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Welcome to the Knowledge BaseYou must be signed in to rate a question. Please sign in at the right or sign up to become a member of NetworkPMI here. Thank you. Pending QuestionsHIPAA Topics
Dear Mr. Ginsberg, With all of this talk about HIPAA privacy and security, how come we never hear about HIPAA evaluating whether or not physicians have complied? I agree that information should be protected, but it seems like a lot of hoopla for nothing.
Hi David, I was wondering if we have a confidentiality statement on file that was signed when employees were hired, BUT it doesn’t directly use the word HIPPA but does in fact state our policy on confidentiality and safe communications in it. Would that suffice for the sanction policy required by HIPPA? Thanks
Dear Mr. Ginsberg, My practice has put lot of time and energy into HIPAA, especially regarding security and training. HIPAA threatens big fines and even imprisonment for failure to comply with the security rule, but how do they know who has complied and who has not? Is there some entity that should be monitoring if a physician's office or hospital has created policies or addressed areas set forth by HIPAA? Compliance Topics
I provide a training program that I would like to offer as CEU credits. Can you please point me in the right direction?
After many yrs in podiatry I am now in dermatology. May I bill a consultation chg w/ a -26 since he has to read the lab results before advising the pt as to surgery or not. Also can I use 99070 for supplies used during suture removal & dressing changes?? These were things done in the podiatry ofc, ins. only. Thank you.
I work for a DME company and bill only HCPCS codes. I have questions/concerns about billing Medicare for specific codes that require the KX modifier (KX -specific required documentation on file). I am referring to Medicare / Cigna Government Service DME MAC Jurisdiction C website list of the LCDs (Local Coverage Determination). Based on the Documentation Requirements – Section 1833(e), there seems to be a difference is interpretation about what is required and what is not. My employer has told me the only thing we need from the physician are the orders, and it is not necessary to have the pt’s medical records on file such as the physician’s office notes, hospital records, nursing home records, home health agency records, or records from other healthcare professionals to support the need for the equipment. My employer & billing supervisor told me how they “Interpret” (the documentation requirements) is that we only need to get the documentation IF Medicare request the records. I have a different understanding on this matter and out of concern sent an inquiry to Cigna asking the following questions about the KX modifier: When the KX modifier is required for billing, are we required to have a copy of the documentation like the medical office visit notes in our file prior to billing? Does the KX modifier mean that we will have the medical records-documentation available only if requested? Does the physician's order cover the need for documentation? I received at written response from Cigna Government Services: Suppliers are required to have documentation on file to support the medical necessity for the durable medical equipment (DME) item before using the KX modifier. The documentation would include diagnosis information, physician examinations, patient's medical records, and Certificates of Medical Necessity (if applicable). Once you have properly obtained all the documentation requirements that are outlined in the LCDs then you may bill with the KX modifier. I shared the written response from Cigna with my employer and once again told it was subject to interpretation. In addition, they told me they called a couple of other DME companies who also interpret additional documentation is needed only if Medicare request the records. Am I reading too much into this and can you offer any advice? Thank you!
Isn't there a new Medicare Lifetime Authorization Form? I thought I heard that there is a more detailed one out there. Thanks
Hi Audrey, I am hoping you can help with a coding question. We are a hospital owned family practice. If our doctor refers to another doctor (specialist) who is also owned by the hospital and shares the same tax id, can he charge a consult? Also, if the other physician is still family practice but offers a service that our doctor doesn't (bone density, osteoporosis) can a consult be charged? Thanks for any clarification you can give.
Our doctor wants to thin our old charts, but she keeps taking out certain tests, instead of complete years and we always have to reference the old chart. Is there anything in writing stating what should be kept in a chart under these circumstances?
Hello Audrey, I work for a group of Psychiatrists in Dallas. We are in an office setting. We also see patients at a free standing mental health facility. I was asked to research if an MD under contract with us, can do the H&P;s in the observation are at the hospital? Thank you. Kim Stooksberry
Audrey, Hello, We are in need of help resolving a coding issue. We have some doctors in are practice that order saliva hormone testing on patient through a lab that goes by the name of ZRT Labratories. We have been told that there are no valid codes for saliva testing. We have been instructed to use bogus codes 999991 saliva extradiol, 99992 saliva progesterone, 99993 saliva testosterone, 99994 saliva dhea-s because the code book does not have appropriate codes. It does provide codes for serum hormones. Are problem is patient want these codes billed to their insurance company and we have told them these codes are bogus therefore insurance will not pay for it and they want it billed anyway so the insurance company claims we are in violation since we are not providing correct codes. If we are missing something in our coding books can you please instruct us where to look. Thank You Beckie, CMC,CMIS Arlington Family Practice 817-277-6444 Patient Relations and Collections Topics
Where is the best place to go for guidelines for refunds/credit balances. For both insurance companies and patients?
We have a disputed bill who happens to be an attorney. He wants the HCFA forms that we submitted to the insurance company. We have supplied him with the cpt codes but did not give him the HCFA. The HCFA has the diagnosis codes so is it ok to give him copies of the HCFA?
