Medical Billing is Like a Horror Movie!

I am a fan of the “classic” horror movie.  This does not mean Friday the 13^th or Nightmare on Elm Street.  I am talking real classics like Dracula with Bela Lugosi, The Mummy and Frankenstein with Boris Karloff and The Wolf Man with Lon Chaney, Jr.  You get the idea.  Arguably not truly scary compared with the blood, gore and special effects of today’s multi-million dollar blockbuster films, but I prefer them.  There is beauty in their simplicity (all the women have gorgeous complexions in black and white) and maybe even more creativity based on the lack of true technology available at the time.  Granted I could probably build a better looking Dracula castle out of Lego® blocks these days, but that is what makes them fun.

So in the spirit of Halloween, I decided to put my inner mad scientist to the test and see what kind of “horror movie” theme I could apply to the scary world of medical billing.

Hmm, zombies, vampires, mummies, werewolves, and monsters made from recycled body parts. The theme definitely seems to be previously dead and now alive, except for the werewolf; he is the “odd man out”.  So let’s start with him.

The curse of the wolf man centers around that dreaded night, about once a month, when the moon is full.  The mild mannered human becomes a crazed, blood thirsty wolf-human hybrid that always managed to find some poor unsuspecting sap wandering in the woods, how convenient.

In medical billing, I can relate this to the end of the month scramble for charges.  Are you chasing down charge slips (like that guy in the woods)? Do you become frothy at the mouth with hungry eyes (like the werewolf after that guy gets caught and he’s ready to eat him) while matching them to your schedule and verifying in your EMR? If you said yes, then you could be a medical billing werewolf.

Want to know how to break this curse? It’s not “death by silver”; it’s something much less fatal.
Iridium Suite practice management software can import data directly from your EHR by using our Connectivity Clearinghouse eliminating the need for manual demographic or charge entry.

AH, vampires so romantic these days.  I don’t get how someone can be romantic without a heartbeat!  Not to mention who wants a man that sleeps all day and is up all night flying around the house.

Are you awake all night worrying about the financial health of your medical practice? Then you could be a medical billing vampire.  Does your practice seem to stay alive but you don’t know if it still has a heartbeat? Then it could be a medical practice vampire.

How can you sleep at night and ensure your practice has a healthy heartbeat?  Come out of the shadows and into the sunshine by analyzing key factors found in your practice reports.  I like to refer to them as the vital signs: Pulse, Blood Pressure, and Temperature.  (To get more information on these terms, you can download this free white paper: “Check the Vital Signs of Your Medical Practice”.)

A regular review of reports, monthly, quarterly, etc., is crucial in keeping your practice alive.  Iridium Suite billing software allows the user to format, save and schedule reports that are automatically sent to your email.  Keeping that “vital” information readily available at your fingertips (like a cross and string of garlic) they will keep the medical practice vampire away!

The mummy, wrapped in cloth, unable to speak, can only moan and groan, buried for thousands of years and entrusted with protecting the riches of the princess until the end of time (or until he catches on fire).  That is a heavy burden.

Do you find yourself buried in paper EOBs, constantly trying to find your way out of the tomb of EOBs?  Like digging up a mummy, covered in sand, each movement of the shovel seems to cause more sand (EOBs) to fall into the hole (land on your desk).  If you manage to get free, then you have to “protect the riches” or in this case, collect what is rightfully due, whether it is from patients or insurers.  If this sounds like you, then you are a medical billing mummy.

You don’t have to resort to fire to get rid deal with those EOBs or unpaid claims.  You can eliminate the majority of your EOB tomb with Iridium Suite medical billing software.  It has the ability to automatically adjudicate ERAs received from the ACH with little to no user interaction.

For assistance in strategies to protect the riches, see these informative articles:
“Top 7 Claim Denials”  “How to Appeal a Medicare Denial” “Don’t Let Patient Billing Ruin Your Good Rep”

The Frankenstein monster was created from body parts from numerous previously deceased “donors”; then reanimated with electricity.  How could parts from different persons ever work in a coordinated and organized way to accomplish one goal?  It is no wonder he had all the issues with the towns people.

In your medical office, the right hand (front desk) may not know what the left hand (billing office) is doing or vice versa.  Keep your medical practice from being like that monster and develop a well thought out office workflow process involving all the “bodies” in your office.  This allows them to work as one cohesive unit.  Access this free white paper on “Medical Office Workflow”.

