nutrition. ...
Documentation for Negative Pressure Wound Therapy
March 9th, 2018 - Medicare Learning Network
The Medicare Learning Network provides guidance on required documentation for negative pressure wound therapy.
Anthem Will Not Give Modifier 25 a Pay Cut
March 1st, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Anthems original plan was to take a 50% reduction when providers reported claims using modifier 25, it was then lowered to a 25% reduction and has now been fully rescinded, to the relief of providers.  The policy was to go into effect March 1, 2018, however, due to strong opposition from ...
No HCPCS Code Available? Now What?
February 21st, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
HCPCS level II codes classify products into categories for the purpose of claims processing. HCPCS level II codes are alphanumeric with a descriptive terminology that identifies the item or service used primarily for billing purposes. There are several types of HCPCS level II codes such as: Permanent National Codes Dental Codes Miscellaneous Codes Temporary National ...
Reporting Tooth Numbers and Oral Cavity Areas
February 1st, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
When billing for dental procedures you need to identify the exact tooth and/or location in the oral cavity. Qualifiers are used to report the location and tooth number. When billing procedures on teeth and the oral cavity, the JP qualifier is used to identify the tooth number(s) and the JO ...
Physical Therapists: Rules For Nerve Conduction And Needle Electromyographic (EMG) Codes
February 1st, 2018 - Find-A-Code
According to Noridian L35081, nerve conduction code 95905 does not have levels of supervision 21, 22, 6a, 66, 77 or 7a assigned to it and is therefore not allowed by Physical Therapists. Nerve conduction codes 95907-95913 had their Physician Supervision of Diagnostic Tests Indicators adjusted to 7A effective 01/01/2013 (CR 8169). Therefore, if authorized by state law, ...
OIG Reviews Medicare Advantage Claims
February 1st, 2018 - Wyn Staheli, Director of Research
On January 16, 2018, the OIG released a report of their findings on claims data for Medicare Advantage plans. While it appears that there were not significant issues, they did find that: "Types of potential errors included inactive or invalid billing provider identifiers; duplicated service lines; missing required data; inconsistent dates; ...
Multiple Diagnostic Imaging Payment Reduction
February 1st, 2018 - Wyn Staheli, Director of Research
CMS and some other payers have adopted policies of reducing payments when certain multiple diagnostic imaging procedures (see Applicable Codes below) are performed in a single session by the same healthcare provider and/or group. They have done the same when there are multiple units for a procedure code. The rationale ...
Observation Z Codes
January 29th, 2018 - Find-A-Code
There are three observation Z code categories. They are for use in very limited circumstances when a person is being observed for a suspected condition that is ruled out. The observation codes are not for use if an injury or illness or any signs or symptoms related to the suspected ...
What's the definition of an Office Visit and Can I Bill it With a Chiropractic Treatment?
January 18th, 2018 - Brandy Brimhall, CPC CPCO CMCO CPMA QCC
What is the definition of Office Visit? Can It be billed with a Chiropractic Treatment? What about using code 99123 E&M code for office visits? Can we bill of office visits even though we are giving chiropractic care?
QCC FAQs
January 17th, 2018 - ChiroCode
Qualified Chiropractic Coder (QCC) certification FAQs: What's on the test? What score do I need to pass? How long is the test? How many times can I take the test? Can I use my books? And other questions.
Preventative Services: Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)
January 11th, 2018 - Find-A-Code
The following information from the Medicare Learning Network provides guidance on Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)
Paravertebral Joint/Nerve Denervation
January 10th, 2018 - Find-A-Code
A facet joint is supplied by two medial branch nerves. Each medial branch nerve supplies sensation to one half of each facet joint above and below the spinal nerve of origin. Therefore, both of the two related medial nerve branches for each facet joint must be treated. The CPT codes 64635-64636 have a ...
Should ROM Testing be Reported with Evaluation and Management Services?
January 9th, 2018 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT
Reporting the performance of range of motion testing (95851-95852) at the same encounter of an Evaluation and Management (EM) service, produces an NCCI edit resulting in payment for the EM service and denial of the ROM testing. Read the article to learn what other codes ROM testing is considered incidental to.
