What is the ruling for this situation and how do we go about billing it?
We have the medical records to prove service is rendered however, the technicality of outpatient stay of more than the 2 midnight rule is confusing.
Thanks.
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 rationale What is the ruling for this situation and how do we go about billing it?
We have the medical records to prove service is rendered however, the technicality of outpatient stay of more than the 2 midnight rule is confusing.
Thanks.
A former employee of Portland, Oregon-based Northwest Primary Care (NWPC) allegedly stole the personal information of 5,372 patients. The employee accessed this information between April and December 2013, according to a statement released by NWPC. The incident went undetected for two years until law enforcement informed NWPC of the theft on October 13, 2015. NWPC notified the public on December 11, 2015. The former employee accessed patients’:
There is no evidence that the employee used or attempted to use the information, NWPC says. However, NWPC is offering affected patients identity theft protection services including identity recovery services, 12 months of credit monitoring, and a $ 1,000,000 insurance policy.
Reference and background checks are performed on all employees, and employees who work in highly sensitive positions, such as working with patient financial data, undergo additional background checks, NWPC says. Existing policies, procedures, and the employee code of conduct contain guidelines for accessing PHI and prohibit employees from inappropriately accessing or using PHI. NWPC is increasing its technology monitoring and employee training on accessing patient records in response to this incident. Additional technical safeguards will also be implemented to further protect PHI from theft or other criminal activity.
However, my very experienced biller (30 years) is having difficulty making him understand the concept of the 90-day global period and the fact that if we do surgery prior to that time on a second body part, we most likely won’t get paid for the surgery.
So, if a Medicare patient has a surgical procedure with a 90-day global period, when is the earliest that patient can have another procedure by the same surgeon? EG: Patient has a LEFT total knee on 1/1/17. Is the EARLIEST he can have the RIGHT total knee at any date after April 3rd (92 days total as listed in the CMS global period)? Is my biller missing something?
Any references you can point us to would be helpful as the patient states he has two sources that are telling him 60 days – one at the national office and one at the local office. HELP!
Julie V.
TJRC
More physicians and medical practices are choosing to outsource their medical billing. According to a recently released report by Grand View Research, Inc., the demand is expected to result in the rapid growth of the medical billing outsourcing market — from $ 6.3 billion in 2015 to $ 16.9 billion by 2024 — surpassing demand for in-house billing.
This new data echoes similar 2014 research that found that 90 percent of independent and small physician practices were planning to outsource their billing as well.
Here’s why so many physicians are moving from in-house to outsourced medical billing over the next decade and why it may make sense for your practice too.
The entire healthcare industry has faced a bunch of changes over the past several years. From the introduction of the Affordable Care Act to the implementation of ICD-10, physicians are finding it difficult to keep up with all of the new regulations, especially those related to billing and coding.
Below are some of the top reasons why physicians are choosing to outsource medical billing:
Outsourcing your practice’s medical billing can be a tough decision. However, there comes a time when it makes too much financial sense not to pursue it.
Making the switch can be an intimidating and daunting experience, especially for physicians who have completed billing in-house for years. But moving from in-house to outsourced billing can actually be a smooth process — not nearly as scary as many may think.
It’s important to remember that not all billing companies are created equal though. So if you currently outsource your billing and have had a bad experience, don’t settle. Look for a billing company who meets your needs, is responsive, and has a proven track record of increasing reimbursements and paid claims.
And while pricing and budgets should be part of the discussion, refrain from making that the ultimate deciding factor and look long-term instead. Paying a lower fee to a company who collects less money is not the bargain you’re looking for.
Going with a company who has proven recovery rates who also charges a higher fee often wins out. The increased recoveries not only offset the higher fee, but puts more money in your pocket to boot.
Plus, the improved cash flow means physicians can now afford to pay staff to do follow-up work and go after even more of the practice’s money.
If you’re interested in outsourcing your practice’s medical billing, Capture can help. As a physician-owned company, we know that every dollar and claim counts. We understand the complexities of revenue cycle management and how accurate billing processes lead to more satisfied patients — all important factors in maintaining practice profitability.
Why did you decide to outsource your practice’s medical billing? Please join the conversation below.
— This post Why Outsourced Medical Billing Offers More Benefits Than Ever Before was written by Manny Oliverez and first appeared on Capture Billing. Capture Billing is a medical billing company helping medical practices get their insurance claims paid faster, easier and with less stress allowing doctors to focus on their patients.
Screening mammography is a radiologic procedure used for early detection of breast cancer. Medicare has provided Part B coverage of screening mammography for women since 1991. Mammography Code Changes For 2017, CPT® codes 77051, 77052, 77055, 77056, and 77057 are deleted. New codes for these radiology services bundled with CAD are: 77065 Diagnostic mammography, including computer-aided detection […]
AAPC Blog
The extreme predictions about the negative effects of moving to ICD-10 just didn’t happen. Now, over eight months later, one of the country’s leading organizations which has been tracking the ICD-10 transition says that there have been minimal effects at best.
Read the full story here: https://www.healthdatamanagement.com/news/the-transition-to-icd-10-was-easier-than-expected
The post Transition to ICD-10 easier than expected(ICD-10 slowdown of 14%) appeared first on The Coding Network.
If you think of modifier 57 as the “decision for surgery” modifier, it’s time to change your mind. Modifier 57 applies when the physician determines the need for any major procedure—whether surgical or non-surgical. “Major” Means 90-Day Global Period The CPT® manual doesn’t define “major” or “minor” procedures, but the Centers for Medicare & Medicaid […]
AAPC Blog