background preloader

Medical Billing and Coding Outsourcing Blog

Facebook Twitter

OSI Blog: Information on outsourcing medical billing and coding, medical transcription, insurance verification and authorizations, appointment scheduling.

ASC Payment System July 2015 Update - Key Points. The Centers for Medicare and Medicaid Services (CMS) has announced new changes to its payment systems for the second quarter of 2015. It has published the July 2015 update of Ambulatory Surgical Center Payment System (ACS PS). This includes updates to CPT codes and HCPCS codes along with the changes to payment offset. Healthcare providers and ASC (Ambulatory Surgical Center) Coding Companies should be aware of these medical billing and coding updates that will be effective from July 1, 2015. New Device Pass-through Category As per the July update, CMS introduced one new HCPCS Level II device pass-through category code for the Outpatient Prospective Payment System and the ASC PS. C2613: Lung biopsy plug with delivery system The payment indicator for this code is J7 (OPPS pass-through device paid separately when provided integral to a surgical procedure on the ASC list; payment contractor-priced) while the device offset from payment is $24.83.

Repeal Offset Applies to 37224 and 37226. CMS Releases Annual Physician Payment Data. The Centers for Medicare and Medicaid Services (CMS) recently released fee-for-service payment data for individual physicians in an effort to make the opaque US Healthcare system more accountable. CMS is distinguishing between payments for medical services such as an office visit and payments for administered Part B drugs.

This sudden breakout comes after oncologists complained that the “2012 Medicare payment totals” (released last year) mostly represented reimbursement for drugs that they had to purchase, which was not actual revenue. Data about hospital inpatient and outpatient charges was first released in the year 2013. The new sets of data released by the CMS (on June 1, 2015) provides details regarding money in payments from medical billing by hospitals for both inpatient and outpatient services and Medicare payment for physicians in 2013.

According to Niall Brennan, CMS’ chief data officer, “the agency will continue to release hospital and physician data annually.” Tips for Endocrinologists to Ensure Proper ICD-10 Coding. The expansion of diagnosis codes with ICD-10 makes the endocrinology medical coding process more complex as this specialty involves a wide array of diagnoses and procedures. Endocrinology providers should have a better knowledge about the endocrine system and much more detailed documentation to choose the most appropriate codes. Specificity is very important when it comes to data quality, medical necessity and reimbursement. Here are some effective tips for endocrinologists to prepare well for ICD-10 coding and avoid claim denials or drop in reimbursement.

Some of the crucial diagnoses in this specialty and their coding are as follows. Diabetes In order to select the correct ICD-10 code for diabetes, your documentation should include the following: The basic ICD-10 codes for diabetes mellitus are as follows: These codes are further elaborated according to the varying characteristics of diabetes mellitus. Malignant Neoplasm Endocrine and Metabolic Disorders Cushing’s syndrome. Major Changes Affecting 2015 E/M Coding.

There occurred significant changes in CPT medical coding this year with an estimated 264 new codes, 143 deleted codes, and 134 revised codes and most of these codes do have an effect on primary care physicians. The significant changes in evaluation and management (E/M) section greatly impact physician coding. The changes are introduced for advance care planning, E/M prenatal visit guidance and care management services. Following are some details regarding these changes. Advance Care Planning Advance care planning is a new subsection under E/M section and two codes are included in this section: 99497: Advance care planning for the first 30 minutes99498: Add-on code assigned for each additional 30 minutes These time-based codes are used to report face-to-face discussion of advance directives, with or without completing relevant legal forms. Advance care planning codes can be billed with the following E/M services: Care Management E/M Prenatal Visit Guidance. Medical Coding Services for Easy ICD-10 Transition.

Many healthcare organisations and small practices are facing difficulties such as escalating costs, fewer reimbursements etc in the transition to ICD-10. In-house medical billing and coding can be tedious and may incur higher cost in purchasing advanced technology systems. Lack of knowledge about the new system can lead to claim denial, and loss of revenue among other issues. To overcome these glitches, it is better to opt for the services of a good medical coding company. Outsourcing to a reliable provider can bring the following benefits: Maintaining proper coding, billing pattern and complete documentation is important in case there is an audit.