Diathermy eg Microwave Use and Documentation
January 4th, 2018 - Find-A-Code
According to CGS Administrators, the objective of these treatments is to cause vasodilation and relieve pain from muscle spasm. Because heating is accomplished without physical contact between the modality and the skin, it can be used even if skin is abraded, as long as there is no significant edema.Diathermy achieves ...
Initial Evaluation Codes for PT's and OT's
January 4th, 2018 - Find-A-Code
According to CGS Administrators, for initial evaluations, PTs shall use code 97161-97163 and OTs shall use code 97164-97167. Physicians and other qualified non-physician providers should use the evaluation and management codes 99201-99350 for evaluations.Consider the following points when billing for an evaluation. These evaluation codes are untimed, billable as one unit. Do ...
General Physical Therapy Modality Guidelines
January 4th, 2018 - Find-A-Code
According to CGS Administrators, CPT codes 97012, 97016, 97018, 97022, 97024, 97026, and 97028 require supervision by the qualified professional/auxiliary personnel of the patient during the intervention. CPT codes 97032, 97033, 97034, 97035, 97036, and 97039 require direct (one-on-one) contact with the patient by the provider (constant attendance). Coverage for these codes ...
Hydrotherapy Guidelines
January 4th, 2018 - Find-A-Code
According to CGS Administrators, hydrotherapy involves the patient’s immersion in a tank of agitated water in order to relieve muscle spasm, improve circulation, or cleanse wounds, ulcers, or exfoliative skin conditions.Qualified professional/auxiliary personnel one-on-one supervision of the patient is required. If the level of care does not require the skills of ...
Ultrasound Therapy
January 4th, 2018 - Find-A-Code
According to CGS Administrators, therapeutic ultrasound is a deep heating modality that produces a sound wave of 0.8 to 3.0 MHz. In the human body ultrasound has several pronounced effects on biologic tissues. It is attenuated by certain tissues and reflected by bone. Thus, tissues lying immediately next to bone may receive ...
Special Skilled Nursing Facility (SNF) Billing Exceptions for Laboratory Tests PUB-100 40.4
January 4th, 2018 - Find-A-Code
When a SNF furnishes laboratory services directly, it must have a Clinical Laboratory Improvement Act (CLIA) number or a CLIA certificate of waiver, and the laboratory itself must be in the portion of the facility so certified. Normally the A/B MAC (A) makes payment under Part B for clinical laboratory ...
Skilled Therapy, When it's Appropriate and Billable
January 4th, 2018 - Find-A-Code
According to CGS Administrators, "A service is not considered a skilled therapy service merely because it is furnished by a therapist or by a therapist/therapy assistant under the direct or general supervision, as applicable, of a therapist. If a service can be self-administered or safely and effectively furnished by an unskilled person, ...
Rural Health Clinic (RHC) Billing PUB-100 40.5
January 4th, 2018 - Find-A-Code
For independent RHCs, laboratory services provided in the RHC’s laboratory are not included in the all-inclusive rate payment to the RHC and may be billed separately to the A/B MAC (B). This includes the six basic laboratory tests required for certification as well as any other laboratory tests provided in ...
PT and OT Reevaluation Coding
January 4th, 2018 - Find-A-Code
According to CGS Administrators, the reevaluation is focused on evaluation of progress toward current goals and making a professional judgment about continued care, modifying goals and/or treatment, or terminating services. Reevaluation provides additional objective information not included in other documentation, such as treatment or progress notes.Reevaluations are distinct from therapy ...
Physical Therapist can now bill for a substitute Physical Therapist
January 4th, 2018 - Find-A-Code
As of 6/13/2017 Medicare contractors shall accept claims from Physical Therapists, Provider Specialty 65 – Physical Therapist in Private Practice, for services provided by a substitute physical therapist under a fee-for-time compensation arrangement when submitted with the Q6 modifier. The A/B MAC Part B may pay the patient’s regular physician for physicians' ...
Mechanical Traction Therapy
January 4th, 2018 - Find-A-Code
According to CGS Administrators, traction is generally limited to the cervical or lumbar spine with the expectation of relieving pain in or originating from those areas.Specific indications for the use of mechanical traction include cervical and/or lumbar radiculopathy and back disorders such as disc herniation, lumbago, and sciatica.This modality is typically used in conjunction with ...
