Bill This!: Determine Which Agency You’ll Bill in This SNF Case   (February 2012) First Release

How would you bill each component of this case?

Test your skilled nursing facility (SNF) billing skills with this case study from a Medical Office Billing & Collections Alert subscriber in Maryland.

I have a case where I’m having trouble assigning the deciding what to bill and which entity to seek payment from. One of our longtime patients now lives in a skilled nursing facility. She wants to continue visiting our office although the nursing facility [...]

Incident-to Billing: Shore Up You Incident-to Claims or Face OIG Scrutiny This Year   (January 2012)

Ensure your visit meets 4 criteria before filing an incident-to claim.If you don’t know how to correctly bill the services the non-physician practitioners (NPPs) in your office perform, it could cost you more than the 15 percent difference in reimbursement rates.Here’s why: As part of its 2012 Work Plan, released on last October, the HHS Office of Inspector General (OIG) plans to scrutinize incident to services.Your best bet for avoiding OIG scrutiny is no to [...]

News You Can Use: You’ll Be Spared a 27 Percent Pay Cut — At Least Until the End of February   (January 2012)

At nearly the last minute, Congress votes to boost conversion factor.Although the government appeared poised to take a big bite out of your Medicare payments, you have another two months before you need to worry about losing pay. That’s because the 27 percent Medicare pay cuts that practices have feared since last fall were once again kicked to the curb by Congress, resulting in a new, but most likely, temporary Medicare Physician Fee Schedule conversion [...]

News You Can Use: Figure Out Which 5010 Category Your Practices Falls Under   (January 2012)

Watch out: Not everyone will have until March 31 to comply.You thought you wouldn’t face enforcement action regarding 5010 compliance until March 31, 2012. Now CMS tells providers that they are being watched carefully – and that some of them will not actually have until March to switch to 5010.CMS Accelerates Changeover In a Dec. 14, 2011 news release, CMS announced that it is monitoring progress toward 5010 compliance and has found that some practices are unnecessarily [...]

Clip and Save: Check Modifier Assignments Before Processing Appeals — This Handy Chart Will Help   (January 2012)

Same-day procedures don’t mean the denial is appropriate – verify before writing off the charges. As a biller, you may not actually assign the codes and modifiers to claims for your physician’s services. But if the coding is the reason your claim gets denied, you’ll need to do some investigative work. Modifiers are an area of coding that causes many claims errors, so even if you don’t code physician services you should know which modifiers apply [...]

You Be the Billing Expert: Does Ability to Bill the Patient Expire?   (January 2012)

Question: Is there a time limit on when you can bill a patient for their balance due after the insurance company processes the claim? For example, if the patient still owes a balance (according to insurance’s allowed charges) after two or three years, are we able to still bill the patient?Colorado SubscriberAnswer: There is no national regulation that limits when you can bill a patient. You should check your state’s laws, however, to ensure there [...]

Reader Questions: Capture EpiPen® Kit Pay With J0171   (January 2012)

Question: We used the EpiPen® kit in the office for a patient who experienced an allergic reaction to contrast dye. How do we bill for using this kit? Vermont Subscriber Answer: Use of an EpiPen® represents an injection of epinephrine. As such, it would be appropriate to code its administration using codes 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) and J0171 (Injection, adrenalin, epinephrine, 0.1 mg).

Reader Questions: No History? Don’t Assume Comprehensive Level   (January 2012)

Question: Our physician admitted someone as an initial inpatient, but couldn’t get all her information. He performed a comprehensive exam and complex medical decision making based on the patient’s current condition. Can we give credit for a comprehensive history even though he couldn’t obtain a comprehensive ROS (review of systems) due to the patient being mentally confused? South Carolina Subscriber Answer: There is no written rule that you can automatically give credit for a comprehensive [...]

Reader Questions: Pay Attention to Month, Not Year, With Birthday Rule   (January 2012)

Question: I just received a call from a patient’s parent claiming that we didn’t follow the birthday rule when we billed the mother’s insurance. The mother’s birthday is 09/30/1965 and the father’s birthday is 11/30/1958. The mother says that since the father is older, we should have billed his insurance rather than hers. What is the birthday rule and whose insurance should we have billed?Iowa Subscriber Answer: You’ll only follow the “birthday rule” in determining [...]

Reader Questions: 99241-99255: Keep Consults When Possible   (January 2012)

Question: Can we still use “consult” E/M codes?North Carolina SubscriberAnswer: The answer to that question depends on the payer. If your insurer accepts the codes, then yes, you can continue to use E/M consult codes.Starting in 2010, Medicare discontinued recognition of the consult codes 99241-99255 (Office or other outpatient consultation …). Some payers continued to accept these codes, however, and CPT® maintained the codes in 2011 and again in 2012. Opportunity: You shouldn’t stop using [...]