Super slow moving, brain eating zombies have become very popular in recent years.  Ever wonder why they eat brains, are they trying to absorb the knowledge of their victims?  In medical billing, the only constant is things are always changing.  There is a consistent need for education.  Prevent yourself from turning into a brain eating medical billing zombie by building a network of reliable resources.

There is a wealth of information available on payer websites, with many that offer subscriptions to newsletters and bulletins.  Online medical billing forums can be found on sites such as LinkedIn where industry experts ask and answer wide ranges of billing and coding related questions. 

Healthcare industry blog sites are numerous as well.  Expose yourself to as many knowledge sources as possible to obtain the widest range of quality, helpful information.

Medical Business Systems has a complete education section and offers subscription to the “Biller’s Blog Newsletter".  You can follow us on Google+, Facebook, LinkedIn, and Twitter.

Hopefully you have been entertained and enlightened and now have the tools you need to make sure your life never turns into a classic horror movie!

Make Your EHR a Team Player

Radiation Oncologists are completely surrounded by some of the most advanced technology available.  So no one understands more than they do the necessity of several complex software programs and intricate radiation therapy equipment to interface seamlessly and provide accurate and complete data at the blink of an eye.

 So then why should you not be able to have the same functionality between all types of medical software containing all types of patient data.  Integrating multiple systems to form your DATA TEAM can enhance your work environment and improve efficiency.

 This especially applies to those EHR systems that are holding your billing data hostage.  Your billing and coding software should be able to directly import data such as patient demographics and procedures performed from your EHR. This type of integration will eliminate the need for re-entry of patient data into the billing system by office staff.

 Here is the good news:  Iridium Suite medical billing software now comes with the Connectivity Clearinghouse enabling connections to multiple EHR systems. You can connect to your EHR as often as your office work flow dictates. With accurate and complete data entry in your EHR, you are able to bring in all the necessary information to bill and file your patient claims.

The Connectivity Clearinghouse offers flexibility by supporting a wide range of secure communication protocols such as: LLP, HTTPS, and SFTP.

It can also easily customize HL7 data fields allowing medical data systems to exchange a wider variety of information.

In addition to accommodating HL7 data formats, the Connectivity Clearinghouse works with other data formats such as XML, ANSI EDI x12 and DICOM, offering greater interoperability between systems.

 By utilizing the Connectivity Clearinghouse, practices are able to achieve seamless integration between their EHRs and practice management systems.  This level of integration enhances office staff productivity and reduces errors by eliminating the need to key data multiple times into multiple systems.

For those Radiation Oncologists: Iridium Suite is compatible with most of the major Record and Verify Systems, including Mosaiq (IMPAC) and Aria.  Oncochart imports are done easily via HL7 for no additional cost.

 The versatility of the Connectivity Clearinghouse found in Iridium Suite practice management software provides the foundation to integrate with your existing Electronic Health Record and/or Record and Verify systems, saving your practice time and money.

Help Patients Get the Most out of Their Initial Preventive Physical Examination

“Prevention and early detection” are some of the current “buzz words” in healthcare.  It is for good reason.  Statistics continually show that early detection of disease equals better outcomes, while some diseases are “headed off at the pass” by following recommended preventive measures.  Both of these also contribute to lowering medical costs for payers and patients.  This is a win-win situation all the way around.

In order to facilitate prevention and early detection, many such provisions were added into the “Obamacare law”, The Patient Protection and Affordable Care Act.  Prior to the ACA, CMS had established coverage policies regarding preventive services for its beneficiaries.

One of the crucial preventive services is the Initial Preventive Physical Examination (IPPE). This evaluation and management service is provided to a new Medicare beneficiary within the first 12 months of coverage.

The IPPE should not be confused with the Annual Wellness Visit (AWV) that is provided annually after the first 12 months of beneficiary coverage.  HCPCs Codes G0438 and G0439. Click here for further details on the AWV.

There are 7 components that must be satisfied in order for a provider to consider the visit an IPPE:

1. A review of an individual's medical and social history with attention to modifiable risk factors,

2. A review of an individual's potential (risk factors) for depression,

3. A review of the individual's functional ability and level of safety,

4. An examination to include an individual's height, weight, blood,

5. Performance of an electrocardiogram (EKG) and interpretation of the EKG,

6. Education, counseling, and referral based on the results of the review and evaluation services described in the previous five elements, and

7. Education, counseling, and referral (including a brief written plan such as a checklist provided to the individual for obtaining the appropriate screenings and other preventive services that are covered as separate Medicare Part B benefits).  

