|
Medical Billing &
Coding
Are you getting properly paid for your work that you performed?
If you feel you are working harder and your income is not where it
should be, then you are probably right. Take a detailed look at
collection performance on your reports. You will be amazed how much money is being left on the table for over 90 days.
We can assist you in performing a review or an
audit.
The average physician loses
$200,000.00 per year from improper coding & billing!
You may not get paid for services performed if your staff or
current billing company does not properly file claims and perform
intense follow-up. Your income from surgical procedures depends on
proper use of modifiers with correct procedure. Follow-up of
unpaid claims and appeals need to be performed in a timely manner.
It's important to monitor your
collection procedures on a monthly basis.
Review your reports and take a detailed look at follow-up for
maximizing revenue:
-
Run Accounts Receivable Report and
find out how much money is outstanding over 90 days or ask your
billing company to provide you the same report so you know how far
behind or current they are.
-
Did you write-off inappropriate denials from the insurance
company?
-
Is your staff properly checking the
insurance verification and collecting co-pays or deductibles at
the front desk? Do you send out monthly patient statements? Are
phone calls made to patients to resolve outstanding balances?
-
Is your coding done properly utilizing correct level
modifiers? This is the key to get maximize reimbursement for your
practice.
Patient Consultation on the day of immediate surgery - Modifier 57
For major surgical cases only you could bill for consultation or
evaluation of the problem that leads to surgery if the decision
for surgery is immediate. Adding modifier 57 to your hospital or office
visit codes will notify the carrier, the decision for
surgery was made on the same day the procedure was performed.
Procedures performed on the same day as an office visit - Modifier
25
You must add modifier 25 to E&M codes for certain procedures
performed in addition to the office visit. Forgetting to add this
important modifier will result in denial of the office visit and
your practice loses money.
When to use Modifier 59
Multiple procedures should not be bundled in certain
circumstances. Certain cases should be billed with modifier 59.
Modifier 22
This code should get added to extensive cases. A copy of your
operative report should be sent along with your claim for
additional payment. You will need to watch this one. Proper
follow-up for additional fees paid is very important. If you do
not get paid additional funds for additional work you must appeal.
69990 Surgical Microscope
This code should be billed when a surgical microscope is utilized
during surgery. Make sure the surgical code used does not already
include the use of a surgical microscope within the code
description.
Modifier 63
This modifier should be added when surgical procedures are
performed on infants less than 4kg. You may need to appeal with
operative report for payment of this modifier. Appendix F of your
CPT manual includes a summary of codes that are exempt from use of
this modifier.
Modifier 78
This modifier should be added when a related surgery is done
during the post-operative period of a previous surgery done by the
same doctor or a doctor in the physician group.
Modifier 79
This modifier should be added when an unrelated procedure is done
during the post operative period by the same doctor or a doctor in
the group. An example of this would be if a physician operated on
one eye and the operated on the other eye during the post
operative period. Another example is if a physician does a hernia
repair and then the patient comes back in for an appendectomy.
Do you charge for services that are not included in the surgical
global package?
Please make sure you study your AMA approved CPT manual for
documentation guidelines. If you don't note the findings in your
documentation you did not do it. The information provided here is
for informational purposes only and all coding guidelines should
be verified with CPT.
|
