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Code changes for the April update to the 2019 Medicare Physician Fee Schedule Database (MPFSDB) are effective for dates of service on and after Jan. 1, 2019. Medicare Administrative Contractors (MAC) will not search their files to retract payment for claims already paid or to retroactively pay claims. To ensure proper claims payment, providers will […]
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I need your help… I am working in a practice that have been doing the hospital billing the same way for the last couple of decades. They are very fortunate to have the same employee for almost 40 years. Now that I involved in the hospital billing I have been informed that they wait until the patient is discharged from the hospital to create the claim. I have never heard of such rule and I cannot find any documentation to prove it right or wrong either. From previous experience, this rule was not recommended. I have always created the claims on a daily basis if possible, but at the end of the month all visits were counted as part of the monthly financial report therefore all hospital claims were created and sent to the insurance companies by the last day of the month.
My questions is: How do you do it in your practice, your experience? What is your recommendation? Should we wait until the patient is discharge from the hospital to create and send the claim>
In advance, thank you for your help and the learning experience.
Isvel Bacallao CPC
I’ve been sending my provider 3 encounters, one for how many lesions she did cryo on (document states 5+, when I emailed to ask, she stated 4, asked her to add addendum to state that), and the other 2 were for trigger point injections (she stated 10 trigger point injections were done, but did not state how many muscles were involved). These have been outstanding since November and I send her an email at least once a week for her to fix it. My supervisor gave the other coder in my team these encounters to review and accept the charges… other coder accepted the charges as is and the provider never corrected her documentation… These were accepted 01/09/2019… these visits were for end of November/Middle of December… I’ve been coding for 5 years now, but I’ve never ran into an issue where the provider does not add what little documentation I request, or a practice that submits claims where the documentation doesn’t match the codes. I was also not told that the other coder would be taking on these encounters… and when I went to follow up on them, I saw they were already accepted and on their way to the insurance.
Is this normal for other practices to just go with what the providers have entered although their codes chosen doesn’t match the documentation requirements and definitions?
Thanks for the help,
L
Recent wait time research by Vitals, a consumer physician-choice service, indicates the amount of time patients cool their heels in your waiting room is the most important factor in their overall experience at a doctor’s office. The overall wait time appears to affect a physician’s rating on Vitals’ database. Physicians with five stars had a 13 minute, 17 second […]
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