Since the 2014 federal mandate for providers to adopt electronic health records (EHRs), almost all healthcare organizations have made the switch over from paper medical records. With good intentions of better healthcare data capture and easier record sharing and portability, the EHR transition unfortunately opened a new list of problems. The good news is EHR technology […]
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The time limit for filing a request for redetermination may be extended in certain situations. Generally, providers, physicians, or other suppliers are expected to file appeal requests on a timely basis. A request from the provider, physician, or other supplier to extend the period for filing the request for redetermination would not be routinely granted.
Note: A finding by the contractor that good cause exists for late filing for the redetermination does not mean that the party is then excused from the timely filing rules for the reconsideration.
Good cause may be found when the record clearly shows, or the beneficiary alleges, that the delay in filing was due to one of the following:
• Circumstances beyond the beneficiary’s control, including mental or physical impairment (e.g., disability, extended illness) or significant communication difficulties;
• Incorrect or incomplete information about the subject claim and/or appeal was furnished by official sources (the Centers for Medicare & Medicaid (CMS), the contractor, or the Social Security Administration) to the beneficiary (e.g., a party is not notified of her appeal rights or a party receives inaccurate information regarding a filing deadline);
Note: Whenever a beneficiary is not notified of his/her appeal rights or of the time limits for filing, good cause must be found.
• Delay resulting from efforts by the beneficiary to secure supporting evidence, where the beneficiary did not realize that the evidence could be submitted after filing the request;
• When destruction of or other damage to the beneficiary’s records was responsible for the delay in filing (e.g., a fire, natural disaster);
• Unusual or unavoidable circumstances, the nature of which demonstrates that the beneficiary could not reasonably be expected to have been aware of the need to file timely;
• Serious illness which prevented the party from contacting the contractor in person, in writing, or through a friend, relative, or other person;
• A death or serious illness in his or her immediate family; or
• A request was sent to a government agency in good faith within the time limit, and the request did not reach the appropriate contractor until after the time period to file a request expired.
Note: Failure of a billing company or other consultant (that the provider, physician, or other supplier has retained) to timely submit appeals or other information is not grounds for finding good cause for late filing. Also, good cause does not exist where the provider, physician, or other supplier claims that lack of business office management skills or expertise caused the late filing.
See also: Time Limits for Each Level of Appeal
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Good cause for extension of the time limit for filing appeals
The time limit for filing a request for redetermination may be extended in certain situations. Generally, providers, physicians, or other suppliers are expected to file appeal requests on a timely basis. A request from the provider, physician, or other supplier to extend the period for filing the request for redetermination would not be routinely granted.
Note: A finding by the contractor that good cause exists for late filing for the redetermination does not mean that the party is then excused from the timely filing rules for the reconsideration.
Good cause may be found when the record clearly shows, or the beneficiary alleges, that the delay in filing was due to one of the following:
• Circumstances beyond the beneficiary’s control, including mental or physical impairment (e.g., disability, extended illness) or significant communication difficulties;
• Incorrect or incomplete information about the subject claim and/or appeal was furnished by official sources (the Centers for Medicare & Medicaid (CMS), the contractor, or the Social Security Administration) to the beneficiary (e.g., a party is not notified of her appeal rights or a party receives inaccurate information regarding a filing deadline);
Note: Whenever a beneficiary is not notified of his/her appeal rights or of the time limits for filing, good cause must be found.
• Delay resulting from efforts by the beneficiary to secure supporting evidence, where the beneficiary did not realize that the evidence could be submitted after filing the request;
• When destruction of or other damage to the beneficiary’s records was responsible for the delay in filing (e.g., a fire, natural disaster);
• Unusual or unavoidable circumstances, the nature of which demonstrates that the beneficiary could not reasonably be expected to have been aware of the need to file timely;
• Serious illness which prevented the party from contacting the contractor in person, in writing, or through a friend, relative, or other person;
• A death or serious illness in his or her immediate family; or
• A request was sent to a government agency in good faith within the time limit, and the request did not reach the appropriate contractor until after the time period to file a request expired.
Note: Failure of a billing company or other consultant (that the provider, physician, or other supplier has retained) to timely submit appeals or other information is not grounds for finding good cause for late filing. Also, good cause does not exist where the provider, physician, or other supplier claims that lack of business office management skills or expertise caused the late filing.