So, why outsource? Practices, especially smaller ones stand to benefit immensely from outsourcing. Top Health Care Challenges Facing Physicians. Each year healthcare professionals face many changes and challenges in their profession. Ranging from regulatory burdens to delay in payments, physicians are confronted with a wide range of issues. Here are some of the top concerns. ICD 10 implementation – Effective from Oct 1, 2015, physician practices are getting ready to use ICD-10 codes. Early preparations can avoid disruption of claim payments later in 2015. Also, the transition may not cost as much as previously expected. Healthcare providers can also make use of the training materials, the Centers for Medicare and Medicaid Services (CMS) has provided on its Roadto10.org site. HIPAA compliance – Keeping patient health information secure is growing more complicated. In the recent HIPAA conference, OCR officials indicated that the random audits will start again in 2016.

Reimbursement Delays – Physicians also face payment challenges from government agencies, including Medicaid. October is National Chiropractic Health Month. In order to promote the benefits of chiropractic care, October is observed as “National Chiropractic Health Month (NCHM)” each year in the United States. Sponsored by the American Chiropractic Association (ACA), this month-long campaign focuses on bringing attention to the public health crisis caused by pain, and in particular the overuse of prescription pain killers. The nationwide observance helps raise awareness about the significant benefits of chiropractic services and the profession’s natural and patient-centered approach to health and wellness. Chiropractic adjustment is a procedure in which trained specialists (known as chiropractors) use their hands or small instrument to apply a controlled, sudden force to a spinal joint. The goal behind this treatment is to correct structural alignment and improve the body’s physical function.

The American Chiropractic Association estimates that there will be 80,000 chiropractors in the United States by 2020, up from 58,000 in 2010. Daily Coffee Intake May Boost CRC Survival. Colorectal cancer (CRC) is the third most commonly diagnosed cancer in the United States and the third leading cause of death among Americans (both men and women).

Reports suggest that an estimated 135,000 new cases of CRC will be diagnosed and nearly 50,000 deaths due to this disease will occur in the United States in 2015. The potential risk factors associated with this condition include age, genetics and lifestyle factors such as diet, smoking, obesity and alcohol use. CRC, which develops in the colon or the rectum, is a curable disease that often goes undiagnosed due to lack of regular screening. Regular screening helps in the detection and removal of pre-cancerous growths at an early stage, when treatment is most effective. Oncology physicians must educate their patients about the various risk factors associated with this disease and recommend effective treatment modalities. Caffeinated Coffee Intake May Reduce Cancer Reoccurrence.

Using G-codes for Lower GI Endoscopy Procedures in 2015. Since the Centers for Medicare and Medicaid Services (CMS) delayed the implementation of the revaluation of lower GI endoscopy codes in the Medicare Physician Fee Schedule (MPFS) Final Rule for 2015, the agency decided not to recognize the use of new 2015 CPT codes for lower GI endoscopy procedures, and maintain the rates of 2014 for 2015. However, some 2015 CPT codes were introduced for existing procedures that required a new code assignment owing to the changes in code descriptor. CMS created G-codes under HCPCS for those procedures with 2014 code descriptions and crosswalked the reimbursement of those codes to the 2014 rates. G-codes are defined as the procedure codes developed by CMS for recognizing products, supplies and services that are not included in the CPT codes for which there is a programmatic operating need for identifying them separately on a national level.

Physicians should use the G-codes for original (fee-for-service) Medicare and Medicare Advantage plans. October - National Breast Cancer Awareness Month. October is observed as “National Breast Cancer Awareness Month (NBCAM)” each year in the United States in order to raise widespread public awareness about breast cancer, the second leading cause of cancer death among American women.

According to the American Cancer Society (ACS) (2015 statistics) about 231,840 new cases of breast cancer will be diagnosed in women and about 40,290 women will die from this disease. It is estimated about 1 in 8 (12%) women in the US will get breast cancer at some point in their lifetime. Generally, this condition affects women above 40 years of age.

The American Cancer Society recommends that women should undergo breast cancer screening tests at an early age (right from their early 50s or sooner) as these tests help to identify this condition early so that more effective treatment can be provided. Physicians need to identify the symptoms accurately in order to provide adequate treatment at the right time. Join “Breast Cancer Awareness Month” celebration. ICD-10-CM Coding for Hypertension. Hypertension is high blood pressure and a major health problem found in Americans, especially the elderly. This is a serious condition since hypertension is a risk factor for heart disease and other medical problems. If proper treatment is not given, this condition can lead to health concerns such asarteriosclerosis, heart attack, stroke, enlarged heart and kidney damage.