I have a question regarding charging fracture care. My son recently broke his arm and the doctor’s office appears to have charged FX Care. Each additional OV for Reval we have been charged our OV co pay. The office appears to be only charging my insurance for the x-ray no OV as it appears on my eobs. My question is when you charge FX care I thought the co pays did not apply each visit for the global time allowed for the FX Care charges. I thought you could collect a co-ins if deed applied for x-ray or other items used during the FX Care. Am I totally off base with the FX care? The office I previously worked for did not collect co pays each time for FX care only if other SVS were performed during that service. Legal Topics
We had a physician pass away about a year ago. His widow gave all patients medical records to our physician and asked her husbands patients to see us for follow up care. What is our obligation to keep the paper medical records? We have EMR and did not see most of those patients. The few that we did see; we did not need the physicians paper records.
I understand we can extend employee discounts for treatments incurred in our facility as an employee benefit and that it is legal under SB1731. Do we have to set a certain amount,or % of salary in the policy, or can it simply state that "employee coinsurance, relative to practice charges, may be discounted as an employee benefit?" Labor Law and Personnel Management Topics
I recently discovered that my boss, the doctor's daughter-in-law, is writing checks to a friend for falsified "work" performed for the clinic. I have discovered over $800/month going to this "ghost employee". what should I do?
I have previous employees that owe the company for dependent or dental insurance premiums that agreed to pay when they left but I have be unsuccessful in collecting the money owed. Any further steps you can take to collect? Coding Topics
We often have the need to have a translator in the room with the doctor, can we bill for that? If so where might i find the code? Thank you
I have recently contracted to bill for a GYN. He insists on billing routine CPT AND E/M with 25 modifier everytime a pt presents for wellness with a problem. What is your take on this?
We have a patient that came into the office and was evaluated and given a HHN tx and an O2 Sat was completed. At that point an ambulance was called and patient was taken to the E.R. Can we bill for the E&M code? I am getting conflicting opinions on this subject and need to know the right process. Thank you, Debra
Hi Audrey. I have a billing question that I am hoping you can help me with. I took your CMC class last October in Arlington. Anyways, we had a new patient come into the office (Family Practice) to be seen. The nurse took her vitals, chief complaint, and reviewed her medications. The patient left before being seen by the doctor. It is my understanding that I cannot bill the insurance since the physician did not see her. However, my boss argued with me stating that because the nurse did the vitals, etc. that I need to bill a 99201 and for the ICD-9 I just enter the diagnosis from the patients chief complaint which was elevated blood pressure and headaches. Isn't that illegal? The physician did not diagnose her. Again, we have never seen this patient before. Please help!! Thanks, Melanie
I have a coding question. My orthopedist sees a patient for the first time (99243) for a Colles’ fracture (813.41) and knee pain (719.46). Does the exam and determines the Colles’ fracture needs to be reduced. He reduces the fracture (25605) under fluoroscopic control. Even with the modifier the insurance company is denying the fluoroscopy stating it is a bundled procedure. This is also the case for fractures on established patients. Fluro is always being denied. Their reasoning is “separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed”. He does not use regular x-rays for these procedures, only Fluoro and it is his Fluoro machine. Is there something else I can use so he can be paid for this? Thank you
MEDICAID IS DENYING CPT CODE 90703 ON ONE OF OUR PATIENTS THEY SAY THEY NEED A MODIFIER TO SHOW IF THE DR BOUGHT THE MEDICINE FOR INJECTION OR IF IT WAS A SAMPLE, CAN YOU PLEASE TELL ME WHAT MODIFIER TO USE OR WHERE I CAN FIND IT. THANK YOU
What is the difference between "Other" and "Unspecified" in the ICD9 coding system?
would like to know where i can find codes to bill for urgent care services. we are a rural health center with a family practice & peds dr. that will be seeing pts on an urgent care basis. or can we bill with the regular e/m codes. we were also thinking to use 99058 or 99050 to bill. please let me know. thanks. eb
I work for a family practice and our physician does pap smears or well women exams. We are having trouble getting paid when the doctor has to repeat a pap smear because it was abnormal and it is sometimes done twice in a year. What ICD-9 code can I use besides the "Abnormal Pap smear" to get paid because this one is getting denied.
What is the diagnosis code for elevated troponin? Thank you, Rachel Roy
Can a H&P be done by the specialist that will be doing the surgery? If so, can it be billed by the specialist doing the surgery? A H&P is required by the hospital.
Hello Ms. Coaxum, I am a newly certified CMC located in Dallas,Texas. I do not have any medical background in experiance. I am looking to change into the medical profession. I was wondering if you can gave me any pointers or tips to get a start on becoming an a medical biller.
Ms. Coaxum, I've decided to be a medical coder and need some advice about what education I need. I am thinking of getting a certificate in medical coding only from an online class at Kaplin. Do you know anything about this school or could you just tell me if a certificate is all that I need for this field? I've looked at some jobs in this area and most say they want a certified coder with at least a couple of years experience. They teach ICD9 class. but some jobs mention CCS, CCS-P, RHA, RHIT certification and/or RHIA. Thank you |
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