Billing Alert for Long-Term Care August issue is now available
Laureen shows you her proprietary “Bubbling and Highlighting Technique”
Download your Free copy of my "Medical Coding From Home Ebook" at the top right corner of this page 2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers Click here for more sample CPC practice exam questions and answers with full rationaleTag Archives: issue.
Bundling issue
Thanks!
Over Coding Issue
I’ve recently started a new position with a family planning clinic and I’m the first coder they’ve ever had. The previous billing supervisor, who is no longer with the company, put a rule in place that all procedures should be billed with an E/M code & modifier 25. As we all know E/Ms shouldn’t be billed with surgical services unless there is a separately identifiable reason. This rule has been in place for approximately 2 years and our predicament is what to do about the over-payment from the insurance companies. Has anyone run into this in the past? How did your organization handle it? Thank you for any input!
Another visit due to issue with pap
Patient presents for an Annual GYN exam w/ pap.
After the pap is sent to the lab they inform the office that there is not enough of the specimen and the pap needs to be redone.
Patient returns to the office 3 weeks later so provider can perform pap again (only pap) to resend for analysis.
Question: Should a low level e/m be billed for this or should the provider not charge?
Thanks for you help
Renee H
COBGYN
ACP secondary payer issue 99497, 99498
thanks in advance for the help!
Tips from this month’s issue
Tips from this month’s issue
Conducting a phase two audit self-review (p. 1)
1.Although CE desk audits are complete, BA desk audits and comprehensive on-site audits of both CEs and BAs are coming up. Audited entities will have only a limited amount of time to submit documentation, and those that don’t prepare in advance might miss the deadline.
2.The audit protocols are useful beyond simply checking boxes for auditors. By reviewing the audit protocols, CEs and BAs can match their compliance efforts exactly against OCR’s expectations and rules.
3.Some organizations may put audits and other evaluations aside in favor of competing compliance demands. But as OCR increases enforcement and audit activity, and the number and cost of breaches rises, now is the time to review HIPAA compliance.
4.Conducting a self-review can help a BA identify what documents it is missing before an audit letter arrives. After that letter lands in a BA’s inbox, it’s too late to create missing policies or enforce them.
5.A self-review can usually be conducted by the staff who handle HIPAA compliance as part of their regular duties. Other staff, such as human resources, may need to be pulled in to provide additional documentation.
6.The self-review should look beyond policies and procedures on paper: Auditors will want to know if they’re actually followed, and an unenforced policy won’t be a defense if a breach occurs. Take a look at how policies and procedures are followed and whether they should be updated to reflect the actual working environment.
Staying HIPAA compliant on social media (p. 5)
7.Many people use social media for personal purposes, but it’s also a powerful part of many organizations’ marketing campaigns and is invaluable for professional networking and recruitment.
8.A social media’s security policies and terms of use should be carefully reviewed by the security officer before an organization opens an official account.
9.A social media policy is a must, whether an organization operates official social media profiles or if its staff just use social media for personal reasons. The policy should be specific about when and how staff can access social media sites and who is allowed to access the organization’s official social media profile, if applicable.
10.Social media best practices should be part of basic HIPAA training.
11.Staff should not post anything that contains patient names, pictures, or other identifiable information without explicit, HIPAA-compliant permission from the patient.
Reimbursement issue regarding 26145 and exceeding the MEU of 6 by 3 units
Reimbursement issue regarding 26145 and exceeding the MEU of 6 by 3 units.
Scenario:
Provider bills 26145 x 9, exceeding the MUEs by 3 and states in the Op report that a "copious amount of hypertrophic tenosynovium was noted on the nine flexor tendons in the palm and a careful and sharp tenosynovectmoy of the nine tendons in the palm was then performed," would this statement satisfy MAI 3 requirement?
If so, why?
if not, why not?
if I could get a link to support either decision, this would be extremely helpful.
Thank you!
PCP issue
Timely Filing Issue
I was off on a medical leave for 6 mos and when I returned come to find out none of the billing was done have been catching up but getting denials for those 90 days Timely filing issues. Is there some type of forgiveness letter or suggestions anyone might have one how to appeal these denials some are the FHP/ICP or MMAI products others are Aetna Cigna etc.
Thanks
Barb
Radiation Therapy issue
Any insight from someone who has experience in this field would be great. Thank you!