It is very important for physicians to report this condition correctly with appropriate diagnosis codes. As ICD-10 implementation is near, it is time to focus on the new codes used for hypertension. Unlike ICD-9, there is limited number of hypertension codes in ICD-10. The ICD-10 medical coding for hypertension is relatively simpler compared to other complexities. Primary Hypertension In ICD-9, primary or essential hypertension is coded according to the severity of hypertension, malignant (401.0), benign (401.1) or unspecified (401.9). I10:Essential (primary) hypertension Hypertension and Associated Conditions. Undetected Cirrhosis Causing Inconclusive Medical Data Entry. Precise medical data entry and the resultant medical coding are important in gastroenterology, since many of the vital organs come under this category and issues involving them could result in serious health conditions and even fatalities. Cirrhosis Undetected in Hepatitis C Patients – Research Cirrhosis of the liver is a serious condition, causing liver cancer and eventually failure.

While the progression of untreated Hepatitis C inevitably ends up with cirrhosis, many Hepatitis C patients are not diagnosed with cirrhosis even if they have it and their medical records or EHR do not reveal it. A recent research carried out on 2788 hepatitis C patients in four major health systems of the nation by Detroit’s Henry Ford Health System and the CDC (US Centers for Disease Control and Prevention) revealed this fact. Liver Cirrhosis Under-diagnosed and Undocumented Liver Cancer Undetected According to Dr. Improving Diagnosis and Medical Coding for Hepatitis C. Squamous Cell Carcinoma - ICD-10-CM Coding Review for Medical Coding. Squamous cell carcinoma (SCC) is a most common type of skin cancer. The cancer begins in the sqamous cells, the tissue the forms the surface of the cells. This usually occur on the body areas exposed to sunlight including the rim of the ear, lower lip, bald scalp, face, neck, hands, arms and legs.

Though ICD-9 has codes to report this condition, the new ICD-10 coding system provides more specific codes. The details in coding below has been put together for review by Dermatology Oncology practices or Medical Coding Companies who deal with the specialty. SCC – Causes, Signs and Symptoms, Treatment Growing bump that may have a rough, scaly surface and flat reddish patchesLump on the skin or under the nailDome-shaped or crusty lesion that may bleedHaving a sore that doesn’t heal Any change in an existing wart, mole, or other skin lesion should be noted, as it could be a sign of SCC.

ICD-10 Coding and Documentation Specify whether the site is primary, secondary or carcinoma in situ. An Overview of Medicare Billing for Well Woman Exam. Women under age 65 can schedule a Well Woman Visit each year to maintain health and prevent disease. A Well Woman Visit includes a complete checkup, and is separate from any other visit made to the practitioner for sickness or injury. The Affordable Care Act entitles all women to one free well-woman checkup every year. The cost is covered by most insurance companies. Designed to ensure preventive care for women, these visits include the following: Screenings or medical tests to check for diseases early when it is easier to treat them.Services such as shots that can ensure better health and prevent health issues.Education that will enable the patient to make correct health decisions.

A physical examination is a key component of an annual Well Woman Visit and the components of this exam may vary in keeping with the patient’s age, physician preference, and risk factors. Annual Wellness Visit and Well-Woman Visit How to bill out for an annual Well Woman Exam for a patient covered by Medicare? Allergic Rhinitis - Diagnosis, Treatment and Medical Coding. Allergic rhinitis or hay fever is a condition marked by symptoms such as runny nose and itchy eyes, mouth or skin. According to the American College of Allergy, Asthma and Immunology, this condition affects around 40 million to 60 million Americans. This occurs when the immune system of the body sensitizes and overreacts to something in the environment (grass pollen, dust mites, animal fur, mold or hair) which usually cause no problem in most people. Physicians should recognize the symptoms accurately to provide proper treatment at the right time.

Alongside providing treatment, providers need to ensure that medical coding for allergic rhinitis is appropriately done on the medical claims. Following is a brief overview regarding diagnosing allergic rhinitis, treatment modalities and appropriate coding. Accurate Diagnosis and Coding The symptoms of allergic rhinitis vary greatly. It requires one or more allergy tests to better understand the symptoms and assign a definitive diagnosis. Celebrate National Cholesterol Education Month in September.

ICD-10 Coding for Palliative Care. September - National Prostate Cancer Awareness Month. Medical Coding for HIV Screening and Diagnosis. Image-guided Intranasal SPG Block Effective for Migraines. Secondhand Smoke Increases Stroke Risk for Non-Smokers - Finds Study. CMS Proposes Two Medical Billing Codes for End-of-Life Care Discussions. ICD-10 Coding for Sprains and Strains. Coding for Alzheimer's disease - Important Considerations. Study: Rheumatoid Arthritis Increases Risk of Heart Attack. Osteoporosis Coding in 2015 - An Overview. Reimbursement Barriers to Dental Screening.