See also: Time Limits for Each Level of Appeal
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Related Medical Coding Articles
Medical Transcription Outsourcing Has Good Infrastructure
Medical transcription outsourcing has become highly popular due to advancement of technology and the demand for the same in the health care and medical industry. There has been rapid advancement in this field and more and more people have come to believe that transcription is an extremely lucrative profession. This idea has seen a large number of people investing in a transcription business and they have greatly benefited from the same too. The medical and health care industry demands for transcription companies that can provide quality transcription services and take a heavy load off the shoulders of medical professionals and in the wake of this idea, one finds Medical transcription outsourcing to be highly beneficial.
Medical transcription outsourcing is extremely affordable and a large number of people have realized how effective it can be. This is why one sees a majority of medical institutions outsourcing their work to these firms. In fact, since it is easily affordable and can be conveniently used, a large number of firms abroad have started outsourcing their work to transcription companies in India. If you think of setting up your individual transcription unit in your institution, you will have to put in a lot of time, efforts and money before it becomes fully functional. You will first have to get all the expensive equipments, get man power and train them to use it well and transcript projects rightly. However, all this is already in place in transcription companies and you will get your transcription done for less than half of the total amount if you opt for Medical transcription outsourcing instead.
Medical transcription outsourcing has excellent infrastructure and has a lot of well trained professionals who are experienced to manage your projects well. The equipments used is at par with the latest technologies and the labor force is competent and well trained to handle these machines well and give you flawless and quality work. Their aim is to provide the clients with more than what they expect and they take every step possible in that direction. Also, they ensure that all the work is done before time so that the client does not have any grounds to complain.
Acroseas is a global provider of Transcription services & has been providing top-of-the-line transcriptions services to our clients worldwide. For more info – please log onto http://acroseas.com
Related Medical Coding Articles
Medical transcription India maintains good standard
Among many other industries that have rapidly grown due to the increasing technology, is the medical and health care industry. People are increasingly aware of the benefits provided by the health care industry and they do not want to settle for anything less than the best. This means that every single detail has to be given a lot of importance so that the standard and quality of the medical industry is maintained. Delegating tasks to different sectors to make things work smoothly, faster and easily is an extremely smart idea. Among many other firms that have become highly essential in maintaining the standard of the medical industry is the Medical transcription India firms.
Medical transcription India is extremely beneficial as it helps the medical industry take a huge load off the shoulders of the medical professionals and provides the medical institutions with the best transcription services available. They ensure that they maintain extremely stringent rules which see to it that all your work is done well under vigilant supervision. They have trained and experienced professionals who handle your projects and see to it that it is done exactly the way the clients want it done so that the client does not face any glitch due to any error committed by the transcription firm.
Medical transcription India firms see to it that they provide you with all the projects on time. They understand the essence and the importance of the client’s projects. This makes them realize that they cannot take your projects for granted and work extremely hard to get it in place on time and well in advance to ship it to the clients.
Medical transcription India is a sector which has a lot of competition and this ensures that the clients receive their projects at extremely affordable rates. In fact, you spend less than half the money you would have spent had you wanted to establish your own transcription firm. Also, they provide highly accurate work since they use the latest technology and hence have their machines upgraded to the latest systems making it even more desirable to the clients who are looking for perfection.
Acroseas is a global provider of Transcription services & has been providing top-of-the-line transcriptions services to our clients worldwide. For more info – please log onto www.acroseas.com
Related Medical Coding Articles
If You License Your Art, Why Now is a Good Time to Create a Coding System For Your Art
If you license your art or want to license your art, you will make your life easier by creating a code system to keep track of your images. This will make it easier to keep track of what companies have licensed what art for what product and what time frame. Even before you have a contract you will want to keep track of what art a company is interested so you can be efficient with your follow up. But how do you do it, exactly?
When I first decided to create a coding system for my art I sat down and got stuck. For some reason I thought there was a magic formula to code creation – that there was a “right” or “wrong” way to do it, and I certainly didn’t want to do it wrong!
Then I came to my senses and realized that if the code was for me, I could make it any way I pleased! This is not the DaVinci Code after all… it is MY code to organize my art and make my life easier. My code, my rules. Cool!
Then I went back to scratching my head… my code system it couldn’t be too complicated – I wanted to be able to create and decipher the codes with a fancy decoder ring.