  In item 7 above, it mentions referral for covered preventative services.  The Ultrasound Screening for Abdominal Aortic Aneurysm (AAA) – HCPC G0389 requires that the “referral” be directly as a result of an IPPE visit.  In order for the ultrasound to be covered, the IPPE must be on record with CMS and the claim indicates that the service was referred by the clinician at the time of the IPPE.

You can click here for an easy to follow comprehensive chart of all covered preventive services.

At the time of the IPPE, the healthcare professional may choose to provide some of the recommended preventative services to the patient.  These services can be billed to Medicare in addition to the IPPE as separate, payable services.

1.       Adult immunizations such as: influenza and pneumococcal.  For information on coding for these services click here.

2.       Smoking and tobacco-use cessation counseling.  For information on coding for this service click here.

3.       Human Immunodeficiency Virus (HIV) Screening.  For information on coding for this service click here.

4.       Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse.  For information on coding for these services click here.

 Learn about Billing for the IPPE:

To get reimbursed for the IPPE, submit HCPCS code, G0402.  By definition in number 5 above, this benefit always includes a screening EKG.

To get reimbursed for the screening EKG, submit one of the following HCPCS codes:

1.       If providing the full global EKG service - G0403 (Electrocardiogram, routine ECG with 12 leads; performed as a component of the initial preventive examination with interpretation and report)

2.       If providing only the tracing technical component - G0403 (tracing only, without interpretation and report; performed as a component of the initial preventive examination)

3.       If providing only the interpretation and report professional component – G0405 (interpretation and report only, performed as a component of the initial preventive examination) when only the interpretation and report are performed.

Many elements covered in the performance of the IPPE are shared with the standard evaluation and management services (CPTs 99201-99215).  During the IPPE, if the provider determines there is a medically necessary reason to perform additional care to treat an illness or injury, a separate E and M code can be submitted with an appended -25 modifier.

 The Part B deductible and coinsurance/copaymentdo not apply to the IPPE benefit for code G0402.

Billing for Tobacco Use Cessation in Your Oncology Practice

As an Oncologist, your typical evaluation of a patient will include an inquiry regarding tobacco use.  The negative health effects of tobacco use become an even more critical subject when dealing with a patient diagnosed with cancer. See information below on how you can help your patients quit and receive reimbursement from Medicare.

CMS has determined that smoking and tobacco use cessation counseling is covered for a patient with a disease or an adverse health effect that has been found by the U.S. Surgeon General to be linked to tobacco use, or who is taking a therapeutic agent whose metabolism or dosing is affected by tobacco use as based on FDA approved information.  Medicare’s prescription drug benefit covers smoking and tobacco use cessation agents prescribed by a physician.

Although minimal counseling is already covered at each evaluation and management (E&M) visit, Medicare will cover 2 cessation attempts per year.  Each attempt may include a maximum of 4 intermediate or intensive sessions, with the total annual benefit covering up to 8 sessions in a 12 month period.  

The definitions of cessation counseling attempt and session are listed below:

Cessation counseling attempt occurs when a qualified physician or other Medicare-recognized practitioner determines that a beneficiary meets the eligibility requirements above and initiates treatment with a cessation counseling attempt. A cessation counseling attempt includes up to 4 cessation counseling sessions (1 attempt=up to 4 sessions). Two cessation counseling attempts (or up to 8 cessation counseling sessions) are allowed every 12 months. In calculating the 12-month period, it is necessary for at least 11 months to have passed following the month in which the first Medicare-covered cessation counseling attempt/session was performed.

Cessation counseling session means face-to-face patient contact of either the intermediate (greater than 3 minutes and up to 10 minutes) or the intensive (greater than 10 minutes) type performed either by or “incident to” the services of a qualified practitioner for the purpose of counseling the beneficiary to quit smoking or tobacco use. During a 12-month period, the practitioner and the beneficiary would have flexibility to choose between intermediate or intensive cessation strategies for each session.

The procedure codes that represent these sessions are:

99406 – Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes

99407 - Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes

G0436 - Smoking and tobacco use cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes up to 10 minutes

G0437 - Smoking and tobacco use cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes

Please refer to the MPFS for your locality to determine the reimbursement for these procedures.

Your practice can also receive additional financial incentives by participating in the Physician Quality Reporting System (PQRS). Core Measure PQRS# 226 (NQF 0028): Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention.

