Two Days of Hands On Training for Medical Billing Services

One of the things that we would have LOVED to have access to when we started out was to see how a billing service actually operated. What do you do when you get your first work in, how does the software operate, what do denials look like and what do you do with them? So many more things that you can only learn by seeing and doing. Recently we had the opportunity to provide this type of training to another billing service and the results were outstanding. Here is what he had to say about his two day training:

“In early March, I had the distinct opportunity to work with the team at Solutions Medical Billing. I did not have any prior experience with billing at all. I must say that this” hands on experience” is the “PRIMARY” reason for the opportunities I have!!!
In a months time – I have acquired several clients; and there are a few more offices in the works for which I will be billing for as well. The time I spent with the team in Rome, NY was priceless. Their care and readiness to answer your questions provides a very nurturing and productive environment.

I would just like to take this time to say THANKS to the team in Rome, NY – Solutions Medical Billing.”

E. Christopher Robinson
Assurance Medical Billing, LLC

After doing this two day training with Chris we realized that this is the best opportunity we could offer to others trying to get started. Two days of hands on training, asking any questions you may have and seeing the day to day operations of a successful medical billing service. The experience is invaluable. So we developed a flexible agenda so that the training can be tailored to meet the specific needs of the person attending. For more information on this offer and what topics are covered visit our website at Solutions Medical Billing.

Using Modifiers Correctly

We get a lot of questions regarding the correct use of modifiers. Well, actually the questions are usually more on the lines of “One of my services was denied, what modifier can I use to get the service paid?”

The first thing I want to make clear is that it is never okay to add a modifier strictly to get a service paid. Modifiers, like cpt codes, help to describe the services that were performed. So the provider, or a coder who is reviewing the chart would have to determine if a modifier would be appropriate. A biller, just looking at the services cannot add a modifier just to ensure payment.

Having said that, it is important that billers understand modifiers and their use. Many providers do not understand modifiers, or even know that they exist. As a biller, you can educate the provider as to what the modifiers mean and what situations they should be used in. It is ultimately the provider who must determine if the services that were performed warrant adding the modifier.

A good example of this is if you receive a superbill indicating that the patient was seen for hypertension, diabetes, hypercholesterolemia and bursitis of the shoulder. The doctor indicates that he did an established office visit level 4, or a 99214 and an injection of cortisone, 20610. The provider doesn’t indicate that a modifier should be used. If both of these charges are billed out for the same date of service, most insurance carriers will bundle the office visit in with the injection.

As a biller you should question if the provider should be reimbursed for both since there were other medical conditions that the provider addressed. You can’t assume this based on the information that you have and since you were not in the room. That’s why you must check with the provider, not just add the modifier. Ask the provider what the main reason for the office visit was, if the other medical conditions were addressed, how much of the office visit was spent on the bursitis vs the other conditions, and advise him/her that the codes will most likely be bundled together.

Then you can advise him/her that there is a modifier, 25, that indicates that the office visit was a significantly separately identifiable service from the other procedure that was performed. The provider would need to advise the biller if the 25 modifier would be appropriate to use for the situation.

There are many other modifier that can be very useful as well. It is important though that billers do not get caught up in the task of getting claims paid and just use modifiers to accomplish that task. They must be used appropriately, when indicated by the provider of service. You may want to have some of the most commonly used modifiers added to the superbill so that the provider can easily indicate when the modifier is to be used.

Here is a list of some of the more common modifiers:

RT – right

LT – left

25 – significantly separately identifiable E&M service

26 – professional component

TC – technical component

50 – bilateral

59 – Distinct procedural service

79 – Unrelated procedure or service by the same physician during the postoperative period

Copyright 2010 – Michele Redmond

How Good is Your Claim Scrubber?

The best way to reduce outstanding receivables in a medical provider’s office is to make sure that claims being sent out are clean. Clean claims require less effort in collecting payment and result in faster payments. Claims with errors come back as denials and then need to be corrected, resulting in a delay in payment for services, and possibly no payment at all. After all, 42% of denied claims are never appealed or corrected.

Most provider offices do not have the time or the manpower to take care of denials in a timely fashion and it is one of the largest sources of lost money in a medical office. Sending out clean claims results in over 90% being paid on the first submission, leaving less than 10% of claims to be denied. By eliminating the avoidable errors, the real issues can be addressed and less money will be lost. One good way to ensure clean claims is by having a good claim scrubber in place. Many billers do not even know what a claims scrubber is but it actually influences your receivables in a huge way.

A claim scrubber analyzes the data that is on the claim and compares the data to its rules engine before the claim is submitted. There are several levels of claim scrubbing and good claim scrubbers will analyze data on many levels. The most basic claim scrubbing function is to make sure that all required data is present. For example, it will check to make sure a name, valid date of birth, insurance information and id number are present. It will also verify that there is a date of service and a procedure and diagnosis code. But it may not verify if the data is accurate. For example, a basic claim scrubber may not notice if a date of service entered was mistyped and is for an obviously incorrect date, such as 04/01/2001. To a biller it is obvious that the entry person made a typo, but a basic claim scrubber may not catch this.

Another example is if an invalid insurance identification number is entered. Medicare identification numbers are a social security number followed by a letter, sometimes also followed by another number. If the person entering the claims makes a mistake and misses one number, a basic claim scrubber may not notice. But a good claim scrubber would pick up that there were only eight digits instead of nine, giving the user a warning that the claim may have an error.

Today claim scrubbers come with many more capabilities. They not only verify required data is present, but they also analyze icd-9 and cpt codes. They use rules from CMS and other major insurance carriers to detect mismatches and invalid combinations. Warnings will be given if data does not appear to meet carrier guidelines.

Now with web based software the claim scrubbers have improved even more. With the use of data mining a claim scrubber can build on its own knowledge base by continually reevaluating the adjudication rules of different payers. The claim scrubber is constantly improving its own quality of scrubbing capabilities. With this type of scrubbing capability a provider can reduce the percentage of human error and greatly improve the number of clean claims submitted.

Most practice management software systems with electronic claims capabilities come with some form of a claim scrubber. It is important to know how complete the claim scrubber that you are utilizing is. A good claim scrubber can have a huge effect on the accounts receivable of an office.

When we switched from a server based practice management system to a web based system we found that the claims scrubber on the web based Xena Health system caught up to 50% more errors that would have caused denials. The claims scrubber on our old system would have allowed those errors through creating much more work on the back end.

Some of the features in a product like the Xena Health’s inbuilt claims scrubber include

• Required field checks
• Required format checks
• ICD-9 checks and specificity
• E & V code checks
• CPT validity
• HCPCS validity
• The CMS Correct Coding initiative
• Local and national coverage determinations where appropriate
• Payer specific requirements

XENA Health Update

Many of our readers have been asking about what is happening with the new XENA Health Web Based practice management system we have been working with. We have been transferring all of our 70+ providers over from our server based practice management system to Xena Health over the past two months. We have been thrilled with the advantages this web based program has afforded us and the time we will save using XENA.

XENA is currently offering two free clearing houses – Availity and Office Ally and will be adding others soon. They are working diligently at keeping costs down for medical billing services.

XENA is currently working with a limited number of early adopters in flushing out the last remaining glitches to the software. They will be releasing the software for full use 6/1/10. If you are interested in becoming an early adopter or seeing a demo of the software, email me and I’ll get Maggs to give you a call.