Ideally the codes needed to grow with my business. Easy enough to remember, but detailed enough to support a lot of art. I didn’t want to have to create a new system and need to update everything in a year, 3 years, 5 years or even 20 years.
Here is what I came up with: my codes consist of 4 letters and 3 numbers.
The first two letters represent one of 12 categories of art. For example, “DR” means it is a drink collection (like martinis or margaritas – yum!), “CH” means it is a Christmas collection.
The next two letters represent the collection name. So the “Ho, Ho, Holiday” christmas collection is “CH” for Christmas and “HH” for “Ho, Ho”.
The letters tell me the category and collection. Now come the numbers.
Since I design collections with icons, borders and repeat patterns – with words and images thrown in – I have 100’s thru 500’s.
All numbers are 3 digits and represent an individual piece of art in the collection, be it an icon, a border or pattern.
Icons: 100’s – so CHHH101 is a Santa, CHHH102 might be a tree, CHHH103 a stocking, etc.
Patterns: 200’s – CHHH201 might be a holly toss – if I have the same pattern in different color ways – say one with a red background and one with tan, I add a letter at the end. So CHHH201A and CHHH201B…
Images: 300’s – mockup images or scenes are 300’s.
Words: 400’s – sometimes I have sayings done in my handwriting or a decorative way – they get 400’s.
Borders: 500’s.
When I finish a collection I create a pdf with pages containing all the icons, borders, words, scenes and patterns – with the code under each. Then if I am at a trade show or email the pdf to a manufacturer, we can jot down the code instead of writing out a long description of the image. The codes save time and decrease confusion. I include codes and images whenever possible in contracts as well.
SO… there is no time like the present. If you start coding right away, you won’t have to go back and code 5 years worth of work. Create a system that makes sense to you and for your work.
Get a jump start on licensing your art by claiming the first chapter of the eBook “How to Get Started in Art Licensing” FOR FREE when you visit http://www.artlicensinginfo.com/freebie.html
Bad news, good news for coders
Bad news, summer is over. Good news, more coding opportunities become available.
Summer is always slow for hiring but starting in September and October many employers ramp up their staff for 2018.
Make sure to check the job board at: http://codersdirect.com/jobs/
Also, I invite all coders that are on Linkedin to join our Coding group at: https://www.linkedin.com/groups/8607661
Thanks,
Mark
43255 Good Bet For Coding For Excessive Blood Loss
When you are coding for excessive blood loss, modifier 22 may not be what you are looking for. The answer may depend on more appropriate CPTs such as 43255 and critical care codes.
Think about endoscopy with injection as option
Scenario 1:
The physician injects epinephrine into a duodenal ulcer to control active bleeding during endoscopy with biopsy. 43239, Upper gastrointestinal endoscopy including esophagus, stomach and either the duodenum and/or jejunum as apt; with biopsy, single or multiple).
Previously, you may opt to use 43239 appended with modifier 22 (Increased procedural services) if the doctor required effort to control the patient’s bleeding.
However this option would need you to submit additional paper documentation to support your modifier 22 claim. Instead of submitting yourself to potential hassles, you can accurately describe the session by reporting 43239 for the biopsy and 43255 for the control of bleeding provided that the bleeding was not caused by the biopsy.
As is obvious from 43255’s descriptor, this procedure describes control of bleeding by any method including injection.
Requirement: On your claim, you should append modifier 59 to 43255, and then report 43239. Omitting the modifier would give payers the impression that the biopsy (or physician) caused the bleeding and bundle 43255 into 43239.
Extraordinary bleeding requires critical care coding
Scenario 2: When the gastroenterologist is about to carry out an upper GI endoscopy, the patient experiences gastrointestinal bleeding so severe that the doctor must suspend the endoscopy and spend 40 minutes lavaging blood from the gastro-intestinal tract before continuing.
Code it: This time, the critical code 99291 is your best choice.
Here’s why” If the gastroenterologist caused the bleeding, you cannot bill for the control of bleeding procedure. You should call on control-of- bleeding codes only when treatment is required to control bleeding that occurs spontaneously, or as a consequence of traumatic injury (noniatrogenic), and not as a result of another type of operative intervention, the CPT Assistant states.
Remember that the time spent at the bedside carrying out services including lavage of gastric blood isn’t included in the performance of a subsequent endoscopic procedure and is not part of the E&M service that might be carried out on the same day.
