Medicare Patient Wonders if 99397 was Coded Correctly

I received the following comment and questions from one of my readers, Mark. He is a Medicare patient who had a full routine physical exam from his physician. Mark asks if his doctor coded the physical properly with a 99397, which is not covered by Medicare, or if the doctor should have used the Annual Wellness Visit code, G0438 (or G0439), which is covered by Medicare. There is a lot of confusion out there on what these exams are comprised of and how these exams should be billed. We come across this type of question often so I thought I would share it in this blog post.

Q: “In November 2011 I scheduled a Wellness Exam after receiving a notice from Medicare. I turned 65 on November 16, 2010, so this was my initial notice. My physician explained the limited scope of the exam and recommended that I get a full physical, which I agreed to. Last month I received a bill for approximately half, $116.87, of the total $228.00; Tricare4Life picked up the balance of $111.13. I called the billing office and asked them why Medicare had not been billed for any part of the exam. I was informed that Medicare will not pay any part of the 99397 physical. When I asked them why they didn’t bill Medicare for a Wellness Exam, which I subsequently learned they would have billed under G0439, I was informed that because I had received a 99397 physical they couldn’t bill Medicare for a Wellness Exam and then bill Tricare4Life and me for the additional services over and above the Wellness Exam, as that would be considered fraudulent. I then asked what Medicare would have billed for the Wellness Exam and was told $254.00. I did a little research and discovered the following on the Medicare.gov web site under “Welcome to Medicare Preventative Visit” where it discusses “Your costs in Original Medicare”: “You pay nothing for the yearly ‘wellness’ visit if the doctor or other health care provider accepts assignment. If you get additional tests or services during the same visit that aren’t covered under these preventative benefits, you may have to pay coinsurance, and the Part B deductible may apply.” What is there in either a G0438 or G0439 exam that is not covered in a 99397 exam; and, why wouldn’t I just be billed for whatever a 99397 exam covers that is above and beyond the scope of a G0438 or G0439 exam? Am I being defrauded by my medical service provider, or am I just dealing with a coding department that is merely ignorant?” 

A: There is no fraud or ignorance here but there was a failure in communication from the doctor’s office. A full physical exam, 99397, is different than an Annual Wellness Visit, G0438/G0439, or “Welcome to Medicare Exam”, G0402. A full physical is NOT covered by Medicare and patients are responsible for the cost and can be billed. Some secondary insurance companies may cover the full physical exam which helps beneficiaries.

The decision for which service a patient should receive needs to be made prior to any exam as it determines the scope of the exam and the documentation needed for the exam. Plus, if explained properly to the patient, the patient can choose which exam they want the physician to perform. The patient may still have to pay based on their decision but at least there are no surprises.

Unfortunately there is a lot of confusion as to what each exam covers and how it is reimbursed by Medicare (from patients and from physician’s offices). Medicare does not make things easy.

 There are 3 exams that cause the confusion:

• Comprehensive Preventative Medicine: 99387 New Patient / 99397 Established Patient
• Initial Preventative Physical Exam (IPPE) aka “Welcome to Medicare Exam”: G0402
• Annual Wellness Visit (AWV): G0438 Initial / G0439 Subsequent

Let’s take a closer look at what each procedure code covers and how it could have been billed in this case.

Initial Preventive Physical Exam (IPPE) G0402

The Initial Preventive Physical Exam (IPPE) G0402 could have been provided and billed out by your provider during the first 12 months of receiving Medicare. If you saw the physician before 11/16/2011 this Medicare exam would have been covered. There were also additional once in a lifetime benefits that could also have been provided to you in conjunction with the IPPE (a “Welcome to Medicare” EKG, the Ultrasound Screening for Abdominal Aortic Aneurysm (AAA), and the

Pneumococcal Vaccine). However, if you were not seen by a provider or if your physician did not actually provide these services then unfortunately you missed out on these

benefits as they must be done within the first year of Medicare eligibility. It is the patient’s responsibility to schedule this exam however I suggest that it is good customer service for the medical office to call the patient to schedule an appointment.

The components of an IPPE are: 

• Review of the beneficiary’s medical and social history
• Review of the beneficiary’s potential risk factors for depression and other mood disorders
• Review of the beneficiary’s functional ability and level of safety
• An examination
• End-of-life planning
• Education, counseling, and referral based on the previous five components
• Education, counseling, and referral for other preventive services

Medicare provides a quick reference information sheet on the IPPE at http://www.cms.gov/MLNProducts/downloads/MPS_QRI_IPPE001a.pdf

Annual Wellness Visits (AWV) G0438 / G0439

The AWV is not an annual routine preventative physical exam. Those exams are much more comprehensive than the AWV. Many healthcare providers believe that the AWV is a routine physical exam and bill the G0438/G0439. That is incorrect.

In this case it looks like the physician knew the differences in the exams and their requirements and limitation, and recommended a full physical which was agreed to so an AWV would not be appropriate to bill.

It sounds like the cost may have not been explained. It is technically not the responsibility of the medical practice to explain the cost of the full physical exams, as it is a Medicare non-covered service by statute, but it sure would be a good idea to provide the patient with the cost information first instead of letting them find out later that they owe money (and usually a substantial amount).

The Annual Wellness Visit is comprised of only the following elements:

• Medical and family history
• List of current medical providers
• Height, weight, BMI, BP and other appropriate routine measurements
• Detection of cognitive impairment
• Review risk factors
• Review of functional ability
• Establish a written screening schedule for next 5-10 years
• Establish list of risk factors
• Provide advice and referrals to health education and preventative counseling services
• Other elements as determined by the Secretary of Health and Human Services

Also since the routine preventive exam (99397/99387) is different than the AWV, Medicare allows both services to be performed at the same visit and billed with proper documentation.

A complete list of the covered services of the AWV can be found at this link: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads//MM7079.pdf

Comprehensive Preventative Medicine:
99387 New Patient / 99397 Established Patient

Lastly we come to the Comprehensive Preventative Medicine Exam. Patients and medical providers refer to this exam by such names as a routine physical, annual physical, annual exam, well exam, routine exam, full physical, annual routine physical, etc. Regardless of what the exam is called, the CPT codes 99397 (established patient) and 99387 (new patient) which represent the preventive care examination have very specific parameters and are never reimbursed by Medicare.

The 99397 is defined as the following:

Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older.

Just as an example, according to the United Healthcare website for patients with a Medicare Advantage Plan (link at: https://www.uhcwest.com/vgn/images/portal/cit_60701/600758632_Medicare_Advantage_$0_Copay_Wellness_Exams-2012_Coding_Procedures.pdf) an Annual Routine Physical is defined as the following:

The purpose of the Annual Routine Physical is to provide a comprehensive physical examination in order to screen for disease, promote a healthy lifestyle, and assess an individual’s potential risk factors for future medical problems. Any clinical laboratory tests or other diagnostic services performed at the time of the wellness visit may be subject to a copayment or coinsurance as applicable.

This exam includes all or some of the following components as applicable:

• History
• Vital Signs
• General Appearance
• Heart Exam
• Lung Exam
• Head and Neck Exam
• Abdominal Exam
• Neurological Exam
• Dermatological Exam
• Extremities Exam
• Male Physical Exam: Testicular, Hernia, Penis, and Prostate Exams
• Female Physical Exam: Breast and Pelvic Exams
• Counseling to include healthy behaviors and screening services

Summary

The Annual Wellness Visit G0438 and the 99397 are completely separate codes and the AWV is not to be used in place of the 99397. Since the 99397 is never covered by Medicare and the physician recommended a full physical which was accepted prior to any exam being performed, with just the provided information, everything looks like it was done properly. Sometimes a secondary insurer will pay for these services but it depends on your individual coverage and benefits.

Additionally, billing the 99397 (not covered by Medicare) and billing the AWV at the same time is not fraudulent and can be billed if that is exactly what happened and the physician has the proper documentation.

Please note that Medicare rules are complex and change all the time. What is current information today may be incorrect tomorrow. Always check with your local Medicare carrier.

Other posts you might like:

1. Q&A: What are the Medicare Annual Exam Codes and Newborn Codes?
2. Medicare G0438 – G0439: Two New Annual Wellness Visit Codes
3. ICD-10 is Coming, Will Your Medical Billing Department Be Ready

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Q&A: Am I Just Dealing with a Coding Department that is Ignorant?

WEBSITE: Medical Billing Company | Capture Billing

When choosing an Electronic Health Record (EHR), my client practices often come to me asking what they should take into consideration . Of course you should pay attention to whether the system has features to support your specialty (or has the flexibility to let you custom-add those features yourself). And of course you should ask whether the product would put you in position to qualify for Meaningful Use.

But that’s not the whole picture. Considering the amount of money you’ll be spending on your system (thankfully, with some of that being reimbursed by American Recovery and Reinvestment Act of 2009 ARRA funds) you should also take into account the vendor’s longevity, in light of the coming consolidation in the EHR industry once fewer doctors are going out to buy their first EHR ever.

This advice is inspired by a recent piece in Health IT News. Allscripts just had a shakeup, with many board members walking out, causing Allscripts stock to plummet. Pundits predict this stress could lead to Allscripts closing down one of its EHR products.

What does this event mean for you? First, that when considering what EHR to buy, you need to pay attention to more than just its certification and Meaningful Use credentials. You need to learn about the vendor’s standing as a company. And second, that even buying from big guys doesn’t necessarily mean your EHR product won’t get phased out in a few years (still, big brands do offer a measure of security).

Of course, change is inevitable. You can’t know for certain whether the company you buy from is going to be around ten years from now… any more than you can know for certain which stocks will rise.

Take control of the situation and manage your risk by asking vendors of EHRs you’re considering a few important questions, such as:

• How long has your company been around?