 Information on this measure is detailed below:

Description: Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco user

Numerator: Patients who were screened for tobacco use at least once within 24 months AND who received tobacco cessation counseling intervention if identified as a tobacco user

Definitions: Tobacco Use – Includes use of any type of tobacco 

Cessation Counseling Intervention – Includes brief counseling (3 minutes or less), and/or pharmacotherapy

Advanced Practice management software like Iridium Suite, has an integrated PQRS claim scrubber.  The practice can configure the medical billing system to automatically request that the physician sets up PQRS measures for each patient. The claim scrubber also recognizes which billing codes are potential PQRS denominators and automatically suggests the PQRS numerator codes that should be added to the claim. The biller simply accepts these suggestions and the claim scrubber automatically adds the proper PQRS charge codes to the claim.

Place of Service Coding Crucial in Radiation Oncology

It has been a year since CMS implemented its new place of service coding instructions per CR7631. If you are a Radiation Oncologist providing services in the outpatient department of a hospital and have not reviewed your place of service (POS) coding practices, you could be heading for trouble.

The Office of the Inspector General (OIG) has identified one of the most common POS coding errors is represented by the incorrect use of code 11,“office”, for services provided in the outpatient department of a hospital.

The CMS ruling instructs providers to use the place of service that represents the setting in which the beneficiary received the face-to-face service. Unless a provider has a separately maintained office space in the hospital or medical campus where the services was rendered, the POS is considered “outpatient hospital” and must show POS code 22.  

NOTE: This applies to evaluation and management services as well as “procedural” services.

You may wonder why using POS code 11 instead of 22 makes a difference. For services paid under the MPFS, there is a reduced reimbursement of procedures billed by providers in the outpatient hospital department. 

This reduction is based upon the facility bearing the costs for the space provided, required support staff and equipment that are utilized in rendering the service.  Expenses the provider is typically responsible for in an “office” setting. 

Note: Providers that incorrectly submit POS code 11 are being overpaid for their outpatient hospital procedures, and if audited, are subject to paying refunds to Medicare. This type of “over billing” if determined deliberate would be considered Medicare fraud.   

                                                        

Avoid overpayments by evaluating the configuration of your practice management system to ensure the POS codes that are being submitted for all of your service locations are set up correctly. 

Iridium Suite medical billing software by Medical Business Systems is designed to contain a comprehensive table of all your practice service locations with built-in POS coding tied to each one. This is just one of the many ways in which Iridium Suite enables you and your staff to submit the most accurate and complete billing as possible.

What’s the Buzz on ICD-10?

October 2013 has arrived with much flurry about a lot of hot topics: the ACA, debt ceiling, government shut down, the HIX.

 It’s probably easy to lose sight that we are finally less than a year away from the 2014 ICD-10 deadline, right?  So, unless you have been living in a cave or on a deserted island for several years, the mention of this pending ICD-10 implementation is familiar, maybe too familiar.
For years we have heard: “You better get ready for ICD-10.   It’s coming on ‘blah blah date’ whether you like it or not!”

 If you are like me, when you feel as if you have been beat over the head with an issue, you want to just ignore it or pretend it doesn’t exist.  Well it does exist and it has existed in a variety of customized “national” versions for quite some time all over the world.

NOTE:  The US will use ICD-10-CM for diagnosis coding (CM standing for “Clinical Modification” of the World Health Organization International version with 68,000 codes) and the ICD-10-PCS for inpatient hospital procedures (PCS standing for “Procedure Coding System” unique to the US with 76,000 codes).

  It’s amazing, as Americans we believe ourselves to be so “progressive” and “innovative”, but in this instance, we are seriously lagging behind.  The great benefit of ICD-10 is that it allows the true “clinical” status of the patient to be “translated” into codes.

How it Works: Characters 1-3 (the category of disease); 4 (etiology of disease); 5 (body part affected), 6 (severity of illness) and 7 (placeholder for extension of the code to increase specificity)

  These codes then can be measured and analyzed to compare treatment regimens and outcomes.  This statistical data (that) can provide valuable information to help ensure quality, standardized care for all patients regardless of geography, gender, socio-economic status, etc.

 I am sure your inbox and mailbox are flooded with offers from this company and that company, all hawking seminars and coding guides.

Note: CMS offers numerous free resources for ICD-10 preparation.  Visit the CMS ICD-10 website, sign up for CMS ICD-10 Industry Email Updates or follow them on Twitter.

I want to look at just a few key points to help guide you in the direction you need to go to get ready for this challenging, but exciting change to the medical billing world.

• Due to the addition of characters/digits in the ICD-10 tables, it is important to verify with you’re your software vendor that they have made the appropriate changes to accommodate these additions.   Clinicians will also now in some cases “code” more than the previous limit of 4 diagnoses.  Your practice management software provider will need to take this into account as well. 