Erythropoietin Stimulating Agents (ESA)
November 27th, 2017 - Wyn Staheli, Director of Research
Coverage ESA is typically covered for the following condition(s): Treatment of anemia associated with chronic renal failure (whether or not that patient is on dialysis) Treatment of significant anemia in patients with non-myeloid malignancies where anemia is due to the effect of concomitantly administered chemotherapy Treatment of anemia due to AZT and/or other Nucleoside Reverse Transcriptase Inhibitors (NRTI) used in treatment of HIV/AIDS Treatment of selected ...
Escharotomy Procedural Cross-Walking CPT to ICD-10-PCS
November 10th, 2017 - Brandon Dee Leavitt CPC, QCC
An Escharotomy is used for "local treatment of burned surface" per the AMA Guidelines, when incisions are performed on the burn site. Notice, when cross-walking 16035 or 16036 to inpatient codes, Find-A-Code crosswalks lead to Body System H, Operation 8 - Division of the skin, and Operation N -...
Payment Rulings and Small Provider Practices
November 6th, 2017 - Wyn Staheli, Director of Research
Fall has always been the season for CMS fee changes and on November 2, 2017, CMS announced the finalization of four rules which directly impact the following payment systems: Physician Fee Schedule Final Policy, Payment, and Quality Provisions for CY 2018 Hospital OPPS and ASC Payment System and Quality Reporting Programs Changes ...
New Payment Rulings Could Affect You
November 6th, 2017 - Wyn Staheli, Director of Research
Fall has always been the season for CMS fee changes and on November 2, 2017, CMS announced the finalization of four rules which directly impact the following payment systems: Physician Fee Schedule Final Policy, Payment, and Quality Provisions for CY 2018 Hospital OPPS and ASC Payment System and Quality Reporting Programs Changes ...
Physicians Reciprocal Billing Arrangements
October 18th, 2017 - Chris Woolstenhulme, CPC, CMRS
A reciprocal billing arrangement is when there is an agreement between physicians to cover each others practice. A physician or his practice may set up reciprocal billing arrangements with one or more physicians to cover another practice or their own practice. There is certain criteria that must...
Dental Providers- So what are ICD 10 codes?
September 11th, 2017 - Christine Taxin
What has been your definition so far when asked about how they are different? What does an ICD-10 code look like? How does an ICD-10 code work? Have you seen commercials about medical coding schools and wonder if the profession is right for you? With the field expected to grow faster ...
Global Surgical Package: When to Bill and When Not to Bill, that is the Question
September 8th, 2017 - Stephanie Allard, CPC, CEMA, RHIT
The global surgical package is inclusive of the services that would normally be provided to the patient following surgery. Depending on the global period assigned to a CPT code, the pre-operative, intra-operative and post-operative services could be included in the global surgical package.....
NEW Mandatory ABN Form to Take Effect June 21, 2017
August 17th, 2017 - Mario Fucinari DC, CCSP, CPCO, MCS-P, MCS-I
The Centers for Medicare and Medicaid Services (CMS) has revised the Advanced Beneficiary Notice of Non-coverage (ABN) Form. The revised Advanced Beneficiary Notice of Non-coverage (ABN), Form CMS-R-131, is issued to the patient or client by providers, physicians, practitioners, and suppliers in situations where Medicare payment is expected to be ...
If It’s Not a Consultation, What Is It?
August 16th, 2017 - Omega Renne, CPC, CPCO, CPMA, CEMC, CIMC
You thought you had a consultation supported in your documentation, and now you find out that you cannot bill the consultation codes (99241-99245, 99251- 99255). So, what are the top reasons for a consultation not to be supported? If the payer does not support these codes If the documentation does not support ...
United HealthCare Ending Consultation Reimbursements: Effective October 1st, 2017
August 15th, 2017 - NAMAS
While Medicare discontinued payment allowance for consultation services (ranges 99241-99245 and 99251-99255) in January 2010, many commercial carriers have continued to cover these services. United Healthcare is now joining Medicare's opinion on consultation services. In the June 2017 edition of the United HealthCare Bulletin, United Healthcare has announced that effective October ...
How to Bill a Dressing Change
August 1st, 2017 - Chris Woolstenhulme, CPC, CMRS
A dressing change may not be billed as either a debridement or other wound care service under any circumstance (e.g., CPT 97597, 97598, 97602). Medicare does not separately reimburse for dressing changes or patient/caregiver training in the care of the wound. These services are reimbursed as part of a billable procedure code that, commonly but not necessarily, ...