• How many clients do you have now? Where are they located? Knowing the number of clients is a good basic fact to know to help you judge what other practices have chosen to trust the vendor with their data. Diversity is good here, just as in a stock portfolio… if clients are across the country or world chances are better the company will weather economic difficulties better. If there’s less diversity, find out the reason for this. If your vendor specializes in podiatry practice software in Florida, what will happen when most podiatrists have systems in place?

• How long have you been working in [specialty area]? (if applicable) Chances are that vendors with loyalty to a certain specialty will have the experience and reputation to continue to generate business from new practitioners entering the field who are familiar with the product.

• How large is your staff? Think about it this way: if it’s a small company and the two product developers in charge of doing all of the company’s updates decide to switch careers, will it put the vendor’s future at risk? At the same time, if it’s a huge company it may just indicate that the company is reeling in sales during boom times and will lay everyone off once the flood slows to a trickle.

• What do you see your company looking like 3 to 5 years from now? This is a fair question to ask; you’re investing your money in their product, so in a way you’re becoming a stakeholder in their future.

Another question the prospect of consolidation should raise is the question of where your data would go in the event that your software is stored on the cloud. Be sure that the company can answer this question for you and put the answer in writing.

Other posts you might like:

1. Certified Electronic Medical Records EHR Coming this Fall
2. Looking for the Meaning of Meaningful Use
3. Should Medical Billing Companies be Afraid of EHRs?

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Choose Your EHR Wisely: 5 Non-Technical Questions to Ask Your Vendor Now

WEBSITE: Medical Billing Company | Capture Billing

Healthcare costs in the United States have skyrocketed in recent decades. Recently, the Huffington Post ran an article discussing major disparities in the cost of simple procedures like an appendectomy. These dramatic differences in costs have many people scratching their heads asking how it is possible that fees can vary so dramatically for the same procedure. While the Huffington Post article was referring to hospital charges, the same question applies to doctor bills, or physician fees as well. 

Disparities in the cost of healthcare services between physicians in the same specialty and same geographic region can have a major impact on a physician’s practice. This means that physician’s practices must be cautious when setting their fee schedules, particularly in light of the fact that patients are becoming more and savvier about healthcare options.

I am certainly not implying that a physician should undercharge for services, but rather providers must focus creating a methodical fee schedule. In other words, providers must create a fee schedule that can be justified to patients while returning maximum reimbursement. 

First, let’s start by understanding what the term fee schedule means. There are actually two related meanings. For the physician, a fee schedule is the list of charges or fees that the doctor wants to be paid for services. Think of this as a price tag for every different service in a doctor’s office. For the insurance company, the fee schedule is a list of the amounts the insurance will allow in payment for the doctor’s services. 

These facts make it very difficult, if not impossible for providers to abide the so called “reasonable and customary”. In the end, physicians have no choice but to charge rates high enough to exceed the maximum possible payment and take a contract adjustment in hopes of maximizing revenue. Unfortunately, patients do not understand the concept of contracted rates or contract adjustments. Not only high fees negatively impact the physician’s reputation, it can also make it more difficult for the physician’s staff or billing service to collect patient balances. Furthermore, high fees can be a terrible burden for patients without insurance. 

So how does one set a reasonable and customary fee schedule?
     Glad you asked… 

Let’s start with this most important thing to know. Although the doctor and the insurance have a contract saying that a certain rate will be paid, the insurance will never pay anymore than the physician charge. That means if you send a charge to the insurance for an amount lower than they would normally allow, the insurance will pay you the lower rate. This is why you must set your fee schedule high enough to accommodate the highest paying insurance company. 

The next thing to consider is simplicity. Physicians generally treat a lot of different patients with all different insurances. Technically, the insurances are required to give you a copy of their fee schedule upon request and it is a good idea to obtain that fee schedule to check that the insurance is paying correctly. But considering that the practice will have a lot of diversity in insurance mix, insurance fee schedules change, and various factors like modifiers and place of service affect reimbursement – it is difficult to maintain a separate fee schedule for every insurance company. The simplest way to calculate a fair fee schedule is to start with Medicare. 

Medicare’s fee schedules are determined by the U.S. Government. Their fee schedule (or amount that they will allow fee for service providers for rendering services) calculates the amount of work involved in a particular procedure times a conversion factor that accounts for the cost of being a doctor in a particular geographic region (similar to a regional cost of living). The conversion factor is publically available in the Federal Register. 

Now, Medicare is by no means the highest fee schedule, so you should not use it for commercial insurance billing without some modification. Still, with a little tweaking Medicare’s fee schedule is a great place to start. The Medicare fee schedule is available on all local Medicare websites and is generally updated every year with new calculations.

It is important to use your local Medicare fee schedule because the conversion factor (the multiplier) used to calculate the payments vary by geographic location and the goal here is to maximize revenue. For example, since it is more expensive to work in New York City, the doctors receive a higher payment rate that a small Midwestern town with a lower cost of living. So if you use the wrong geographic location’s fee schedule, you may lose out on valuable revenue. 

In order to exceed other insurance’s fee schedules and avoid underpayments, a good rule of thumb is to multiply Medicare’s fee schedule by 1.5 to 2 times for each CPT code. For example, if Medicare allows $100 for procedure code 99215 your fee schedule would be $100 x 2 = $200. Two times Medicare is usually just about right, it is not too high but it is high enough to exceed other insurance’s higher-than-Medicare fee schedules so you do not run the risk of receiving underpayments. 

Using the Medicare fee schedule as a starting point in establishing a practice fee schedule makes a complex task easy. It also helps you to simplify annual fee schedule maintenance. Further, as Medicare’s rates are publicly available, you have a clear and concise way to explain your costs to patients while charging commercial insurances an appropriate rate that will maximize revenue.

_________________________________

This is a guest post by Holly DeMuro, CPC. Holly has 15 years experience consulting in business management, medical billing and coding, and healthcare information technology. She is certified as a Professional Coder by the AAPC. To learn more visit her blog at healthcareisbusiness.blogspot.com or check out her profile on Linkedin.

Other posts you might like:

1. CMS Tells Medicare Contractors to Hold Claims
2. 2011 Medicare Codes for Flu Shots: Q2035, Q2036, Q2037, Q2038
3. Medicare Changes GA and Adds GX Modifier for Advanced Beneficiary Notices

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Why Do Doctor Bills Vary Widely?

WEBSITE: Medical Billing Company | Capture Billing

This is another guest post by Katie Matlack from Software Advice. In her post Katie writes about why doctors should use Google+ to market their medical practice online.

For doctors trying to reach their patients online, using Google+ can provide surprising marketing benefits that help them be more “findable” on the web. Consider that 44 percent of all Internet users search online to find information about health professionals, and suddenly the importance for physicians of having a good online presence should be more clear.

In this article I’ll discuss three reasons why I think that, if you participate in Google+, the newest social network, you can improve the chances your practice will come up when prospective patients search for something you’ve written about.

1. Rise in the Rankings

First, participating in Google+ gives doctors an advantage because content you share on Google+ has an “edge” against other stories. That’s right–Google (the search engine) likes stories that’ve gotten shared or +1’d on Google+ better.

For example, if a doctor writes a post about back pain and shares it via Google+, Google will favor this post in search results for topics related to back pain over comparable results not linked to a Google+ user. That’s important–because the higher up your content appears in search results, the more likely it is someone will visit your site.

2. Amplify Your Web Activity

Second, benefits of participating in Google+ grow as your network grows. Fellow blogger and search marketing expert Brian Whalley elaborates on what this means:

“[As you build up] a large following on Google+, content you’ve shared with your followers will also show up in those followers’ relevant Google.com searches, keeping your business [medical practice] top of mind and increasing its visibility among existing followers across multiple channels.”

3. Stand Out From the Crowd

Third, Google+ helps physicians stand out in search results because of the social data (such as your headshot, a link to your Google+ profile, and/or the number of people who have +1’d your article) included along with your content as another perk of participating. Social data will make people trust your content and make a searcher more likely to click it.

You might’ve read recent articles pooh-pooh’ing Google+ because there “isn’t a lot to do on it” or because people spend (waste?) less time on it than on its competitors.

But the truth is, these articles miss the point: which is that when you use Google+, you enhance your visibility every time someone searches on Google.com. Who cares if your patients don’t use Google+? They definitely use Google–and that’s where the results of your engagement on Google+ will show up.

Establishing yourself as a trusted medical expert is only going to become more important over time. The cost of healthcare is rising and patients even today often don’t view distance as a deal breaker if it means better treatment at lower cost. Where will patients head to find the best healthcare out there?

More than likely, to the Web.

Katie Matlack is the Medical Market Analyst at Software Advice. She writes about healthcare marketing and health IT, including medical insurance billing software. For a 5-step guide to getting started on Google+ today, plus a more in-depth discussion of the perks of Google+ and more resources to help you get started, please visit the original article on the Software Advice blog.

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AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Why Should Doctors Use Google+ for Online Marketing?

WEBSITE: Medical Billing Company | Capture Billing

This is a guest post by my colleague Katie Matlack from Software Advice. In her post Katie writes about how medical billing companies are needed and best suited to help physicians with their Electronic Medical Records.

With the mainstreaming of electronic health records (EHRs), some medical billing service company professionals may be concerned that doctors perceive that an EHR could replace them. Given the automatic coding and error-checking features of an EHR, this fear is not without some foundation in truth. But as more and more medical practices adopt EHRs, the reality has not been that billing service companies are phased out. In fact, billing service providers should view the commonplace EHR as an opportunity. Why? Because EHR-related assistance services represent an opening for billing services: a way to strengthening ties to their medical practice clients. In order for your billing service company to do well, follow these five steps I’ve outlined below. 

Step 1: Know what EHRs DON’T offer
Educate yourself rather than looking fearfully at EHRs. If a physician you work for does hint that she is thinking of phasing out your services you should be prepared to have a rational conversation with her. For example, even the best EHRs can’t make collection calls, arrange for payment plans, obtain the right supporting documents, or pinpoint opportunities for upcoding. “The reality is that the software doesn’t replace you at all,” said Ian Gary, national sales representative for Health Fusion, an EHR vendor.

