Billing & Coding

Of nearly 15,000 test claims received by the Centers for Medicare & Medicaid for the first round of end-to-end ICD-10 testing, 81 percent were accepted, according to statistics revealed by the agency Wednesday.

Fee Resources (Resource 171)

The establishment of appropriate fees for services is one of the greatest challenges in health care. You need to understand the following concepts:

Claims Processing (Resource 199)

A properly completed claim (whether paper or electronic) is a critical component of the reimbursement process. A clean claim is vital to the processing and payment of your claims. The "cleaner" the claim, the faster you will receive payment. It is the responsibility of the provider to understand what is needed and required by the carrier, then provide that information in the specified manner and time frame.

You need to understand the following concepts:

Consumer Driven Plans (Resource 154)

Consumer Directed Healthcare Plans (CDHP) were developed as a way to shift the control of healthcare dollars from the insurance companies to the patient (consumer). The goal of these types of plans is to allow the patient to take a more active role in their own health and healthcare decisions in an effort to control costs.

Medicare Definition of Timed Codes (Resource 345)

Many procedure codes are considered "timed codes," that is, the number of units are determined by the amount of time spent performing the service. To clarify questions about this, the Medicare Claims Processing Manual, Chapter 5 - Part B Outpatient Rehabilitation and CORF/OPT Services, states the following (emphasis added):

20.2 - Reporting of Service Units With HCPCS
(Rev. 3367, 10-07-15))

Testing & Screening Tools (Resource 284)

There are numerous types of behavioral health screening tools available for healthcare providers. This page includes some general information and resources for some of these screening tools. Let us know if you would like others included here as well.

AUDIT - Alcohol Use Disorders Identification Test

10 Question survey - can be done as interview or as patient completed questionaire.

There are several new features in ICD-10-CM. Watch for these new features such as: 

Combination Codes

Combination Codes For Certain Conditions and Common Associated Symptoms and Manifestations

Examples:

•K57.21 – Diverticulitis of large intestine with perforation and abscess with bleeding;

•E11.341 – Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema; and

•I25.110 – Atherosclerotic heart disease of native coronary artery with unstable angina pectoris

 

Supplies Resources (Resource 347)

Providing medical supplies to your patients can benefit both the patient and your practice. However, there are specific protocols that need to be followed in order to properly bill supplies. Not only do the proper codes need to be selected, but the appropriate use of modifiers is essential. Also, some payers have their own specific requirements that must be followed. For information on codes and modifiers, refer to Section I-Supply Codes of the Behavioral Health MultiBook.

Links:

TENS Rentals

Q: How do you submit TENS (Transcutaneous Electrical Nerve Stimulation) rentals for reimbursement? I have some insurance companies that pay without question and others that deny this.

A:Use the correct TENS unit code, either E0720 for two lead or E0730 for four lead, and append the modifier -RR to designate Rental. Example E0720-RR.

Other popular supply modifiers include -NU to signify a new product and -UE to signify the sale of a used product.

Supply Codes

Q: Is there more specific codes for supplies rather than using 99070?

 

A: Yes. The HCPCS supply code series includes multiple more specific supply codes. The HCPCS supply codes are still too often overlooked and unused by providers. You will find that the HCPCS supply codes are more specific and as a result, often has more applicable codes for accurate reporting than the standard 99070 which is a non-specific, general supply code.

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