Preparations to Tackle Revenue Loss after ICD-10 Roll Out. 2015 Early Release Vaccine Codes and Proper Coding. Meeting HEDIS Quality Care Goals. Value-based Reimbursement - Beneficial for Primary care. Mammograms May Lead to Over diagnosis of Breast Cancer. Efficient Coding and Billing Can Keep RAC Audit Fears At Bay. Smoking Increases the Risk of Dying from Prostate Cancer. Coding for Kidney Transplantation - An Overview. Remote Medical Billing - A Growing Trend. Implementing ICD-10-CM and Its Advantages. No Cardiac Stress Tests for Low Risk Adults - ACP Advises.

Physicians Not Confident in Managing Patients Using Opioids. Why Outsource Oral and Maxillofacial Medical Coding Tasks. Outsource to Cut Patient Appointment Scheduling Hassles. Benefit Verification – An Important Step in Medical Billing Process. ACP Releases Wiser Cancer Screening Techniques. Exercise Can Help Manage Fibromyalgia Pain - Finds Study. Benefits of Professional Medical Data Entry Services.

Tomosynthesis More Effective to Detect Breast Cancer. OASIS-C Documentation of Surgical Wounds. Screening and Surveillance for Pre-mature CRC Diagnosis. More Marijuana ER Visits after Legalizing Sales in Colorado. CMS to Give More Details on ICD-10-PCS Section X in June. Spread Awareness about CMV Prevention this June. Arthritis Diagnosis and Treatment - Important Facts. How Extending Medicaid Raise Affects Patient Inflow and Billing. HIT Can Impact the Future Demand for Physicians.

Celebrate National Stroke Awareness Month 2015. National STD Awareness Month – Negative Impacts of STDs. Alzheime's Takes a Heavier Toll on Women than Men. AMA Issues Resources to Help Physicians Address the Risks. High Risk of Cardiovascular Disease in Women with Migraine. Screening Important for Early Detection of Colorectal Cancer. OCR's HIPAA Audit Program to Return. Celebrate National Colorectal Cancer Awareness Month 2015. Alzheimer's Disease - Routine Tests Facilitates Early Treatment.

Google Health Search and Medical SEO. Dermatology Payments Likely to Reduce in 2015 and Further. Celebrate Congenital Heart Defect Awareness Week (CHD) 2015. Major Medical Coding and Billing Changes Taking Effect in 2015. Telehealth Coverage Increased by Medicaid. Steps Orthopedic Surgeons Could Take to Prevent Medication Errors. The Need to Make EHRs User-friendly. Top Challenges Medical Practices Face. CMS Issues Decision Memo for Proposed Coverage of Mitral Valve Repair. Study Finds Double Mastectomy Often Done for No Reason. Oncologists Must Help Curb Deadliness of Pancreatic Cancer.

More Hospitals Choose Outsourcing to Improve ICD-10 Documentation. Many Uninsured Uninformed About Obamacare Open Enrollment Period. How to Avoid EHR-related Medical Record Cloning. EHR Systems and ICD-10 Transition. Why is it Crucial to Update the U.S. Medical Coding System. Medical Specialties Significantly Impacted by ICD-10. Important Facts About Epilepsy - Symptoms, Diagnosis and Treatment. Increase in Hospitalization and ER Use After Medicaid Expansion is Temporary. Population Health Management - The Case for Value Based Healthcare. Second Open Enrollment Begins, How Will the Changes Affect Your Medical Billing?

7th Annual Medical Coding and Reimbursement Conference 2014, Dec 5-7. Documentation Tips for Uncertain Diagnoses. Living Kidney Donors Facing Serious Insurance Related Difficulties. Heavy Caffeine Consumption Can Cause Severe BP Spikes in MAOI Patients. Mitigating HeartBleed Risk for Healthcare Data Security. Provisions of the 2015 Medicare Physician Fee Schedule. Misunderstanding about Doctors' Medical Billing and Coding for Medicare. Alarming Rise in Adult Obesity Rates in the U.S. Google's Patient-Doctor Video Chat to Promote Virtual Office Visits. New ICD-10 Implementation Date - Generates Mixed Responses. Submit Citizenship Details for Health Insurance Eligibility. ACA Non Compliance - Companies May Face Penalties. Medical Billing for HPV Vaccine Administration. Outpatient Diagnostic Errors Now Common in the US. How Patient Engagement Benefits Your Revenue Cycle.