Step 2: Remember the value YOU offer
As I said in my original article on the topic: “After you establish that some parts of medical billing can only be done by a well-trained human being, the next step is to communicate to your clients that your team is in the ideal position to help them with their EHR transition. Your employees are most likely already well-versed in how their EHR system works since many billing services work with multiple EHR vendors. Moreover, who better to advise a practice than the company that is already familiar with their diagnostic codes, terminology and pain points? As Steven Tolle, Vice President of Solutions Management at EHR vendor Allscripts said in an article on the topic, “[Third-party billing companies] have the trust of physicians, and you can leverage that to expand your business.”

Step 3: Extend your services

You can offer a number of EHR-related services to clients, such as:

• On-site support on the go-live date
• Help personalizing EHR templates
• Ongoing troubleshooting support

Katie Matlack is the Medical Market Analyst for Software Advice, where she writes about medical billing software reviews. For more detail on new revenue streams for billing service companies and the final two steps in the process, please check out the original article on the Software Advice blog. Thanks for reading!

Other posts you might like:

1. Pay for Performance and EHRs
2. Meaningful Use: Commercial Insurance Companies Adopt Criteria
3. Health Insurance Companies Process 1 in 5 Claims Wrong

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Should Medical Billing Companies be Afraid of EHRs?

WEBSITE: Medical Billing Company | Capture Billing

Electronic Health Records and Meaningful Use are on the minds of physicians and administrators all around the country.  David Lee from eRECORDS.com wrote a post about the Meaningful Use Stage 2 Proposed Rule that was just announced. He writes a nice summary on the main points of the rule. I have included his post so you can take a quick read of this new information.

What else could we talk about as our perspective?  Of course, Meaningful Use Stage 2 Proposed Rule…

It’s finally here.  The long awaited and much anticipated proposed rule for meaningful use stage 2. Okay, maybe not everyone was anxiously waiting for it but it does start to shed some light to what the providers, hospitals and EHR vendors must do with the 2^nd stage of meaningful use.  First of all, let’s review what the high level goal is for Stage 2.  Sitting between Stage 1 (data capture) and Stage 3 (improved and more efficient care) goals, stage 2 is about exchanging data.  Like stage 1, CMS and ONC were very pragmatic about how they came up with the proposed rule.  They seem to have balanced the need to sustain the momentum from stage 1 while keeping an eye towards providers who are struggling to meet stage 1 requirements.  Here’s the list of key items from the proposed rule for meaningful use stage 2 for Eligible Professionals. 

• Everyone starts stage 2 in 2014.  For those who have attested for meaningful use in 2011, stage 2 now starts in 2014 (from 2013) to be in sync with everyone else.  Essentially, there is no penalty for early achievers of meaningful use.
• Stage 1 requirements will have updates for 2013.  The good news is that you have options to either meet the updated stage 1 requirements or simply stick with what’s defined with the stage 1 final rule.
• Qualification requirement for the Medicaid incentive program have greatly loosened.  If you did not qualify for Medicaid incentive program in 2011 or 2012, check again because you may qualify under the new qualification requirements.  The best part is once the stage 2 is in final rule form, new qualification goes in effect.  That means it could be as early as 2013.
• Stage 2 requirements are much tougher.  Number of Measure objectives remained the same (20) with 17 Core measures (was 15) and 3 of 5 Menu measures (was 5 out of 10).  CQM requirements however, increases to 12 (was 6).  In addition, measurement goals are generally higher (e.g. recording vital signs increases from 50% to 80%) and overall requirements are much more complex (some measures have multiple components to meet).  Don’t kid yourself.  Stage 2 is definitely more challenging than stage 1.
• Patient engagement will play a bigger role in meeting stage 2 requirements.  For example, it is no longer good enough to just provide patients their health information.  Patients will need to actually view and download their health information.
• Transmission and exchange of information is no longer satisfied by simply doing a “test”.  With stage 2, you actually need to transmit and exchange “real” information and more than just once.
• Although exchanging of data is key to stage 2 goal, HIE is not required.  Secure email can be used to exchange data instead.
• Alignment with other programs has begun, starting with the PQRS.
• Payment adjustments begin in 2015 but deadlines differ.  If you achieve meaningful use in 2011 or 2012, you will need to achieve meaningful use in 2013 to avoid penalty adjustment in 2015.  However, if you don’t achieve meaningful use by 2013, you must achieve meaningful use three months before the close of 2014 to avoid penalty in 2015. 

Let’s also not forget the sister proposed rule related to the standards and specifications for EHR system that was released at the same time.  This proposed rule is primarily about updating the certification rules so that the ONC certified EHR systems meet the stage 2 requirements.
 
For most providers, meaningful use stage 2 means little in 2012.  However, for those who have achieved or are planning to achieve stage 1 requirements at the minimal level, stage 2 proposed rule should be reviewed before the end of 2012 to determine gaps.  That way, at least you have the 2013 year to close the gaps.

For additional resources, visit eRECORDS.com and checkout their Worry Free™ Program that takes away the hassle and gives you a worry-free way to achieving meaningful use and get your EHR incentive payments.
 

Other posts you might like:

1. Meaningful Use Requirements Final Rule is a Massive 864 Pages
2. Looking for the Meaning of Meaningful Use
3. Your Guide to Meaningful Use from eRecords

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Meaningful Use Stage 2 Proposed Rule

WEBSITE: Medical Billing Company | Capture Billing

We recently presented a brief review of the Privacy Rule provision of the Health Insurance Portability and Accountability Act (HIPAA) to the Arlington County Medical Society that meets at Virginia Hospital Center which is just outside of Washington, DC.  Physicians, Practice administrators and office managers came to our HIPAA Compliance training refresher class.

It is important to review the privacy procedures and policies that your practice has in place on an annual basis and ensure that the HIPAA guidelines are adhered to.

Some of the highlights that were discussed included:

• What is the HIPAA Privacy Rule and how does it affect practices?
• Definition of Protected Health Information (PHI)
• Rules of Use and Disclosure of PHI and examples
• Notice of Policy Practices and administrative requirements (policy manual, Privacy/Security Officer)
• Tips on De-identification
• Enforcement and Compliance

Below is the slide presentation given at the meting.  The slides are detailed so you will get a lot of information from this sideshow.  We also included references so that you can do your own research on HIPAA and the Privacy Rule.

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AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: HIPAA Compliance Presentation

WEBSITE: Medical Billing Company | Capture Billing

HEALTHCARE: Pay for Performance and Electronic Health Records

This is a guest post from Jonathan Krasner from BEI, a healthcare IT company located in Reston, Virginia.  Jonathan talks about Pay for Performance and how it relates to Electronic Health Records (EHR).

We all know that our healthcare system is very expensive and massive efforts are underway to implement reforms. The reforms come in many different areas, with differing levels of impact as there is no “silver bullet” that will fix the system. One of the major reform undertakings has to do with how providers and hospitals are paid.

Currently we operate primarily in a “Fee for Service” (FFS) environment. Under FFS, providers are paid for performing a specific service: an operation, procedure, consult, etc. One of the problems with FFS is that it assumes that providing a service is synonymous with a patient achieving a certain, generally positive, outcome (remission from disease, for example). That is not always the case. Alternatively, if you were to ask a patient what he/she would like to “purchase” when seeing a provider, they would reply with something like “I would like to get my condition under control”, or “I would like to be cured of this disease”, i.e. the patient would like to “purchase” an “outcome” or “result”.

The concept of “purchasing” an “outcome” has been around for a while and is known by various names: Pay for Performance, Outcomes Based Payments, Value Based Purchasing and Accountable Care are a few. Over time, the industry will standardize on a single term, but in this article we use the term Pay for Performance (P4P). There are several important things to know about P4P:

• Essentially, P4P uses financial bonuses to encourage physicians to meet standardized performance quality measures and to boost positive clinical outcomes and patient satisfaction (just as an aside, in the US today, 75% of all companies associate at least part of an employee’s pay to measures of performance).

• It does not apply to treating an individual patient. Rather it applies to a group of patients in a panel, where outcomes can be statistically predicted with accuracy.

• It cannot apply to all conditions and diseases. It only applies to patient panels with specific conditions. These conditions are those where the outcomes can be predicted with statistical accuracy. For example, starting October 1, 2012, hospitals will be reimbursed differently for three conditions: heart attacks, heart failure and pneumonia. The payment rate allows only a certain amount of readmissions. If a hospital’s readmission rate is considered to be excessive, they will be subject to rate reductions.

We are not trying to argue the merits of P4P. However, it will become, in one shape or form, part of the payment system in the future. In addition to the Medicare announcement mentioned above, United Healthcare recently announced that they will be paying for some oncology services in this manner. Most major payers have some type of P4P program in place or are developing one.

But what does this have to do with EHRs? Plenty! Here are some thoughts:

• As mentioned above, P4P relies on a lot of data, from a lot of patients. You can’t P4P unless you can measure performance. You certainly cannot implement a P4P program with a physician that is using paper charts. The data that is resident in a physician’s EHR will be instrumental in determining what actual performance or outcomes are.

• As a side note to the above, the data must be available in a standardized electronic format for it to be evaluated.

• A shift to accepted evidence-based standards of care will be required. For certain conditions, physicians will be asked to use certain clinical policies and procedures. EHRs will be used to document that these standards have been adhered to.

• Many P4P programs will involve the concept of the Patient Centered Medical Home. This does not just apply to primary care physicians. Part of PCMH involves identifying gaps in care – as an example, making sure every patient over 50 receives a colonoscopy at the appropriate intervals. These gaps in care can only be identified by and addressed using the data in an EHR. The EHR cannot only be used to identify gaps in care, but also any type of medical data point, i.e. patients with certain lab results, patients on certain medications, etc. By rapidly identifying patients with certain characteristics, physicians can quickly target appropriate care.