Requirements for Physicians Orders for DME/HCPCS
August 1st, 2017 - Chris Woolstenhulme, CPC, CMRS
Effective July 1, 2013, certain DME/HCPCS codes require a valid detailed written order prior to delivery. There are very specific rules and requirements requiring medical necessity and orders/prescriptions. It is also required to keep a copy in the patients chart. If billing CMS and commercial payers payers, the DME prescribed may be denied ...
Inpatient Compliance: Split-Shared Services
June 23rd, 2017 - Grant Huang
In the inpatient setting, a physician can combine his or her documentation with that of a non-physician provider (N.P.P.) to support an E and M service while billing the resulting code under the physician. This is called a “split-shared” service and allows physicians to bill at 100% of the fee ...
Modifiers: Reporting Wound Dressings
April 26th, 2017 - Chris Woolstenhulme, CPC, CMRS
When reporting dressings for wounds, it is important to indicate if the dressing is the primary or secondary dressing as well the number of wounds the dressing will be used for. Primary Dressing: May be therapeutic or protective coverings applied to wounds either on the skin or caused by an opening ...
Billing Dermal Filler Injections
April 20th, 2017 - Chris Woolstenhulme, CPC, CMRS
When billing dermal filler injections, separate payment may be made under the OPPS and ASC payment systems for HCPCS G0429- Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (lds) (e.g., as a result of highly active antiretroviral therapy). Use in addition: Q2026- Injection, radiesse, 0.1 ml, and Q2028 - Injection, sculptra, 0.5 mg With a diagnosis of B20 - ...
Treating TMJ
April 4th, 2017 - Chris Woolstenhulme, CPC, CMRS
Temporomandibular Joint (TMJ) Syndrome can include a wide variety of conditions that may be characterized as TMJ. Also there are a wide variety of methods for treating these conditions. Many of the procedures are excluded from coverage in the Medicare program for services or devices. There are other services and appliances ...
Respiratory Assist Devices (RAD) E0470 and E0471 - Billing Reminders
March 28th, 2017 - Chris Woolstenhulme, CPC, CMRS
Add the KX modifier to all claims for RADs and accessories for the first through third months if all thecoverage criteria have been met. Add the KX modifier to all claims for the fourth month and thereafter if all the coverage criteria have been met and if the physician signed and dated a ...
Devices Used for Treatment with TMJ
March 27th, 2017 - Chris Woolstenhulme, CPC, CMRS
Dynamic splinting systems or devices are used to assist in restoring physical function and are commonly used for treating TMJ. Injury or joint stiffness are diagnoses that may qualify for medically necessity. If physical therapy has proven ineffective to restore or improve range of motion, mechanical devices are often a next step. This ...
Reporting Unilateral Procedures
March 13th, 2017 - Chris Woolstenhulme, CPC, CMRS
Some procedures are unilateral such as D7840-Condylectomy. It is important to consult with your payer on reporting requirements. Some payers require two separate line items with a LT or RT HCPCS Modifier, while others require only one modifier to be appended to the claim. When billing a medical code for a Condylectomy, ...
New Taxonomy Codes Added for Glaucoma Specialists
March 8th, 2017 - Chris Woolstenhulme, CPC, CMRS
NUCC announced a new set of codes released 01/01/2017 with the effective date of 04/01/2017 for Allopathic & Osteopathic Physicians. For ophthalmology, the new taxonomy codes are specifically for Glaucoma Specialists in Healthcare. 207WX0009X Under the Allopathic & Osteopathic Physicians; Ophthalmology was added: Glaucoma Specialist - An ophthalmologist who specializes in the treatment of glaucoma and other ...
Alcohol and Tobacco Use During Pregnancy
March 3rd, 2017 - Chris Woolstenhulme, CPC, CMRS
If a mother uses alcohol or tobacco during pregnancy, be sure to assign O99.31 "Alcohol use complicating pregnancy, childbirth, and the puerperium." Document the time of the encounter (such as the trimester), during childbirth, or during the puerperium. NOTE: You also need to assign a secondary code from category F10- to identify manifestation of the alcohol use. The following ...
Care Plan Oversight Services
March 1st, 2017 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Care Plan oversight services is commonly done but rarely billed. The following codes can only be billed once every 30 days. The use of the following codes are determined by the complexity and approximate time spent by the physician or other health care professional within a 30-day period. G0179 MD re-certification HHA PT May be ...
