iMAXX Medical Billing Solutions Knowledge Hub

iMAX Medical Billing Knowledge Hub

Same-day Preventive and E/M Services

[lightbox link=”” thumb=”×218.jpg” width=”300″ align=”left” title=”5-Coding-friendly-Documentation-Tips” frame=”true” icon=”image”]Sometimes, at a scheduled preventive visit, the patient mentions a new or worsened condition. If the patient complaint requires additional workup, beyond that usually associated with the preventive service, you may choose to report a problem-focused visit in addition to the preventive service. The CPT® codebook instructs: If an abnormality is encountered or a preexisting problem is addressed in the process of performing this preventive medicine evaluation and management service, and if the problem or abnormality is significant enough to require additional work to perform the key components of a problem-oriented E/M service,

Patient Billing When Medicare Is the Secondary Payer

[lightbox link=”” thumb=”×160.jpg” width=”300″ align=”left” title=”paid” frame=”true” icon=”image”]When Medicare acts as a secondary payer—that is, when another insurer, such as workman’s compensation, is primary—you cannot bill the patient for any amount unless the secondary claim has been filed with Medicare, and Medicare determines the amount owed by the patient. If the amount paid by the primary payer is equal to, or more than, the amount the patient owes, as determined by Medicare, and you know that the deductible has been met, you do not have to submit a claim to Medicare (Medicare will pay nothing). You still may wish to

The Right (and Left) Time to Bill Modifier 50

[lightbox link=”” thumb=”×300.png” width=”282″ align=”left” title=”ipad dr” frame=”true” icon=”image”]Modifier 50 Bilateral procedure can sometimes cause confusion because of the seemingly redundant anatomical modifiers RT (right) and LT (left). Although these modifiers may seem interchangeable, they are not. Bilateral surgery is defined as a procedure performed on both sides of the body at the same operative session or on the same day that is not otherwise identified in its code descriptor as “bilateral” or “bilateral or unilateral.” Medicare and payers that follow Medicare rules require the code for such a procedure to be billed on a single claim line with modifier

Five Tips for Coding-friendly Documentation

[lightbox link=”” thumb=”×218.jpg” width=”300″ align=”left” title=”5-Coding-friendly-Documentation-Tips” frame=”true” icon=”image”]Meeting documentation requirements for coding shouldn’t be a burden. Five pointers can go a long way to ensure that your documentation leads to accurate coding for the services you provide. 1. Document Your Decision Making In the eyes of a coder (or auditor), “Not documented = Not done.” But, the provider can’t document everything, and irrelevant details can be as bad as too few details. The best documentation captures the provider’s clinical decision-making process. What is the purpose of the visit? What information about this patient is relevant to his or her complaint? How does

Split/Shared E/M Encounters

[lightbox link=”” thumb=”×256.jpg” width=”300″ align=”left” title=”confident doc” frame=”true” icon=”image”]One trend that is inarguably growing is the use of Nonphysician Practitioners (Nurse Practitioners, Physician Assistants) in physician practices. In the inpatient setting, physicians often are billing the services of these practitioners as split/shared visits. What I have been surprised to find is such a broad lack of understanding of the requirements for billing under CMS’s policies (see Chapter 12 of the CMS Claims Processing Manual). Besides the obvious proper and accurate claims submission we all strive for, the split/shared billing concept is especially important to grasp, as there is a 15

Post All Payments Quickly, Even Those Not Auto-posted

[lightbox link=”” thumb=”×160.jpg” width=”300″ align=”left” title=”paid” frame=”true” icon=”image”]Many practices electronically auto-post a significant portion of claims volume—up to 80 percent, or more. What many practices do not know is that Web-based products exist to help support the balance. Some clearinghouses, for example, offer electronic e-processing by collaborating with banks to convert paper documents to 835 data. The process usually entails scanning paper files, lifting data from images, and creating files that can be posted electronically. One often-overlooked benefit of electronically posting all primary insurance payments — whether received electronically or converted from paper — is more accurate secondary claims filings. Another

7 Billing and Coding Errors to Avoid

[lightbox link=”” thumb=”×300.jpg” width=”214″ align=”right” title=”money trash” frame=”true” icon=”image”]   1) Duplicate claim submitted — Claims are often denied as duplicates for the following reasons: The claim was previously processed (i.e., no payment made, allowed amount applied to deductible on the initial claim). The provider re-files the claim to “correct” it. The second claim submitted is considered a duplicate because the initial claim was processed correctly. The provider automatically re-files the claim to seek payment if the initial claim has not been paid within 30 days. 2) Non-covered services — Medicare defines many “exclusions” such as: personal comfort items self-administered

Nearly 550 New, Changed, and Deleted codes for CPT 2015

[lightbox link=”” thumb=”×218.jpg” width=”300″ align=”left” title=”cpt book” frame=”true” icon=”image”]CPT® 2015 includes nearly 550 new, changed, and deleted codes, as well as added and revised guidelines, parenthetical comments, and terminology. The changes will especially affect family practice, internal medicine, cardiovascular, gastrology, pathology/laboratory, and radiology. Seven changes affect the evaluation and management (E/M) section; E/M services represent the most often reported codes in the CPT® codeset. In Category I codes, spinal procedures (e.g., arthrodesis) in both the 20000 and 60000 codes sections of the CPT® Surgical chapter received a revamp. More than 56 new and changed codes mark the cardiovascular sections, in

“Convenient” Doesn’t Equal “Necessary”

[lightbox link=”” thumb=”×300.jpg” width=”200″ align=”left” title=”cash doc” frame=”true” icon=”image”]Insurers will pay only for services deemed to be medically necessary, based on the patient’s chief complaint or additional conditions that require work-up or focused attention. Services provided out of “convenience” for the patient will not be considered medically necessary if the patient did not have any specific complaints relating to the service. This often happens in specialty practices with subspecialists within the same group practice. For example, in an ophthalmology practice, the patient comes in to see the general ophthalmologist. Because he has traveled three hours to get to the clinic,

Think You Know Patient Collections? Test Your Payment Knowledge with Our Quick Quiz

[lightbox link=”” thumb=”” width=”200″ align=”right” title=”Set-Your-Practice-Up-for-Payment-Success-Webinar-Image-200-px1″ frame=”true” icon=”image”]Do you know what really works when it comes to patient collections? Find out if you’re up on the latest patient payment strategies—take our quick Payment Success Quiz and find out how you score. 1. In terms of getting paid, which point on the “Payability Touch Timeline” is most important? a. Before Visit b. During Visit c. After Visit d. All of the above 2. Before the patient’s visit, it’s important to: a. Set arrival expectation b. Collect insurance information c. Verify insurance information d. Set payment expectation e. Send a reminder f.