Meaningful Use is just the first stop in the long journey of utilizing EHRs in the transformation of the healthcare system as we know it. EHRs will be used not only to improve clinical outcomes, increase practice efficiency, but will also be an integral part of the payment systems of the future.

Visit BEI at www.beihealthcare.com or call Jonathan at 571-612-3344 for more information on this topic. 

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AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Pay for Performance and EHRs

WEBSITE: Medical Billing Company | Capture Billing

Loudoun County, VA – Capture Billing & Consulting, Inc., a medical billing company located in South Riding, Virginia, establishes its new education division. The new division will be managed by Michelle Ivanchukov, CPC, CSS-P (Certified Professional Coding) and Katie Jennings, RN(Registered Nurse).

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AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Medical Billing Education Outreach Program is Established by Capture Billing

WEBSITE: Medical Billing Company | Capture Billing

Loudoun County, VA – Capture Billing & Consulting, Inc., a national medical billing company located in South Riding, Virginia, will begin the first semester of 2012 teaching Medical Terminology for the Allied Health Professional at Northern Virginia Community College (NVCC), Loudoun Campus in Sterling, Virginia.

NVCC’s “Medical Terminology for the Allied Health Professional” class will be taught by Katie Jennings. Allied Health Professional; refers to individuals who work in a variety fields within the medical community. Katie’s experience as a medical biller and nurse has helped her navigate in both the clinical and administrative aspects of healthcare. Katie’s knowledge and use of medical terminology has been a great source of information in designing the class.

“This in-depth class will assist students interested in the medical billing field. Learning the fundamentals of medical terminology via the introduction of anatomy will help prepare students for the Certified Coding Professional (CPC) exam”, says Katie, “in addition to preparing students for a career in the healthcare industry”.

In this class students will learn medical prefixes, suffixes, root words, and commonly used medical terms by the allied health professional. The class structure will allow students a chance to learn the proper pronunciation and definitions of medical terminology and how physicians use them.

The five session class will help students prepare for the CPC certification exam and to succeed in the medical billing and coding field. As medical billing standards change and become more complicated, qualified individuals will be highly sought after.

To learn more about these and other medical billing course please visit:

5 Session Class: http://www.nvcc.edu/wdce/loudoun/courses/classinfo.asp?ID=HLTH+1567+

Northern Community College:  http://www.nvcc.edu/wdce/loudoun/courses/alphalist.asp

ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

CONTACT INFORMATION

Capture Billing & Consulting Inc.
25055 Riding Plaza, Suite 160
South Riding, VA 20152
(703) 327-1800
Contact: Manny Oliverez
Website: http://www.CaptureBilling.com

Other posts you might like:

1. Medical Billing Company Teaches CPC Exam Preparation Course at Local Community College
2. Medical Billing Company Teaches Medical Billing, Coding and Collections at Local Community College
3. Medical Billing Company CEO Offers Medical Revenue Cycle Management Class through Local Community College

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Medical Billing Company Teaches Medical Terminology for the Allied Health Professional at Local Community College

WEBSITE: Medical Billing Company | Capture Billing

Loudoun County, VA – Capture Billing & Consulting, Inc., a national medical billing company located in South Riding, Virginia, will be teaching a Certified Professional Coder (CPC) exam preparation class at the beginning of 2012 at Northern Virginia Community College (NVCC), Loudoun Campus in Sterling, Virginia.

Manny Oliverez, CEO and Co-Owner of Capture Billing and several of his experienced medical billers and coderswill be teaching an extensive class to prepare participants for the five and a half hour long CPC exam. The CPC preparation course will cover the principles and purpose of the Current Procedural Terminology (CPT), International Classification of Diseases (ICD-9 CM) and the Healthcare Common Procedural Coding System (HCPCS) coding manuals. The prep-course will also enable aspiring medical billing coders to assign procedure and diagnosis codes to the highest level of specificity.

“My experienced and knowledgeable staff has taught this class for the past couple of years and we have only had positive feedback from the participants who have completed it. The CPC certification exam is a thorough exam and anyone who plans to take it would greatly benefit from this preparation course”, says Manny.

This intensive preparation course will give the test taker access to the latest coding updates as well as review important aspects of the exam. The instructors will provide helpful test taking tips such as ways to tag and highlight the coding reference books to enable the test taker to move quickly from question to question, as well as time management suggestions such as which questions you should answer first. This valuable information will assist participants throughout the exam. They will also review and answer practice test questions and address any concerns regarding the exam.

To learn more please visit: www.capturebilling.com

ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

CONTACT INFORMATION

Capture Billing & Consulting Inc.
25055 Riding Plaza, Suite 160
South Riding, VA 20152
(703) 327-1800

Contact: Manny Oliverez
Website: http://www.CaptureBilling.com

Other posts you might like:

1. Capture Medical Billing Teaches CPC Exam Preparation Course
2. Medical Billing Company Teaches Medical Billing, Coding and Collections at Local Community College
3. Medical Billing Company CEO Offers Medical Revenue Cycle Management Class through Local Community College

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Medical Billing Company Teaches CPC Exam Preparation Course at Local Community College

WEBSITE: Medical Billing Company | Capture Billing

Loudoun County, VA – Capture Billing & Consulting, Inc., a medical billing company located in South Riding, Virginia, has produced several short educational videos to help medical office managers, medical coders and medical billers with coding and other similar topics. The short videos provide medical billing tips.

Capture Billing’s short medical billing videos are produced with medical billing tips in mind. Some of the topics these videos cover are coding for Medicare Flu Shots, Charging Patient No-show Fees, and information on electronic health records (EHRs) and Meaningful Use to name a few. Manny Oliverez, CEO and Co-Owner of Capture Billing, is not only a Certified Coding Professional he is also the creator and host of these videos.

“We began producing these videos to help inform physicians and medical practices of recent changes or current challenges that occur within the medical billing field. We have received thousands of views and a great deal of positive feedback to our medical billing videos which has encouraged us to produce more”, says Manny Oliverez.

The “Whiteboard Series” is a series of two to three minute videos focused on current topics within the medical billing field, as well as review of proper billing and coding procedures. All of the current videos have been posted on iTunes and on Capture Billing’s YouTube channel. Viewers may also subscribe to the series. By subscribing to the series of medical billing podcasts the viewer will be able to download current videos and they will be notified when new videos become available.

For more information on Capture Billing videos please visit: http://www.capturebilling.com/videos

 ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

CONTACT INFORMATION

Capture Billing & Consulting Inc.
25055 Riding Plaza, Suite 160
South Riding, VA 20152
(703) 327-1800
Contact: Manny Oliverez
Website: http://www.CaptureBilling.com

Other posts you might like:

1. Medical Billing Company Website is a Big Success
2. Capture Billing Now Podcasts on iTunes with its Medical Billing Minute
3. Medical Billing Company Expands Their Pediatric Medical Billing Division

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Medical Billing Company Produces Medical Billing Tips Videos for iTunes and YouTube

WEBSITE: Medical Billing Company | Capture Billing

Loudoun County, VA – Capture Billing & Consulting, Inc., a Medical Billing Company located in South Riding, Virginia, is pleased to announce the success of its new website http://www.CaptureBilling.com. In its first few months of going live the website which is focused on Medical Billing received over 17,000 page views per
month, up from 200 only a year ago.

Capture Billing provides outsourced Medical Billing Services to small and large medical practices. Its new website outlines and describes all the services that Capture performs. Capture’s website goes beyond your typical medical billing website, which is one reason it has received so much attention and has built a large following.

One of the main features of the website is the Medical Billing and Coding Blog. Online searchers can find tips on medical billing and coding that include how to bill for flu shots, how to use Medicare modifiers, and other basic information about coding. The website also lists and reviews the steps involved in the process of submitting claims to insurance companies. In addition to our informational videos, Capture also provides a Sample Medical Billing Report that physicians and their medical practices need to run a financially successful business.

“We’ve come across many practices that do not supply monthly reporting to their clients, however we do. We have a sample report package available for download so that physicians can see what monthly reports they should be receiving from their medical billing companies or in-house billing staff. These reports inform physicians and medical managers about overall practice management, practice performance and coding, as well as insurance reimbursements and aging of accounts”, says Manny Oliverez CEO, and Co-Founder of Capture Billing. “The reports are an essential tool to help physicians keep their finger on the pulse of the practice to ensure profitability.”

Another popular feature is the Medical Billing Videos section. Each video comes with a searchable transcript and covers topics such as tips on Charging Patients No-show Fees and Coding for Medicare. The most popular video is the “High-Tech Act: Electronic Health Records and Meaningful Use” video which has been view thousands of times. All the videos as well as Podcasts are available by subscribing to iTunes or to the Capture Billing’s YouTube channel.

Capture is consistently updating their website with the newest medical billing and medical coding information available. They also add new features periodically; one update coming soon is a new report that covers Billing a Well Exam to Medicare.

ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

CONTACT INFORMATION

Capture Billing & Consulting Inc.
25055 Riding Plaza, Suite 160
South Riding, VA 20152
(703) 327-1800
Contact: Manny Oliverez

No related posts.

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Medical Billing Company Website is a Big Success

WEBSITE: Medical Billing Company | Capture Billing

Loudoun County, VA – Capture Billing & Consulting, Inc., a nationwide medical billing company located in South Riding, Virginia, is pleased to announce the formation of its new OBGYN Medical Billing Department. Katie Jennings, an experienced teacher and seasoned employee at Capture Billing, has been chosen to head the new department.

An OBGYN practice consists of obstetricians and gynecologists. Obstetricians are physicians who specialize in pregnancy, labor and postpartum (pueperium) and gynecologists specialize in the female reproductive system and associated detection and treatment of disorders and diseases.