Sleep Studies: Billing with Reduced Hours
January 12th, 2017 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
When using codes 95800, 95801, 95806, 95807, 95810, and 95811, and fewer than six hours of recording is performed, you must report the reduced services using modifier 52. Also, when using 95782 and 95783, and fewer than seven hours of recording is performed, modifier 52 would be appended to the appropriate code. 95805 would require modifier 52 if fewer than four hours of recording is performed. Medicare recognizes the ...
Discounts
December 7th, 2016 - Wyn Staheli, Director of Research
All healthcare providers need to be aware that there are both appropriate and inappropriate ways to discount your fees. Both state and federal laws can impact your practice financial policy regarding fee discounts. Additionally, we recommend carefully reviewing either Chapter 1.5-Fees of the Behavioral Health DeskBook or the Insurance and Reimbursement chapter ...
Dental Examination Prior to Kidney Transplantation
December 6th, 2016 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Despite the "dental services exclusion" in §1862(a)(12) of the Act (see the Medicare Benefit Policy Manual, Chapter 16, "General Exclusions from Coverage," §140), an oral or dental examination performed on an inpatient basis as part of a comprehensive workup prior to renal transplant surgery is a covered service. This is because ...
Billing for Prosthesis Designed and Prepared by the Dentist
December 6th, 2016 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
For maxillofacial services, if a prosthesis is provided, and is designed and prepared by the dentist, the Medicare Part B carrier may be billed with CPT codes 21076 through 21089. If the prosthesis is prepared by an outside laboratory, the laboratory bill goes to the Durable Medical Equipment Regional Carrier (DMERC), with Level ...
Shift Your Focus: The New Generation of Dental Billing
October 3rd, 2016 - Christine Taxin
More and more information emerges each day about the connection between certain serious medical conditions and poor oral health. Consider these headlines found in a recent dental journal: “Periodontal disease may have even more of an impact on overall health than previously thought,” and, “Biomarkers in Saliva Help Detect Early-Stage ...
10 reasons why medical practices prefer working with medical billing service companies!
September 29th, 2016 - Adam Smith
1. Training costs can save a healthcare organization over 8% of its operating expenses. A recent study states that teams who work with EHRs require an average of 53.5 hours of training at a cost of $3000. The cost of training a single physician amounts to $1540. That is a whooping amount for...
23 RCM questions you should ask when reviewing a medical billing company
September 29th, 2016 - Ango Mark
So, you have considered taking on the challenges of finding the best medical billing company for your medical practice. We should all by now know that the healthcare industry’s reimbursement laws aren’t going to stay put and be as they are. The changes they undergo are constant and...
Dental Offices - Billing Medical Insurance for covered procedures
September 12th, 2016 - Christine Taxin
If your dental office isn’t billing medical insurance for certain procedures, you’re missing out on an important way of serving your patients and expanding your practice. Currently, only about 64% of Americans are covered by a dental insurance plan. But the Affordable Care Act requires nearly 100% of Americans to be covered ...
1500 Claim Form Tips
August 3rd, 2016 - ChiroCode
The following rules for the 1500 claim form are excerpts from NUCC and Medicare instructions, but they are generally universal and apply to claims submitted either electronically or on paper. Please note that payment rules can change frequently for any payer, so consult with specific insurance payers for their adaptations. The ...
3 Steps To Be As Successful As University Of Virginia’s Medical Group Practice.
July 19th, 2016 - Adam Smith
How keeping track of the key performance indicators has given this group practice an edge over its competitors in handling the revenue cycle… The shift to value-based economic systems has de-stabilized many healthcare organization’s economic dispositions. Group practices endured...
6 Simple steps to create secondary claims using eClinicalWorks!
March 16th, 2016 - Victoria
With the help of web analytics , question and answer websites, forums, we came across the most searched queries . And, today we will discuss one of them. We reached out to Sophia Johnson,eClinicalWorks billing specialist at PracticeBridge to share her insights and she provided us six simple steps to...
How to submit Medicaid/Medicare secondary claims electronically using eClinicalWorks!
March 15th, 2016 - Victoria
It has never been a cakewalk working with an EHR. You know how tough it can be, if you don’t have an eClinicalWorks expert to help you with billing needs. What do you do when you are not aware of a certain feature or a procedure? We reached out to some organizations to know how what they did...