Note: The HCFA 1500 form is being revised also to “make room” for the added characters as well as codes in general.  The revised CMS-1500 form (version 02/12) will replace version 08/05. The revised form will give providers the ability to indicate  whether they are using ICD-9 or ICD-10 diagnosis codes. ICD-9 codes must be used for services provided before October 1, 2014, while ICD-10 codes should be used for services provided on or after October 1, 2014. The revised form also allows  for additional diagnosis codes, expanding from 4 possible codes to 12. Medicare will begin accepting the revised form on January 6, 2014. Starting April 1,  2014, Medicare will accept only the revised version of the form.

• If you utilize a trading partner (i.e. clearinghouse) for submitting claims or submit directly to payers, you should monitor communications published on their websites or enroll for e-mail newsletters to keep abreast of their progress on the implementing ICD-10 processing.  If they require testing by you, make sure you begin as early as possible to ensure any glitches can be identified before the deadline.

• Thorough medical billing specialists utilize guidelines such as: Medicare NCDs and LCDs and commercial payers’ medical policies when verifying coverage based on the medical necessity of procedures.  Any policies that reference ICD-9 codes will (all) be re-written in order to convert them to the proper ICD-10 standard.  This is another item that should be monitored on payer websites to keep up to date on the availability of the updated guidelines.

If you are unfamiliar with medical policies as mentioned above and would like more information on how they affect your reimbursement, follow this link for a free white paper on “Understanding Medicare Fiscal Intermediaries LCDs and How They Affect You” or for blog article “Reviewing Commercial Carrier Medical Policies/Clinical Guidelines” click here.

• A great preparation tool to determine how this change will affect your workflow process in to perform a “dry run” through your current documentation for your most used ICD-9 codes.  Have appropriate staff practice converting them to ICD-10.  This should give you a basis to begin making any necessary process changes and identify the extent of additional staff training that may be required.As with any change, preparation is the key. 

Now is the time to get “your ducks is a row.”

Head and Neck Cancer Treatment Needs the Care Team Approach

If you “need a village to raise a child”; then, you “need a care team to treat Head and Neck Cancer”.

I reached out to South Florida Radiation Oncologist, Dr. James T. Parsons for his insight on how the complexities of treating Head and Neck Cancers can be lessened by utilizing a well synchronized group of medical professional.  Dr. Parsons is an internationally recognized expert in the field of Head and Neck Cancer treatment. 

 

We would like to emphasize the importance of a coordinated team approach for successful treatment of one of the most complex of all cancer diagnoses.

Unless they have a previous experience or personal knowledge, when most people think of cancer treatment, rarely do they truly understand that it will require a finely choreographed coordination amongst several healthcare professionals and other caregivers.

I posed the following questions to Dr. Parsons about the “Care Team” approach in the treatment of Head and Neck Cancers.

Q:  Who would you say are the necessary healthcare professionals that a patient should consult when he or she is diagnosed with Head and Neck Cancer?

A:

1.  Head and Neck Surgeon
2.  Medical Oncologist
3. Radiation Oncologist
4.  Dentist
5. Oral Surgeon

Q:  How do patients navigate through the many treatment options, such as chemotherapy, radiation therapy and surgery or combinations of multiple modalities, to make the right decision about their treatment course?

A:  This is one of the benefits of having a “Care Team” approach.  If all the healthcare providers work together in evaluating the patient’s treatment needs, usually this provides a consensus of opinion, simplifying the decision-making process for the patient.  Occasionally, providers may agree on multiple treatments options, this is when assistance from family and/or close friends can be extremely helpful in the decision making process.

Q:  You mention the patient’s family and friends; I assume these persons can also have a tremendous impact on the well-being of the patient during and after treatment.  Do you consider family and friends to be part of the patient “Care Team” as well?

A:  Definitely.  Treatment for Head and Neck type cancers, like most cancers, can produce multiple side effects.  A strong at home support system is just as crucial to the success of the treatment as any medical service.  Once treatment begins, additional healthcare resources may join the “Care Team” such as: social workers, registered dieticians, and home health nurses or aides.  

Q:  Any final thoughts on the “Care Team” approach?

A:  Early intervention by the surgeon, medical oncologist, radiation oncologist, dentist and oral surgeon ensure that a rational plan of care can be developed, reducing the occurrence of any surprises along the way.

You can follow this link to the National Institutes of Health’s website for more information on Oral Cancer:

http://search.nih.gov/search?utf8=%E2%9C%93&sc=1&query=oral+cancer&m=&embedded=&affiliate=nih&filter=moderate