OBGYN practices have unusual medical billing concerns but the most frequent and most frustrating issue is commonly known as “Broken Global”. Broken global occurs when a pregnant patient obtains new insurance or switches to a different practice during the course of her pregnancy. Each insurance carrier has their own specific billing policies and procedures regarding antepartum codes for single as well as multiple (twins, triplets, etc.) births. In order to bill correctly and in a timely manner medical billers and medical coders need to be well versed in each insurance carriers policies and procedures regarding broken global. Another dilemma OBGYN billers face is billing for multiple surgeries at one time. In many cases a doctor will perform more than one or more surgeries on a patient at a time and each surgery will need to be billed separately.

Katie’s knowledge and expertise not only comes from many years of billing for OBGYN, but also from teaching. Katie has been teaching medical billing and medical terminology at the local community college for over seven years. Her comprehensive knowledge of medical billing and her ability to understand the complex nature of the OBGYN billing process has played a huge role in her success as an employee and teacher.

“Working in the medical billing industry and keeping up to date with the rules and regulations regarding antepartum billing has allowed me to stay current in this constantly changing industry”, says Katie.

“Our growing success in streamlining medical billing processes for our clients and increasing their total revenue has made it possible for Capture to focus on OBGYN specialties. The difficulty around antepartum billing has given us a chance to expand our business by creating a department entirely focused on medical billing for OBGYN”, says Manny Oliverez, CEO of Capture Billing and Consulting.

Katie and her team will handle charge posting and review, patient billing functions and billing inquiry calls in addition to guiding doctors and their staff through the antepartum medical billing process; from charge entry, insurance claims submission and denial management to revenue follow-up. Capture’s focus is to alleviate the confusion that accompanies antepartum, and broken global billing and to help medical practices get paid for the services they provide. Capture wants to ensure that physicians and their practice’s get paid for all of the services that they provide, which will help their medical practices to continue to thrive.

Capture Billing’s expertise in complex claim submissions and appeal follow up will allow OBGYN practices to focus on their patients medical needs while eliminating loss of revenue. Capture will meet with individual practices and their employees to answer questions and review monthly reports that assist each practice in tracking their bottom line and their revenue growth.

ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

No related posts.

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Medical Billing Company Forms New OBGYN Medical Billing Division

WEBSITE: Medical Billing Company | Capture Billing

5010 is the Standard Now: Are Your Insurance Claims Going to Get Paid?

Capture Billing has been working toward preparing for the transition to HIPAA Version 5010 for the past several months. The time has come and we are ready. As of January 1, 2012 all insurance claims must be submitted with the new 5010 format as mandated by the federal government.

Just because we are ready does this mean that insurance companies are ready? Will there still be some problems with insurance claims submission? Yes, I believe so.

The reason we estimate there will be problems is that as the insurance companies start receiving claims in the new 5010 format, even with all the testing that should have been done, there still may be issues with acceptance of the insurance claims. There are always glitches when software is upgraded and this is a big huge change.

My main concern is for small medical practices that may not be as tech savvy or have the resources to get help. Are they ready? Will all their claims be denied? Will they know how to work with their practice management software vendor and insurance company Electronic Data Interchange (EDI) departments to get their claims paid?

I think practices may have cash flow problems in the next few weeks as glitches in the system appear. And not just the small practices but the big medical practices also. Reimbursement issues may well extend into February before there is some relief.

We will be monitoring the 5010 transition situation very closely to make sure the medical practices we service don’t see a reduction in revenue or at least only a minimal change.

Keep a close eye on your claims to make sure they go through and are accepted by the clearinghouse and insurance companies. Make sure you carefully review all the Explanation of Benefits (EOBs) you receive from the insurance payers to ensure you are getting paid for the services you provided.

I would like to hear how your transition went and if you are having any problems. Please leave me a comment.

No related posts.

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: 5010 for Insurance Claim Submission is Here

WEBSITE: Medical Billing Company | Capture Billing

Loudoun County, VA – Capture Billing & Consulting, Inc., a nationwide medical billing company located in South Riding, Virginia, is pleased to announce the formation of its new Ophthalmology Billing Department. Tonya Arevalo, an experienced and dedicated Team Leader at Capture Billing has been selected to head the new department.

After billing for Ophthalmology and Optometry offices for several years, Capture has decided to design a department strictly focused on Ophthalmology and Optometry billing. Through many years of experience in medical billing, medical coding and revenue cycle management, Capture has gained the trust and confidence of their specialized clients.

“We have had great success in streamlining medical billing processes for our clients as well as increasing their total revenue. Ophthalmology and Optometry billing has become an increasingly major part of our medical billing business, that is why we have decided to expand our business by creating a department entirely focused on that specialty”, says Manny Oliverez, CEO of Capture Billing and Consulting.

The head of the new Ophthalmology billing department, Tonya Arevalo, will oversee all ophthalmic billing functions. Tonya’s extensive knowledge in the ophthalmic field comes from not only working in Ophthalmology practices but from billing for several different ophthalmic practices.

Tonya and her team will handle charge posting, patient billing functions and billing inquiry calls in addition to guiding doctors and their staff through the medical billing process; from charge entry, insurance claims submission and denial management to revenue follow-up. Capture wants to ensure the physicians and their practices get paid for all of the services that they provide.

Typically ophthalmology and optometric practices struggle with following up on claim denials and patient payments which causes practices to lose revenue. Capture will meet with individual practices and their employees to answer questions and review monthly reports that assist each practice in tracking their bottom line and their revenue growth.

For more information on Capture Billing and its new division please visit: http://www.capturebilling.com

ABOUT CAPTURE BILLING
Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

Other posts you might like:

1. Medical Billing Company Forms New Otolaryngology Billing Division
2. Medical Billing Company Forms Internal Medicine Billing Division
3. Medical Billing Company Broadens Family Practice Billing Division

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Medical Billing Company Forms New Ophthalmology Billing Division

WEBSITE: Medical Billing Company | Capture Billing

Pediatric Medical Billing Services Division Expansion by Capture Billing & Consulting, Inc. 

Loudoun County, VA – Capture Billing & Consulting, Inc., a medical billing company located in South Riding, Virginia, is pleased to announce the expansion of their Pediatric Medical Billing Division.

Over seven years ago Capture Medical Billing was formed when Dr. John Farrell and his Pediatric Medical office began thriving.  The quick growth of his Medical Practice left him with the challenging task of submitting medical claims to various insurance companies and ensuring the pediatric medical billing process and reimbursement rates were correct and completed in a timely manner.  This medical billing process required an infinite amount of time and resources.

As a Certified Professional Coder (CPC) and now CEO of Capture Billing, Manny Oliverez was able to assist Dr. Farrell in collecting his revenue from the insurance companies.

In 2004, based on Dr. Farrell’s success, another pediatric medical practice that had problems paying their bills and meeting payroll contacted Capture Billing for help.  Capture, using the medical pediatric billing methods and business practices it had developed, applied the methodology to their practice and took over their medical billing.  Within six months Capture was successful in turning them around and the practice became financially stable enough to hire a new doctor and expand their business.

There are several unique situations in Medical Billing for Pediatrics.  When submitting claims patient eligibility needs to be verified as well as who is financially responsible if the patient’s parents are divorced; some patients even have dual coverage.  These events require a knowledgeable and experienced medical biller to manage.  Other types of billing challenges, similar to the ones listed above have compelled Manny to add new members to his Pediatric Billing Services team.

“We have noticed an increase in the special circumstances that surround Pediatric billing so to ensure our clients are receiving their maximum revenue for the services they provide we have expanded our medical billing team, say Manny Oliverez.”

Capture wants to ensure the Pediatric practices receive revenue for all of the services that they provide, which will help their practices to continue to thrive.

For more information on Capture Billing, its new division and its medical billing and coding blog please visit:  http://www.capturebilling.com

ABOUT CAPTURE BILLING
Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

CONTACT INFORMATION
Capture Billing & Consulting Inc.
25055 Riding Plaza, Suite 160
South Riding, VA 20152
(703) 327-1800
Contact: Manny Oliverez
Website: http://www.CaptureBilling.com

No related posts.

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Medical Billing Company Expands Their Pediatric Medical Billing Division

WEBSITE: Medical Billing Company | Capture Billing

Loudoun County, VA – Capture Billing & Consulting, Inc., a nationwide medical billing company located in South Riding, Virginia, announces Manny Oliverez as the 2012 Vice President for the Leesburg, Virginia Chapter of American Academy of Professional Coders (AAPC).

According to AAPC (www.aapc.com) they are “the nation’s largest training and credentialing organization for the business side of medicine.”  Their organization consists of members in a variety of fields including medical coding and medical billing.  Their members “represent the highest level of expertise in the industry.”  The AAPC provides opportunities in networking, training and certifications as well other professional resources.

As Vice President of the Leesburg chapter of the AAPC, a few of Manny’s responsibilities include but are not limited to, assisting the president with chapter activities, proctoring certification exams, and ensure access to the chapter handbook.

“The AAPC has been a great resource for me.  The professional membership has allowed me to hire several members as employees at Capture Billing.  As 2012 Vice President of the Leesburg chapter of the AAPC I will be able to educate members of the changes happening in the medical billing field, as well as networking with a variety of professionals in the industry,” says Manny.

By utilizing the resources the AAPC has available for its members, Manny’s six year membership has enabled him to forge a variety of business relationships.  Manny encourages his employees to join the AAPC and to take advantage of the information that they provide.

Most of Manny’s employees at Capture Billing and most members of the AAPC have earned Continuing Education Units (CEUs) by attending monthly chapter meetings, or through workshops, webinars and national/regional events and conferences.  To learn more about the AAPC and earning CEUs contact your local chapter visit www.aapc.com.

To learn more about the medical billing services Capture Billing offers please visit: www.capturebilling.com.

ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing service industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available.  By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding, and soon will offer ICD-10 training.  Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provide.

No related posts.

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: American Academy of Professional Coders Has Elected Manny Oliverez of Capture Billing as Local Chapter Vice President for 2012

WEBSITE: Medical Billing Company | Capture Billing

Medicare and Newborns Codes cause some Confusion for Medical Practices

I received the following questions from Jean so I thought I would answer them here on the medical billing and coding blog in case anyone else could use the information.

Q: What is the CPT code for an annual exam for Medicare ….and what are the CPT codes for newborns for the first day, second day and discharge day … ?

A: The CPT code for the annual routine physical exam for Medicare is 99387 (preventative medicine E/M new patient age 65 and older) or 99397 (preventative medicine E/M established patient age 65 or older). This is the same code for all insurance companies. Remember that Medicare does not pay for these codes.  You are able to collect the fees for these services from the patient.  An Advance Beneficiary Notice (ABN) is not needed since this is a Medicare non-covered service.

If you are asking about the Annual Wellness Visit then the codes are G0438 and G0439. And don’t forget about the Welcome to Medicare exam, G0402.

Each of these codes are used for different reasons and have different requirements depending on what the patient needs or wants.

For more information check out my posts on the Welcome to Medicare visit using code G0402 for the Initial Preventative Physical Exam (IPPE), Annual Wellness Visit codes, and How to Bill a Well Woman Exam to Medicare using CPT codes 99387, 99397, G0101, Q0091, G0438 and G0439.

Now for the hospital newborn codes look at the following:

99460 – Initial, Newborn

99462 – Subsequent, Newborn

99238 – Discharge <30 min

99463 – Initial and Discharge Same Day, Newborn

Make sure you look up all these codes in your code book and use them appropriately and make sure your physicians document well.

No related posts.

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Q&A: What are the Medicare Annual Exam Codes and Newborn Codes?

WEBSITE: Medical Billing Company | Capture Billing

Loudoun County, VA – Capture Billing & Consulting, Inc., a medical billing company located in South Riding, Virginia, announces Britt Hansen as the 2012 Treasurer for the Leesburg Virginia Chapter of the American Academy of Professional Coders (AAPC).

According to the AAPC they are “the nation’s largest training and credentialing organization for the business side of medicine”. Their organization consists of members in a variety of fields including medical billing and coding. Their members “represent the highest level of expertise in the industry”. The AAPC provides opportunities in networking, training and certifications as well other professional resources accessed through meetings or online.

“I am excited to be elected as treasurer for my local chapter of the AAPC. I have seen a great deal of growth occur over the last year and I am looking forward to becoming an integral part of the future continued growth of the organization. The information that is shared in the monthly meetings has proven to be extremely valuable in my career in medical billing and coding”, says Britt.

Some of the AAPC treasurer’s major responsibilities are to maintain chapter funds, be primary signer on chapter checking account, and request local chapter reimbursements from AAPC.

A majority of Capture Billing employees and most members of the AAPC have earned Continuing Education Units (CEUs) by attending monthly chapter meetings, or through workshops, webinars and national/regional events and conferences. To learn more about the AAPC and earning CEUs contact your local chapter or visit: www.aapc.com.

To learn more about the medical billing services Capture Billing offers please visit: www.capturebilling.com.

ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing service industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding, and soon will offer ICD-10 training. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provide.

CONTACT INFORMATION

Capture Billing & Consulting Inc.
25055 Riding Plaza, Suite 160
South Riding, VA 20152
(703) 327-1800
Contact: Manny Oliverez

No related posts.

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Medical Billing Company Member Britt Hansen Elected as American Academy of Professional Coders Local Chapter Treasurer for 2012

WEBSITE: Medical Billing Company | Capture Billing

Michelle Ivanchukov from Capture Billing has been elected the 2012 President for the Leesburg, Virginia Chapter of American Academy of Professional Coders

Loudoun County, VA – Capture Billing & Consulting, Inc., a nationwide medical billing company located in South Riding, Virginia, announces Michelle Ivanchukov as the 2012 President for the Leesburg, Virginia Chapter of American Academy of Professional Coders (AAPC).

The AAPC provides continuing education and various certifications to coders and medical billers. Over 100,000 of the AAPC’s members have access to training, networking and job opportunities in the medical coding field and can attend local chapter meetings. The varied certifications available, including Certified Professional Coder (CPC), can be achieved through testing at any local chapter of the AAPC.

“Becoming president of my local chapter of the AAPC has energized me to share my understanding and experiences in medical billing and coding with other chapter members. It also allows me to expand my knowledge base in a variety of medical specialty backgrounds”, say Michelle.

According to the AAPC, as president, some of Michelle’s primary responsibilities are to ensure certification examinations are administered correctly, communicate with other chapter officers and ensure the overall well-being of the chapter.

Michelle has been working for Capture Billing over the past six years and has been a member of the AAPC for 3 years. She will be replacing Jackie Ly in 2012 as President of the Leesburg, Virginia Chapter of the AAPC. Her membership with AAPC has enabled her to stay current on coding and medical billing standards.

A majority of Capture Billing employees and most members of the AAPC have earned Continuing Education Units (CEUs) by attending monthly chapter meetings, or through workshops, webinars and national/regional events and conferences. To learn more about the AAPC and earning CEUs contact your local chapter visit www.aapc.com.

To learn more about the medical billing services Capture Billing offers please visit: www.capturebilling.com.

ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing service industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding, and soon will offer ICD-10 training. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provide.

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AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Medical Billing Company Member Michelle Ivanchukov Elected as American Academy of Professional Coders Local Chapter President for 2012

WEBSITE: Medical Billing Company | Capture Billing

Loudoun County, VA – Capture Billing & Consulting, Inc., a medical billing company located in South Riding, Virginia, will begin the first semester of 2012 with a fast paced two part class on medical billing, medical coding and collections at Northern Virginia Community College (NVCC), Loudoun Campus in Sterling, Virginia.

NVCC’s “Medical Billing, Coding, and Collections” class will be taught by Katie Jennings. Katie not only teaches medical billing classes but her experience as a nurse and medical biller has given her the knowledge and insight into both the medical and business aspects of healthcare. Katie’s familiarity with diagnosis codes and insurance companies’ claims processes has helped influence the design of the class.

“This class is a great introduction into the medical billing field. I cover all aspects involved in medical billing as well as the medical billing process from beginning to end”, says Katie.

Part one of the two part class consists of lecture and theory. A few of the topics that will be covered in the class are claim preparation, documentation, reimbursements, and collections. Part two of the class will be a hands-on computerized class. Participants will learn about data entry, claim adjustments, write-offs as well as other topics, with an introduction to medical billing software and management. The class will also review real life medical billing situations.

Part one and Part two of the program both consist of four sessions each. They will help students prepare to enter the medical billing field as well as those who would like a career change. As medical billing standards change and become more complicated medical offices and medical billing companies will be seeking qualified individuals to manage the billing process.

To learn more about these and other medical billing course please visit:
Part One: http://www.nvcc.edu/wdce/loudoun/courses/classinfo.asp?ID=HLTH+1745
Part Two: http://www.nvcc.edu/wdce/loudoun/courses/classinfo.asp?ID=HLTH+1746
http://www.nvcc.edu/wdce/loudoun/courses/alphalist.asp

ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

CONTACT INFORMATION

Capture Billing & Consulting Inc.
25055 Riding Plaza, Suite 160
South Riding, VA 20152
(703) 327-1800
Contact: Manny Oliverez
Website: http://www.CaptureBilling.com

No related posts.

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Medical Billing Company Teaches Medical Billing, Coding and Collections at Local Community College

WEBSITE: Medical Billing Company | Capture Billing

Loudoun County, VA – Capture Billing & Consulting, Inc., a medical billing company located in South Riding, Virginia, is pleased to announce the formation of the Internal Medicine Medical Billing Division supervised by Britt Hansen, CPC (Certified Professional Coder).

According to ACP (American College of Physicians) “doctors of Internal Medicine focus on adult medicine and have had special study and training focusing on the prevention and treatment of adult diseases”. These doctors are often sought out by other physicians as consultants to assist in the analysis of perplexing diagnoses.

Internal medicine brings a new variety of diagnoses and procedures to the medical billing field. This is why Capture Billing has decided to form a division solely focused on Medical Billing for Internal Medicine. Britt will be overseeing her team of CPCs to ensure all medical claims are submitted with the correct diagnosis codes.

“The broad spectrum of diagnoses and procedures within Internal Medicine has increased my knowledge and understanding of the specific codes insurance companies require to process these individual claims”, says Britt.

Britt and her team will handle posting, patient billing functions and billing inquiry calls in addition to guiding doctors and their staff throughout the entire Internal Medicine Billing process; from charge entry, insurance claims submission and denial management to revenue follow-up. Capture wants to ensure that physicians and their medical practices are paid for all services they provide, which will help increase their revenue.

Capture will meet with individual Internal Medicine practices and their staff to examine billing and coding concerns and review the medical billing process. These meetings are also used to review monthly reports containing but not limited to; current A/R, practice analysis and patient and insurance outstanding detail.

They will review monthly reports assisting individual practices with their revenue growth.

For more information on Capture Billing and its new Internal Medicine Billing division please visit: http://www.capturebilling.com

ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

Capture Billing & Consulting Inc.

25055 Riding Plaza, Suite 160
South Riding, VA 20152
(703) 327-1800
Contact: Manny Oliverez
Website: http://www.CaptureBilling.com

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AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Medical Billing Company Forms Internal Medicine Billing Division

WEBSITE: Medical Billing Company | Capture Billing

Medical Billing Software for Mac | 2011 Guide to Mac Medical Billing Systems

Another piece from Software Advice caught my attention, and I wanted to share it with you because I thought you might find it useful. This one’s on medical billing software – but there’s a twist. Katie Matlack, the blogger covering medical software for Software Advice, noted that with the rise in popularity of iPhones and iPads, many doctors are looking for the same simplicity and convenience in the products they use at work. She also made the point that one area in which doctors are always looking to improve is in medical billing, and from there went on to discuss options that folks with Mac systems have when it comes to medical billing software.