Net Collection Ratio
December 29th, 2015 - Codapedia Editor
The net collection ratio is a calculation that shows the practice how much money they are collecting of the money, which they could have collected after insurance adjustments. It is an excellent measure of how well the practice is doing in collecting accounts receivable.
Post-operative Hospital Visits
October 15th, 2015 - Betsy Nicoletti, M.S., CPC
In 1992, CMS developed the concept of the Global Surgical Package, which pays for surgical services with a single payment. The full description of services that are included in this payment is described in the Medicare Claims Processing Manual, Chapter 12, Section 40 and in a CMS Fact Sheet.
The Critical Role Of Hospital CFOs: A Data Driven Answer [Infographic]
October 6th, 2015 - Adam Smith
We know the evolving role of CFOs in the healthcare industry. There are situations which have forced the executives to make such decisions like changing the vendor, attritions and outsourcing one or more of their processes. There could be ample reasons like transition to value-based model, slow...
How to research coding questions
June 1st, 2015 - Christina Benjamin
How to Research Answers to Coding Questions Perform a search of the discussion board or listserv website prior to posting a new question. For your search terms, include specific words such as the diagnostic statement or procedure statement or the specific code number or ...
Money In Your Pocket: Balance Bill
December 4th, 2014 - Donna Weinstock
Do you routinely balance bill your patients? Do you send the statement as soon as you hear from insurance or do you wait until the end of the month? Balance billing your patients is essential for several reasons. First, it increases your revenue. It may not seem like a lot of money, but the...
CMS: Lot of errors billing psychotherapy services when E/M visit is involved
October 15th, 2014 - Scott Kraft
The Comprehensive Error Rate Testing (CERT) program Medicare uses to assess the accuracy of provider billing has uncovered a big source for mistakes – documentation problems when a patient is receiving psychotherapy services on the same date as an E/M encounter, according to CMS. There are...
Consult Documentation Guidelines
September 3rd, 2014 - Jeannie Cagle, BSN, RN, CPC
By Jeannie Cagle, BSN, RN, CPC For those practices that bill consultation codes, the guidelines can be confusing. Yet, it is worth taking the time to learn the rules to get the additional reimbursement paid for consultation codes over new patient codes. Remember the following: · ...
The Benefit of Checking Benefits
September 3rd, 2014 - Donna Weinstock
Many of your physicians perform surgeries and diagnostic procedures on patients. It is easy to call and determine if precertification is required, but how many of you actually look at what is required of a patient prior to performing the procedure? In many cases outpatient procedures and...
‘Two midnight’ rule draws lawsuit – enforcement currently delayed
August 5th, 2014 - Scott Kraft
The American Hospital Association is leading the charge in a lawsuit against CMS’s controversial “two-midnight rule,” instituted last year to attempt to slow down the expanded use of observation status by hospitals by presuming that any stay intended to cover two or more midnights...
CMS NCD drops clinical trial requirement for FDG PET scans for solid tumors
May 6th, 2014 - Scott Kraft
Patients no longer need to be in a CMS-approved clinical trial for physician practices to get paid for doing as many as four FDG PET scans for solid tumors – one for an initial treatment strategy and three to guide subsequent treatments, according to CMS transmittal 8739 to its Medicare Claims...
Medicare fee schedule’s big pay cut probably temporary – big PQRS change likely permanent
January 3rd, 2014 - Scott Kraft
CMS released Medicare’s 2014 Final Physician Fee Schedule rule on Thanksgiving Eve, delayed from its usual November 1 release by the government shutdown earlier this fall. Fee schedule followers won’t be surprised to see CMS finalize a 20.1% average cut to payments next year,...
Bevy of changes make figuring out 2014 Medicare payments more complicated
January 3rd, 2014 - Scott Kraft
Some years, it is relatively simple to project how your Medicare payments will change for the services rendered. When the only factor in Medicare’s complicated payment formula that changes is the conversion factor, the percentage change in your payment is identical to the percentage change in...
Hospital discharge, nursing facility admit billable on same day by same provider in most instances
November 18th, 2013 - Scott Kraft
Medicare will typically pay for a hospital discharge service (billed with 99238-99239) and a nursing facility admission visit (99304-99306) when billed on the same date of service (DOS) by the same provider without the need for a modifier. As always, however, there are a couple of exceptions. The...
