Some providers slow down their own cash flow because they do not know any better, or they just want to practice the way they have always practiced before, or they let their employees dictate how they are to run their practice. As crazy as it sounds these scenarios are more common than one would think. Payors are reducing reimbursement rates to balance the national debt, so why reduce your own income voluntarily? I have three case studies to share:
Medical Billing of Needle Electromyography (EMG) codes used to be fairly straightforward, but not since the beginning of 2012, when a fairly significant change was instituted to the way in which these procedures are coded.
For many practices, the question of whether or not to outsource the medical billing function has been on the back burner for some time. We say it’s time to take an objective look at the issue and bring yourself closer to making a decision that could be a shot in the arm for the financial health of your practice. Ask yourself just how much it costs you –in hard costs and soft costs—to keep the billing function in-house.
When it comes to retaining medical billing records, current guidelines require that records be retained for a period of four years—the “lookback” period during which the Centers for Medicare and Medicaid Services (CMS) has the right to amend payments made to physicians for whatever reason is deemed appropriate. However, CMS has proposed changing the current four year lookback period to a ten year lookback period—and retaining the right to conduct takebacks for that long, as well. The Proposed Rule was posted by CMS in the Federal Register on February 16, 2012. The proposed 10-year lookback period would be consistent with the False Claims Act statute of limitations under a provision of the Affordable Care Act. The effect of this change in the statute of limitations for taking back funds previously paid to providers is also consistent with the aggressive stance the OIG is taking toward healthcare fraud.
By Christine Moore, CPC, CGSC--Even though Modifier 58 and Modifier 78 have similar meaning and wording, there are a few tips that will help in choosing the correct global period modifier when billing claims.
It seems that no one would volunteer for a pay cut, but some providers are doing just that. Physicians are fighting hard to repeal the government’s 27% SGR reduction, but many in private practice are voluntarily accepting pay cuts anyway. How can this be? The AMA states that many private practices using in-house billers leave an estimated 10%-15% of the practice’s revenue uncollected--either through a lack of billing education or unmotivated employees. And the amount of money that goes uncollected can be staggering.
By Sherry Sparham, CPC-D--Sometimes, there are wrinkles in the way payers process claims for medical billing of new procedures. For instance, in the May, 2011, BCBS Record, there is notice of a New Procedure to Bill For Cryotherapy performed in the office. The new procedure code is 17340. Some of you may remember this procedure was used a while back to bill Medicare for cryotherapy of acne. At present, Medicare no longer covers this procedure, but BCBSMI does cover this code effective 08/01/2011. BCBSMI is still paying for procedure 10040, as well, but there are changes to descriptions for each procedure.
At my last EMR conference, there were well over 600 EMR’s on the market. Some were certified but even more were not. From the latest research according to Mark Anderson from the AC Group, less than 12% of the physicians are using their EMR programs as they were promised or intended. A recent survey indicated that 38% of physicians where unhappy with their EMR’s, and many were seeking to get out of their contracts. Since 2008, more than 5,000 practices have decided to replace or drop their EMR vendors. Many have paid upwards of $40,000 per provider for their EMR products only to find out that the product was oversold, did not meet the practice needs, or found that the vendor went out of business shortly after the implementation.
Currently, under ICD-9, a 453.42 code is for acute venous embolism and thrombosis of deep vessels of distal lower extremity. Included under this code is a diagnosis involving a thrombosis or embolism to the calf, lower leg NOS, or the peroneal or tibial veins. All possible combinations are included under this one code.
In any medical practice or clinic, the objective is to provide the best care possible and be reimbursed at the highest possible rate. The former is in the hands of the provider—usually the clinic or practice owner—who has a vested interest in making sure that “best care possible” proposition is carried out. He has direct control and authority over the level of care patients receive, and can easily make adjustments when circumstances warrant. He is comfortable with his level of knowledge and education, knows his limitations, and brings in consultants when necessary to compensate for any lapse in quality he may feel would detract from the care scenario his patients receive. We all know this is a full time job—and then some. So what about the latter—being reimbursed at the highest possible rate? Usually the physician has some knowledge of coding requirements that comes through osmosis from filling out encounter slips for the patients he sees, but there is hardly enough time in the day for a physician to double check every code on every chart processed by his billers and coders. He is justified in expecting that the biller or coder will exhibit the highest commitment to excellence in knowledge, professional standards, compliance and ethics, even though the biller or coder does not have the ownership interest in the practice that the provider has.