There are several things to keep in mind when you are exploring Mac-compatible medical billing software.

● Can the software support a practice of your size?

● Is your software is appropriate for the specialty your practice serves?

● Do you want to purchase a web-based solution (also known as a hosted or software-as-a-service option – or a traditional Mac-based software system that’s installed on-site at your office)?

That last point can often make people take a step back and wonder what the difference between web-based solutions and native-based solutions and fortunately, Katie talks about the differences in her post, pointing out that web-based solutions are the norm for Mac users in the medical world because the vast majority of medical practices are still PC based (and so there are very few software solutions built specifically for the Mac). However, she also make sthe point that, for offices that run entirely on Apple computers and are looking for a consistent Apple OS look and feel, finding a native Mac solution (such as MacPractice MD) can be the preferred choice.

Katie includes a list of medical billing software options, covering both native Mac solutions as well as web based ones. Head on over to her blog post for a more detailed discussion of how to choose the right medical billing software for your Mac-based office.

No related posts.

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Medical Billing Software for Macs

WEBSITE: Medical Billing Company | Capture Billing

Loudoun County, VA – Capture Billing & Consulting, Inc., a nationwide medical billing company located in South Riding, Virginia, is pleased to announce the broadening of their Family Practice Medical Billing Division.

Capture Billing originally began medical billing for primary care physicians in 2004. Over the past seven years Capture has broadened its client base to include Family Practice Billing and other specialty fields.

Each medical practice has different hurdles they face in medical billing and coding. This is why it is imperative they have qualified and certified medical billing specialists to handle the demanding task of collecting revenue from individual insurance companies to ensure maximum reimbursement.

“Owning my own medical practice has given me the opportunity to see the complexity of the medical billing and coding process first hand. Knowing that insurance and governmental rules and regulations are constantly changing I feel reassured that employing Capture Billing to handle Family Practice Billing will help physicians maximize their insurance reimbursements”, says Dr. John Farrell, co-founder of Capture Billing. “Capture staff undergoes continuous training to stay abreast of all the changes in healthcare.”

Billing for Family Practices involve an array of unique challenges. When processing claims the medical biller needs to know how to code specific courses of action for example; ancillary procedures (venipunctures, injections, EKGs) and minor surgical procedures such as lesion excision, foreign body removal and fracture care.

Capture Billing is experienced with billing for Family Practices and has extensive experience in the claim submission process, from timely claim submissions to maximizing insurance and patient reimbursements. This extensive process is handled by Capture so the practice and it’s physicians can focus on their patients and their patients needs. Capture Billing works with each client separately to ensure they are informed of the medical billing process and to review their revenue growth and provides monthly reports for further analysis.

For more information on Capture Billing and its new division please visit: http://www.capturebilling.com

ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

CONTACT INFORMATION
Capture Billing & Consulting Inc.
25055 Riding Plaza, Suite 160
South Riding, VA 20152
(703) 327-1800
Contact: Manny Oliverez
Website: http://www.CaptureBilling.com

Other posts you might like:

1. Medical Billing Company Forms New Otolaryngology Billing Division
2. Medical Billing Company Client is Voted One of the “Best Doctors in America” for 2011-2012
3. Practice Management: 5 Must Dos for Efficient Medical Receptionists

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Medical Billing Company Broadens Family Practice Billing Division

WEBSITE: Medical Billing Company | Capture Billing

Loudoun County, VA – Capture Billing & Consulting, Inc., a nationwide medical billing company located in South Riding, Virginia, is pleased to announce the formation of its new Otolaryngology Billing Department. Stacy White, an experienced and dedicated Manager at Capture Billing has been selected to head the new department.

As the oldest existing field of specialty medicine in the United States, Otolaryngology (ENT) physicians are trained in medical and surgical procedures. Their main focus is on treating patients with disorders and diseases of the ear, nose, and throat. These physicians may also practice in specialized fields such as allergy, laryngology and facial plastic and reconstructive surgery to name a few. Otolaryngology practices not only bill for office visits, but they also bill for surgical procedures that add to the complexity of the entire medical billing process.

Prior to Capture Billing, Stacy was the billing manager for one of the largest and most successful Otolaryngology practices in the state of Virginia. Her extensive knowledge and experience with medical billing for Otolaryngology procedures and surgeries will enabled Capture Billing to increase its ENT billing.

“We have had great success in streamlining medical billing processes for our clients as well as increasing their total revenue. The uniqueness of Otolaryngology billing has given us a chance to expand our business by creating a department entirely focused on that specialty”, says Manny Oliverez, CEO of Capture Billing.

As the head of the new Otolaryngology billing department, Stacy will oversee all Otolaryngology billing functions. Stacy’s extensive knowledge in the Otolaryngology field comes from over 18 years of experience in the physician billing, 8 of which come from working in Otolaryngology practices.

“There are two very common billing issues that occur in the Otolaryngology field. First, the improper use of modifier 50; this affects reimbursements when billing bilateral procedures. And second, claim denials for CPT code 30520 (septoplasty). These denials require appeals and additional medical documentation. Handling these claims improperly can result in a loss of revenue for the individual practices”, says Stacy. “We will be able to help our practices with these and other billing problems to recoup this income and increase their profitability.”

Stacy and her team will handle all aspects of otolaryngology billing in addition to guiding doctors and their staff through the medical billing process; from charge entry, insurance claims submission, patient billing and denial management to revenue follow-up. Capture wants to ensure the physicians and their practices get paid for all of the services that they provide, which will help medical practices to continue to thrive.

Otolaryngology practices are able to focus on their patients and alleviate the loss of revenue when they allow a company such as Capture Billing to provide them with expert medical billing services.

For more information on Capture Billing, its new division and its medical billing and coding blog please visit: http://www.capturebilling.com

ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

CONTACT INFORMATION

Capture Billing & Consulting Inc.
25055 Riding Plaza, Suite 160
South Riding, VA 20152
(703) 327-1800
Contact: Manny Oliverez

No related posts.

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Medical Billing Company Forms New Otolaryngology Billing Division

WEBSITE: Medical Billing Company | Capture Billing

Use New Medicare Advance Beneficiary Notice ABN CMS-R-131 by January 1, 2012

I received an email from the CMS listserv today reminding me about the new Advance Beneficiary Notice ABN we all have to start using by January 1, 2012.  I wanted to share that information with you all in case you do not subscribe to the Medicare emails.  Below is the info right from CMS.

2011 Version of Advance Beneficiary Notice of Noncoverage Must Be Used Beginning Sun Jan 1, 2012

In May 2011, CMS released an updated version of the Advance Beneficiary Notice of Noncoverage (ABN) (form CMS-R-131), which will replace the 2008 version of this form. The 2011 version contains no substantive changes from the 2008 version of the notice and was approved by the Office of Management and Budget. The 2008 and 2011 ABN notices are identical except that the release date of “3/11” is printed in the lower left hand corner of the new version. The ABN is used by all providers, practitioners, and suppliers paid under Medicare Part B, as well as hospice providers and religious non-medical healthcare institutions (RNHCIs) paid exclusively under Part A.

When the 2011 ABN was posted to the CMS website on Mon May 16, CMS announced a mandatory use date of Thu Sep 1 and permitted providers and suppliers to begin using the new form immediately. Subsequently, we received requests from the industry to extend this deadline in order to permit providers and suppliers with pre-printed stockpiles of ABNs time to exhaust their supplies.

Providers and suppliers are allowed to use either the 2008 or 2011 version of the ABN through the end of this year; beginning Sun Jan 1, 2012, they must begin using the 2011 version. ABNs issued after Sun Jan 1 that are prepared using the 2008 version of the notice will be considered invalid by Medicare contractors. 2008 versions of the ABN that were issued prior to Sun Jan 1 as long-term notification for repetitive services delivered for up to one year will remain effective for the length of time specified on the notice.

Information and a copy of the 2011 version of the ABN (form CMS-R-131) can be found online at http://www.CMS.gov/BNI , under the “FFS Revised ABN” link.

To DOWNLOAD the Revised ABN form CLICK HERE

____________________

It’s Your Turn

What Do you think? Are you using then new ABN? Have you been successful getting Medicare patients to pay for services that were denied? Share your experience in the comments box below.

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AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: New Medicare Advance Beneficiary Notice ABN CMS-R-131 to be used by January 1, 2012

WEBSITE: Medical Billing Company | Capture Billing

How to Attest for Meaningful Use (MU): 3 Tips from a Meaningful User

My friend Huston Neal over at Software Advice just published a piece on how to attest for meaningful use. He interviewed a Dr. Kevin Spencer who uses Greenway PrimeSUITE in his group practice.

Dr. Spencer from Premier Family Physicians in Austin Texas, is a physician that recently attested to meaningful use. In this article he provides three tips to make successfully attesting meaningful use easier for other practices. According to Dr. Spencer, the key components to successfully attesting were:

• Choosing the right EHR software company;

• Undergoing meaningful use training; and,

• Changing documentation processes to fit meaningful use guidelines.

Here is a short excerpt from the post.

“Premier’s patients are also benefiting from the practice’s EHR and MU attestation process. They are more educated about their disease state; they have more information available to them, and; they can be more involved in their health care. Patients can also sign up for Premier’s patient portal and check their medication lists, drug allergies, diagnosis and treatment instructions. Currently, more than 10,600 patients have registered, which is a significant level of engagement.”

I thought readers would find this article to be a useful resource.

You can view the entire post on Houston’s blog at: http://blog.softwareadvice.com/articles/medical/how-to-attest-for-meaningful-use-mu-3-tips-from-a-meaningful-user-1101711/.