Look for standard use of remittance advice codes in 2014
September 6th, 2013 - Scott Kraft
Confusion over how to respond to electronic remittance advice (ERA) will hopefully decline in 2014, thanks to efforts from the Council for Affordable Quality Healthcare (CAQH) to streamline and standardize how payers use ERA codes to convey why your claims are being denied or rejected. These...
Hospital Observation Services
August 28th, 2013 - Dorothy Steed
Hospital observation services are considered outpatient services. They are typically used when a period of time is needed to evaluate the progress or regression. This may include effectiveness of medication/ infusions, results of diagnostic results or other reasons deemed as medically necessary....
Charging Medicare Patients for Missed Appointments
June 20th, 2013 - Cyndee Weston
Previously, each Part B office had their own requirements regarding charging Medicare patients for missed appointments. TRICARE (TriWest Healthcare Alliance) regulations required providers to establish office practice policies regarding "no show" fees and required beneficiaries to sign an...
Selecting a Third-Party Collection Agency and Choosing the Correct Collection Program
June 20th, 2013 - Frank Murphy
Increasing cash flow through the use of a modern, third-party collection agency is a must for practice survival. With states reducing government funding and third-party payers reducing allowables, more and more dollars are being transferred to patient responsibility. Practices now must trim...
How to Manage a Hospital, 101
May 1st, 2013 - Robert Jordshaugen
CEO - stop "Making decisions." If the data and metrics are correct, the decisions are self evident. Spend time instead developing your team, your culture of communication, and ensuring that you are measuring the right activities. Stop managing departments and start managing patients. The...
Charge capture: Paper and Electronic Encounter Forms
May 1st, 2013 - Codapedia Editor
Physicians and Non-Physician Practitioners (NPPs) may want to distance themselves from coding, but implementing an Electronic Health Record (EHR) moves them in the opposite direction. If using an EHR, after completing the note, the clinician selects the CPT® and ICD-9 codes (the procedure and...
Who Qualifies for TCM Services?
April 22nd, 2013 - Lacy Gaskins
Any patient post-discharge whose medical and/or psychosocial problems are complex enough to require TCM services qualifies for these codes. Here are the specifics:   1. Location: “TCM is for higher-risk patients being discharged from an inpatient or observation status to their home, rest home,...
Keeping Track of Your Surgeries
March 22nd, 2013 - Debra Sanders
When working my AR, I work my surgeries separately since that is my big money or bulk money. I want to make sure I get that money in as quickly as possible. For me, I created an excel spreadsheet. The columns are: DOS - PATIENT NAME/MRN - PROC NAME - CARRIER(S) - CPT® - MODIFIER - BILLED -...
No Claim Left Behind
March 22nd, 2013 - Shannon Bosley
Call me crazy, but it is always exciting to me when I assist a practice in getting reimbursed on unpaid or delinquent claims. Claims that were denied, viewed as uncollectable, past filing deadline, or a multitude of other reasons. I even have a little dance that I do! Why not? We need to get...
Why Get Into Medical Billing?
March 22nd, 2013 - Debra Sanders
I am asked alot or read alot where people want to get into medical billing. Some have gone to school and some haven't. Either way, there is more to it than just saying, I want to do that. I've been in this field for over 15 yrs and still learn something new every day. I even learn something I...
Graphical Coding as part of EMR clinical workflow
March 22nd, 2013 - Robert Jordshaugen
The way to ensure a high performing EMR implementation is to fundamentally rethink processes to match what is technologically appropriate, rather than automating existing workflows. Instead of using the existing HIT EMR systems from the major vendors as the workflow driver, start with a sample of...
ABN
September 18th, 2009 - Charlene Burgett
In an attempt to make the ABN more understandable for my physicians and staff, I developed this explanatory paper that is specific to our office; however, the basics apply to all offices. Charlene Burgett,MS-HCM,CMA(AAMA),CPC,CCP,CMSCS,CPM Administrator, North Scottsdale Family Medicine POMAA...
Modifier -24
June 21st, 2009 - Crystal Reeves, CPC, CMPE
Modifier 24 is used to indicate that an Evaluation and Management service was provided by the surgeon to a patient within the global period of a major or minor surgery. The claim must be accompanied by documentation that supports that the service is not related to the postoperative care for the...
