Category Archives: iMAX Medical Billing Insights

Essential Tips for Successful Appeals

Successful appeals are often a result of how you present appeals to your carrier. Here are vital tips to achieve successful appeals. Be Prepared: Anyone speaking with the carrier regarding an appeal—be it a coder, biller, office manager, or provider—should have the knowledge and detailed information necessary to discuss that appeal. The individual should be able to review the operative note with the payer, to explain the rationale for the coding/billing, and to demonstrate why the claim should have been treated differently. Write an Appeal Letter: Don’t just send an explanation of benefits (EOB) with a balance bill. Instead, spell out

Presumptive Drug Testing

Presumptive drug testing services may be performed prior to definitive drug screen testing (80320-80377), when a provider wants to rule out illicit drug uses or to confirm the presence of a particular drug class without identifying individual drugs; or, to distinguish between structural isomers. For example, a patient using prescription opioids for pain management may receive a randomized drug screen service to test for the presence of opioids and illicit drugs, or other prescription drugs that may cause risk when combined with opioids (e.g., benzodiazepines). Presumptive Drug Testing CPT Codes Medicare and private payers require the same codes to report presumptive drug

Warning Signs of Heroin Use for Parents   KNOW THE SIGNS What are the signs of Heroin use? A neatly folded receipt resembling an envelope. A Q-Tip with the cotton bud plucked off. And who doesn’t have some dirt smudges on their doors or light switches? Unless you are aware, many of these seemingly innocent items go unnoticed. Knowing signs of opiate and heroin abuse could save a life. It could keep a family together. It could be the first step in getting someone, whom you care about, off of a dangerous, deadly course. Experts suggest that addicts will almost never be far from their drugs. They

Specialized detox center opening in Chillicothe

CHILLICOTHE, Ohio A first of its kind recovery clinic for Ross County opens its doors Monday. It offers more supported withdrawal from drugs and for longer than any other current program in the area. The two people running it came together through the Heroin Partnership Project, a Ross County collaboration that just won the National Criminal Justice Association Outstanding Criminal Justice Program Award for the impact it has had on the opiate epidemic. They are counselor Pat Friel and Hopewell Health’s Kylie LeMaster. Friel said there is a big need because it is difficult to find available inpatient detox beds

Ohio Providers, Health Insurance Prepare For Medicaid Changes

In two weeks, mental health and addiction services for low-income Ohioans will be moved into Medicaid managed care. Many behavioral health and family services providers say this huge change is straining their finances. But the group that represents Ohio’s health insurers says the move can’t be delayed. Ohio Association of Health Plans President Miranda Motter says the July 1 massive overhaul in how providers will bill for services has been coming for two years. And she says health insurers and the state have set up contingency plans for providers who, in her words, haven’t planned adequately. “I do think that

7 Ways to Develop Daily Discipline

Many people wonder how I manage to stay so disciplined. They think my life must be very hard because I’ve always followed a strict schedule, from when I was training to be an Olympic athlete to now, since I’ve co-founded Onbotraining, an online coaching service that helps people achieve their goals. But I don’t see it that way because I love what I do. My journey to the Olympics showed me what it takes to become skilled at something, and I don’t mind replicating that journey in my professional life. I have never minded the struggle because I know it offers me

Time-Based Code Reporting

When calculating time spent performing a time-based procedure or service, include only those items specifically detailed in the code descriptor. For example, when reporting critical care services (e.g., 99291-99292), you may include the time spent interpreting cardiac output measurements or chest X-rays, performing ventilator management or vascular access, and other services enumerated within CPT® as inclusive of critical care. You may not count toward critical care the time spent performing other, separately reportable services (e.g., endotracheal intubation for airway support, 31500). Carefully review CPT® guidelines and code descriptors to determine which activities you may count toward the time of a

Modifier 59 – To Use or Not to Use

I often call Modifier 59 the prednisone of modifiers. That is because it is very powerful and can do a lot for you, like prednisone is for the patient. But at the same time, it is a two-edged sword, the modifier 59 is exceptionally dangerous when used incorrectly and care is not applied, just like a doctor would find for their patient when using prednisone. Modifier 59 is the universal unbundling modifier. When used on a claim line, it unbundles two procedures that normally would be bundled and not paid together. Modifier 59 is telling the payer that this situation

Oil Your Practice Management Skills in 2018

It’s the new year and the perfect time to make sure your physician’s practice is productive and compliant, and most importantly that your patients are happy. The way you manage patients, the revenue cycle, technology, staff, and medical records can help your practice’s gears move at maximum efficiency to promote a workflow that makes the most out of your resources. Let’s explore ways you can improve office tasks. According to Physicians Practice’s “9 Priorities for Practice Management in 2018,” there are nine ways you can keep healthcare tasks moving to maintain a viable healthcare operation this year: • Protect confidentiality