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Medical Biller's Day 2012

Happy Medical Medical Biller’s Day!  March 22, 2012 is National Medical Biller’s Day.  Medical Billers Day was first initiated by The American Medical Billing Association (AMBA)  in 2008 to honor and recognize the hard work and dedication of medical billing professionals. Many states have received official proclamations from their governor offices declaring the fourth Thursday […]

PECOS: Are You Enrolled? Are Your Referring Dr’s?

Are your providers currently enrolled in the Medicare PECOS system?  Are the providers who regularly refer patients to your clinic enrolled? PECOS:  Provider Enrollment, Chain and Ownership System Many providers are still unaware of the PECOS system, the need for enrollment, and the negative impact that failure to enroll could have on their practice. Although […]

Chiropractors Under the Magnifying Glass of Medicare

Is your practice prepared? Multiple audits performed by TrailBlazer, the Office of the Inspector General and most recently the Comprehensive Error Rate Testing (CERT) contractor have revealed unacceptably high numbers of inappropriately paid claims for chiropractic manipulation. Findings echoed previous results of government auditors. As a result, Chiropractors can continue to expect their claims to […]

Patient Action Alert: Stop the Therapy Cap!

The exceptions process for patients needing physical, occupational, and speech therapy beyond the capped amount ended December 31, 2009. Currently there are two therapy caps, one for physical therapy and speech therapy combined and one for occupational therapy. The 2010 therapy caps are set at $1860 per beneficiary per year. The therapy cap applies to […]

New Place of Service (POS) Code: Walk-in Retail Health Clinic

Mark your calendars!  A new place of service code goes into effect May 1, 2010. Billers and managers for these types of clinics should check with their practice management software companies and clearinghouses to be certain that the new code will be added before the effective date.  They will also want to notify their billing […]

Talking with Patients about Out-of-Pocket Expenses in 2010

The new year is almost nigh and we can expect patient out of pocket costs to go sky high! While it seems that every new year brings higher patient deductibles and coinsurance and reduced benefits, I have definitely seen the trend escalating over the past few years. 2010 portends to be no exception to that […]

Today’s Tip: Submitting Paper Secondary Claims

A good number of provider offices are still submitting secondary claims on paper rather than electronically for a variety of reasons.  Today’s tip was written with the goal of reducing the number of denied secondary paper claims by making just a  few simple changes. Basic information New billing staff should understand that the secondary insurance […]

Texas Dep’t of Insurance Workers Comp Division Releases 2009 Report Card

The Texas Dep’t of Insurance Dep’t of Workers Compensation has recently released the results of its 2009 Performance-Based Oversight Assessment. The results of the assessment could impact your practice. Assessments were conducted on the performance of two key players in the worker’s compensation arena:  insurance carriers and healthcare providers. Insurance carrier report card Insurers were […]

Falls Prevention Awareness Day and Physical Therapy Assessments

As the nation observes Falls Prevention Awareness Day on September 22, the American Physical Therapy Association (APTA) is urging older adults to schedule a balance and falls assessment with a physical therapist to reduce risk of falls and related injuries. Does your practice offer falls risk assessments? Are your referring Dr’s aware that you offer […]

Texas Worker’s Compensation and Preauthorization Rules

There seems to be confusion among healthcare providers and their staff regarding which services must be preauthorized under Texas Worker’s Compensation rules, what is required of the provider, and what are the obligations of the carrier. A number of treatments and services do require preauthorization, below are just a few: Inpatient hospital admissions Surgical procedures […]

Medicare Feedback—Chiropractic Documentation Errors

I often receive calls and emails pertaining to chiropractic services and mysterious Medicare denials and requests for documentation.  There can be a number of reasons for both.  I will be releasing more articles on specific billing issues that are common to chiropractic services, but today we will focus on documentation errors due to the timeliness […]

Legible Documentation Signatures—Not Optional

A recent alert went out from various Medicare contractors concerning the requirement for  healthcare providers to include a legible signature on their documentation. It turns out that in some cases, providers are not signing their documentation at all! Audits conducted by the Office of the Inspector General (OIG) and CERT (Comprehensive Error Rate Testing) have […]

Billing Medicare for Non-Covered Services

Yesterday we discussed the practice of billing non-covered services under a payable code, and clearly established that such a practice would be considered fraudulent. This does not mean that the provider does not deserve to be paid for the service nor does it mean that he must automatically write the charges off as a loss. […]

Billing a Non-covered Service under a Payable Code

Can we do that? I could not begin to recount all the times I have heard healthcare providers or their staff ask if they can bill Medicare or another insurance carrier for a non-covered service that they perform, but just code it as something else so that they can get paid. It is little wonder […]

Avoid Unnecessary Denials! Use your Medicare Local Coverage Determinations!

What is a “Local Coverage Determination” (LCD)?                                                                                          Medicare contracts with private companies like Palmetto, Noridian, Novitas, etc. to administrate—process and pay claims in a specific region. Medicare Carriers and Fiscal Intermediaries (FIs) are private companies that Medicare contracts with to pay bills. More recently some FI’s have been replaced with the MAC […]

Out of Pockets and Deductibles

Please Explain Out of Pockets and Deductibles As in yesterday’s topic, many clinic staff members seem to think that these two terms mean one in the same thing.  The results can be less than desirable if the difference between out of pockets and deductibles is not clearly understood. In a nutshell: Out of Pocket (OOP) […]

Co-pays vs. Co-insurance

Please Explain Co-pays versus Co-insurance I am often asked by providers and their staff to explain what each of these terms actually means.  Some mistakenly believe that the two terms are interchangeable. I discovered that many times when a patient had for example, a 20% coinsurance, the staff would charge the patient $20 a visit […]