Billing for no-shows
April 30th, 2009 - Codapedia Editor
CMS clarified in 2007 that a physician practice may bill Medicare patients for failing to keep an appointment. The CMS MedLearn matters article is attached as a resource. Check with your state Medicaid to see if you can bill Medicaid patients. If you are billing Medicare patients, this must be...
How to bill for Well Woman Exams (WWE)
April 15th, 2009 - Charlene Burgett
Well Woman Exam Coding There are options for billing pelvic exams and Pap smears for non-Medicare payers, albeit inconsistently by health plan. Some health plans will pay G0101, Q0091, S0610 and/or S0612. Some will pay one or another, some will pay a combination of two, others will pay certain...
Incident to Billing or Incident to Service
April 10th, 2009 - Jeannie Cagle, BSN RN CPC
By Jeannie Cagle, BSN, RN, CPC This question appeared in a recent list serve. My two responses are based upon two different assumptions: (1) both providers are physicians, and (2) one of the providers is not a physician. The principal points are that each physician has a unique National Provider...
Using denial tracking to improve collections
April 10th, 2009 - Codapedia Editor
Here are some examples of denials that a practice should track to be sure that they are paid correctly by the insurance company. Set up a denial type for each of these. Fee Schedule Issues: Wrong amount paid per the contracted fee schedule. May be too high or too low Modifier 80...
Using Modifer -59
March 31st, 2009 - Crystal Reeves
By Crystal Reeves, CPC, CMPE, Principal Modifier -59 is probably one of the most misunderstood, misused, and most-feared of all CPT® modifiers. Some practices avoid using it all together because they don’t want to be guilty of unbundling. Some practices do not use it because they are not...
Real Time Claims Adjudication (RTCA)
March 31st, 2009 - Codapedia Editor
Real time claims adjudication (RTCA) is a software interface between a physician's practice management information system and a payers claims processing system that allows the practice to submit a claim at the time of checkout, and receive a response from the insurance company while the patient is...
Denial tracking
March 30th, 2009 - Codapedia Editor
Claims denials have the following outcomes, none of them good: Collection of revenue is delayed Collection for the service never happens Staff members spend time and energy researching and resubmitting claims The denial is lost in the A/R system and never worked There are...
Copying insurance cards
March 30th, 2009 - Codapedia Editor
Is your office copying insurance cards? I have three words of advice: Just stop it. I am amazed at how often I see front desk staff doing this. They ask for the card. Get up from the desk. Walk to the copier. Hopefully, no one else is using it right then. Copy the front. Wait. Take the copy...
The cost of no-shows
March 30th, 2009 - Codapedia Editor
What is a no show in your practice? a huge relief: now we can get caught up lost revenue you can never make up Of course, the answer is both. From a financial perspective, it is critical to keep no shows to a minimum. It is a good idea to track no-shows, to see what they are costing...
Registration policies
March 30th, 2009 - Codapedia Editor
Years ago, we scheduled patient visits in a big book, penciled in the patient name, phone number and reason for the visit. We were done. Now, most practices are using a computerized scheduling system, that allows more than one person to schedule at once (remember passing "the book" back...
Eligibility
March 30th, 2009 - Codapedia Editor
One of the most common sources of denials in physician practices is "patient not eligible for this date of service." The patient presents with an insurance card, the office copies the card, and stores the information. The practice provides service, and perhaps collects a copay, and then...
How to analyze and diagnose a low collection rate
March 5th, 2009 - Elizabeth Woodcock
Woodcock & Associates has provided a diagnostic tool for you to download. Click the Resources link above to get the PDF file.
Accounts Receivable Benchmark Data
February 6th, 2009 - Codapedia Editor
Accounts Receivable benchmark data includes a measurement of the gross collection rate, the net or adjusted collection ratio, an aging report, or an aged trial balance and the total days in accounts receivable outstanding. It is critical for physician practices to measure and track this data on a monthly basis and to compare that data with national standards.
Completing encounter forms
January 29th, 2009 - Codapedia Editor
“Collecting the money is out of my hands.” How many times have we heard physicians express this sentiment, both as wishful thinking and as a statement of fact? Physicians often overlook the most important step in the billing and collection process: telling the billing office what...

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