Nevertheless, you should not report a critical care code carelessly for an excessive bleeding situation that’s not out of the ordinary. Additional time for emergency bedside services less than 30 minutes does not count as billable critical care service. For prolonged critical care services, the physician should specifically note the amount of time in his notes.
We provide you simple, instant connection to official code descriptors & guidelines and other tools for 2010 CPT code, HCPCS lookup that help coders and billers to excel in the work they do every day.
How To Choose A Good Medical Billing Company For Outsourcing?
Step to success: Home work before you hire
1.Check if the company is HIPAA compliant. Find if the company is ISO certified
2.Ask them how they secure patients information apart from the HIPAA compliance.
3.Know their experience in the medical billing field.
4.Know their business strategy
5.How many clients do they work for? (know how your job could be done properly without interruption due to external distraction of other clients)
6.Know & analyze the benefits you get from the company
7.Compare the benefits they provide with the benefit you get when you do the job yourself.
8.Know the deadline that they have set up for task accomplishment in each specialty (This is the SLA – The service level agreement, highly important for timely delivery of services)
9.Know the details about the medical billing software they use.
10.Is their technological infrastructure flexible to make changes if required? (In case of adding new clients, process changes etc.,)
11.Confirm their process accuracy % ( errors in the process might lead to delay or denial of payment)
12.Do complete cost analysis. Ask if there are hidden costs
13.Know the basic information about their employees like: How many employees work in the company, how many are certified
14.Is the company supported with the latest technology to perform your function?
15.Does the company work on denial management?
a.If they work on it, know the level of service.
The most important: Know their business continuity plan in case of emergency, disaster or epidemic disease.
How do they continue the business?
Other – to dos while hiring a medical billing company:
1.Keep the agreement clear.
2.Have an eye on the companys performance.
3.Consult how they react to specific business challenges pertaining to medical billing This is important because you can easily understand their business efficiency
In case you have already hired a medical billing company, check if your service provider is doing well:
1.Are they good performers?
2.Do they complete the task in time? (Never do they cross the deadlines)
3.Is the company flexible to your needs and acts smart at the time of emergency? (just like employing more human resources at the time of need and completing the task )
4.Are they providing you proper monthly reports with suggestions on financial improvement? (are they explanative)
5.Does the company stop with medical billing services alone or gives importance to client satisfaction?
6.How much money do they save you?
7.Are they available to you all time, for your queries and business communication?
Tanya Gill is the Public Relations Manager for ecare India based in Chennai, India. She has wide knowledge and experience in the medical industry. ecare India is a leading medical billing company offering end-end medical billing services and is backed by extensive domain expertise, latest technology and dynamic compliance norms. ecare is HIPAA compliant and is the first Indian medical billing company to get ISO 27001: 2005 certified….
Signs Of Good Medical Coding Schools
If one were to proclaim that he or she has learnt all there is to learn, one either has their head in the clouds or is assuming the ostrich stance. Medical coding schools are quick to point out that they are just the starting point of ones career in this line of profession. As individuals embark on the long and winding journey of familiarizing themselves with medical terms related to the anatomy, procedures, diseases and the like, it is indeed a lifelong journey. Even the very best of physicians are sufficiently modest to attest to their lack of knowledge of what ailments lay ahead. As new diseases are contracted, discovered and studied upon, verification and recognition by the international community is needed before they make their presence in the medical coders book.
It is the responsibility of medical coding schools to keep themselves updated with the latest in the arena. In addition to imparting relevant knowledge to their charges, instructors need to establish codes of conduct for these students to take with them into employment. If in doubt, check and check again. Verify with relevant parties and do not make assumptions as one tends to not have the whole picture. Coders do not step outside their field of expertise as doing so may cause a conflict in the quality of their work and overall integrity of the patients clinical state. To get a head start in this business, some medical coding schools offer a two-pronged approach with programs combining medical coding with medical billing.
Upon completion and graduation, the buck does not yet stop for these individuals about to enter the health care community. As the medical world evolves, the medical coders book is constantly updated. To ensure no one is practicing on yesterdays information, some regions require coders to maintain active certification in order to secure employment. After sufficient years of experience tucked away in ones portfolio, it is timely to source out courses to further ones career and open opportunities to advance the pay scale.
Chris is the writer of this article , you can visit us for more information on Medical Coding Degrees and AAPC: Medical Coding.