Billing & Coding

Do I Need Error and Omissions (E&O) Insurance for My Billing Company?

Having a billing company for the past 20 years, has been a great journey, 20 years ago it was called a Home-Based Business, today it is called a Corporation, more for protection and liability reasons. Over the years Medical billing has been considered low risk until now, and now has developed into a huge liability with HIPAA, E&O and Business Associate agreements to name a few. I have not had to consider whether to carry insurance on my small company until now.

Q. If a patient brings in x-rays from another provider, may I bill 76140, x-ray consultation?


A Laxative is considered a “Self Administered Drug” (SAD).   Insurance will usually pay for the care you provide but will only cover certain drugs in the outpatient setting such as drugs administered through an IV.  Therefore it would not be appropriate to report this under the Outpatient Prospective Payment System (OPPS).

  • If the coverage criteria for therapeutic shoes has not been met, the GY modifier must be added to all claim lines for therapeutic shoes, inserts and modifications. The GY modifier mean the ITEM OR SERVICE STATUTORILY EXCLUDED OR DOES NOT MEET THE DEFINITION OF ANY MEDICARE BENEFIT,  Therefore will not be paid by Medicare.
  • The RT and/or LT modifiers must be submitted with all HCPCS codes in the therapeutic shoes policy.

In order to meet all the general requirements for coverage under the incident-to provision, an FDA approved drug or biological must:

Use G0283 Electrical Stimulation to one or more areas for indications other than wound care, as part of a therapy plan (TENS, IFC, NMES)for medicare.

HCPCS code G0283 should be used for unattended electrical stimulation, to one or more areas for indications other than wound care. (Note: CPT code 97014 is considered invalid for Medicare for all outpatient settings and united healthcare for private practices (most other payers recognize 97014)

Claims that are denied for medical necessity must be appealed and should not be resubmitted.

If you have a claim that are denied for medical necessity you should not re-submit your claim Instead, contact your carrier to see if you can do a phone review or attach documentation supporting your appeal and send your claim in with an appeal letter. These claims must be appealed and should not be resubmitted.

You need to have a prescription on file and note the correct modifiers on your claim form stating all conditions have been met (for Medicare). I have had better results attaching the prescription to the claim, however it is not required.

Telehealth Psychiatric Service (Resource 283)

Telehealth (also known as telemedicine) is playing an ever increasing roll in the reimbursement process. Internet services continue to expand and many insurance payers/providers are now covering (paying for) telehealth services. Telepsychiatry (providing behavioral health services in a telehealth environment) has been highly successful because video conferencing makes providing psych services as realitvely simply and inexpensive process.

Effective April 1, 2014, the SI for HCPCS code Q2052 (Services, supplies, and accessories used in the home under the Medicare intravenous immune globulin (IVIG) demonstration) will change:

1)  From SI=N (Paid under OPPS; payment is packaged into payment for other services. Therefore, there is no separate APC payment.)

2) To SI=E (Not paid by Medicare when submitted on outpatient claims (any outpatient bill type)).


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