No related posts.

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: 3 Tips from a EHR Meaningful Use User

WEBSITE: Medical Billing Company | Capture Billing

Billing Flu Shots to Medicare and Commercial Insurance Companies

Since it is now flu season I have been getting a lot of questions on how to bill flu shots to commercial insurance companies and Medicare. The codes used for a particular vaccine will vary depending on intramuscular vs. intranasal use, age of patient, formulation, preservative free, and split or live virus. If you are unsure of what code to use I suggest looking at the package information that came with the vaccine. Usually you can find the code on the packaging, and if you can’t find it in the documentation then call the supplier.

This is how most of our primary care practices bill for flu shots. Your situation may be different so make sure to check all the influenza vaccine codes 90654-90668 and use the appropriate code for the vaccine administered to the patient.

Commercial Insurance Carriers

90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)
90658 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use

Medicare

G0008 Administration of Influenza Virus Vaccine
Q203x Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use

Keep in mind that there are several codes for the flu vaccine when you bill for Medicare flu shots. The code you use is dependent on the manufacturer of the vaccine. Replace the code above with the correct vaccine code below.

Here is the list of the new Medicare Flu Vaccine codes for 2011. Choose the code based on the manufacture:

Q2035 Afluria Vaccine: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)

Q2036 Flulaval Vaccine: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)

Q2037 Fluvirin Vaccine: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)

Q2038 Fluzone Vaccine: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)

Q2039 NOS (Not Otherwise Specified) Vaccine: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Not Otherwise Specified)

Check out the short video we made about coding for the Medicare flu shot CLICK HERE

Pediatric Billing

If a child is under the age of 9 and has not previously received a flu shot, then usually two shots are given one month apart. After the initial series, in subsequent years only one shot is needed. When billing for the initial flu shot keep in mind that insurance should pay for both the initial flu shot and the flu shot given 30 days later. Be sure to follow up with the insurance companies if reimbursement is not issued for the second shot of the initial series. Typically these are denied but can be paid with a simple appeal or phone call correcting the denial.

90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)

Use the age appropriate codes as needed.
90657 Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use
Or
90658 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use

CPT copyright 2010 American Medical Association. All rights reserved.
CPT is a registered trademark of the American Medical Association.

Other posts you might like:

1. 2011 Medicare Codes for Flu Shots: Q2035, Q2036, Q2037, Q2038
2. Medicare: Video Helps Explain New Influenza Vaccine Q Codes for 2011
3. Coding for the 2010 Flu Shot: Three Vaccines, One Code

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: How to Bill for Flu Shots

WEBSITE: Medical Billing Company | Capture Billing

Medical Billing Tips Video Podcast
Coding for the H1N1 Swine Flu Vaccine
Episode 1

This episode of Medical Billing Tips helps physicians and medical billers to bill for the H1N1 Swine Flu Vaccine.

http://www.youtube.com/watch?v=DZz7eAeGmhc

Video Transcript & Show Notes

Ouch! I just got the Swine Flu Shot officially known as the H1N1 vaccine. There’s been a lot of confusion on how medical practices should bill for the H1N1, so let’s find out how they should.

Since the government is providing the vaccine you won’t be able to bill for it, but you are allowed to charge for administering the vaccine. Use CPT code 90470 this includes the administration and counseling for either intramuscular or intranasal versions of the vaccine.

The CPT code for the H1N1 vaccine is 90663, Medicare of course has come up with their own code, G9141 for the admin and G9142 for the vaccine.

The ICD-9 or diagnosis code should be V04.81. Even though the vaccine is provided for free, some insurers want you to code for the vaccine and some don’t. If you do code for it submit a fee of zero and be aware that some insurers have announced that a patient will not have to pay a co-pay or co-insurance, and you can now code an additional 99211 for a nurse visit.

Check with your insurance carriers, Medicare and Medicaid for specific billing requirements. My name is Manny Oliverez and this has been the Medical Billing Tips podcast.

No related posts.

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Medical Billing Tips | Billing for the H1N1 Swine Flu Vaccine

WEBSITE: Medical Billing Company | Capture Billing

Medical Billing Tips Audio Podcast
Coding for the H1N1 Swine Flu Vaccine
Episode 1

This episode of Medical Billing Tips helps physicians and medical billers to bill for the H1N1 Swine Flu Vaccine. The use of code 90470, 90663 and Medicare G codes G9141 and G9142 are discussed. Check with your insurance carriers, Medicare and Medicaid for specific billing requirements.

Other posts you might like:

1. Medical Billing Minute – Billing for the H1N1 Swine Flu Vaccine
2. Video Released to Help Physicians Bill Insurance for the H1N1 Swine Flu Vaccine
3. Video Released to Help Physicians Bill Insurance for the H1N1 Swine Flu

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Coding for the H1N1 Swine Flu Vaccine

WEBSITE: Medical Billing Company | Capture Billing

Capture’s Medical Billing client Bao Nguyen of Generations Family Practice is named one of the “Best Doctors in America” for 2011-2012

Loudoun County, VA – Capture Billing & Consulting, Inc., a leading national medical billing company headquartered in South Riding, Virginia, is pleased to announce that one of their clients physicians, Bao Nguyen, DO of Generations Family Practice located in Reston Virginia, was named one of the “Best Doctors in America” 2011-2012.

Boston-based Best Doctors, Inc., founded by physicians in 1989, gives the “The Best Doctors in America” award to physicians. Its database is compiled from a comprehensive survey of more than 45,000 physicians in the United States. Only doctors in the top 3-5% of their specialty earn the prestigious honor of being named one of the “Best Doctors in America”.

“We are honored to have Dr. Nguyen and Generations as a client.” says, Manny Oliverez CEO of Capture Billing.

Winners of the “Best Doctor in America” are chosen by a panel of their peers and recognized for their expertise in their field.  Along with Dr. Nguyen, Capture has worked with other physicians who have won a variety of prestigious awards including Dr. John Farrell, owner of Farrell Pediatrics.

To receive some of the same billing tips Dr. Nguyen receives visit the Medical Billing and Coding Blog.

ABOUT CAPTURE BILLING
Capture Billing and Consulting, Inc., a leader in the outsourced medical billing service industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available.  By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding, and soon will offer ICD-10 training.  Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance claim reimbursement for services they provide.

CONTACT INFORMATION
Capture Billing & Consulting, Inc.
25055 Ridging Plaza, Suite 160
South Riding, VA 20152
(703) 327-1800
Contact: Manny Oliverez
Pressroom: Medical Billing News
Website: www.CaptureBilling.com

Other posts you might like:

1. American Academy of Professional Coders Local Chapter Elected Manny Oliverez of Capture Medical Billing for 2012 President
2. Medical Billing Company CEO Offers Medical Revenue Cycle Management Class through Local Community College
3. Doctors Should Run Their Practices Like a Business

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Medical Billing Company Client is Voted One of the “Best Doctors in America” for 2011-2012

WEBSITE: Medical Billing Company | Capture Billing

Manny Oliverez of Capture Billing & Consulting, Inc. will be teaching a Medical Revenue Cycle Management class at Local Community College.

Loudoun County, VA – Capture Billing & Consulting, Inc., a national medical billing company located in South Riding, Virginia, is excited to announce that Manny Oliverez, CEO of Capture Billing, will be teaching Medical Revenue Cycle Management on Saturday, August 27, 2011 at the Loudoun Campus of Northern Virginia Community College (NVCC).

The Medical Revenue Cycle Management class is part of a series of 5 classes of the Medical Office Administration Program in the Workforce Development Department of the college. The courses are geared towards helping individuals with specific training needs in the field of medical billing.  Students that take all the classes receive a Certificate.

Students of the Revenue Cycle class consist of workers in the medical billing and coding field updating their current skills, students entering or re-entering the workforce and students changing careers.  The course will cover the entire medical billing revenue cycle and will provide practical hands-on solutions on how to best manage medical billing claims and how to get them paid quickly.

“In today’s economy of lower insurance reimbursements and higher deductibles it is important for insurance claims to get paid quickly and for patients to be billed correctly, which is why I designed the Medical Revenue Cycle Management class”, says Oliverez.

Manny Oliverez is a Certified Professional Coder (CPC) as well as the co-founder of his own medical billing company.  Oliverez has been in the healthcare industry for over 17 years and has noticed a demand for helping medical practices collect their revenue in a more efficient manner.

A few of the topics the course will examine are best practices for over-the-counter collections, electronic insurance claim submissions, claim appeals, patient billing and the use of reports designed for benchmarking and setting goals to keep bringing in revenue.

To learn more about the NVCC’s Medical Office Administration Program please visit: http://www.nvcc.edu/wdce/loudoun/certificate/certificate2.asp?p=Medical+Office+Administration#cList

ABOUT CAPTURE BILLING
Capture Billing and Consulting, Inc., a leader in the outsourced medical billing service industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available.  By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding, and soon will offer ICD-10 training.  Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provide.

No related posts.

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Medical Billing Company CEO Offers Medical Revenue Cycle Management Class through Local Community College

WEBSITE: Medical Billing Company | Capture Billing

Medicare Billing for Well Woman Exam Using Codes G0101 and Q0091 and Annual Wellness Visits AWV G0438 and G0439

As we are all aware, Medicare now allows for the Annual Wellness Visit (AWV) G0438 or subsequent AWV G0439, but how does this relate to an annual Well Woman Exam?  IT DOESN’T.

An annual Well Woman Exam is a completely separate evaluation and management service from an AWV and unless the provider specifically evaluates a patient for both the AWV and a Well Woman Exam, the AWV should not be billed out.  So how does a provider bill out for an annual Well Woman Exam for a patient covered by Medicare?  Let’s discuss the components of the annual exam first.

What does an Annual Exam include?

Preventive Medicine Service codes are defined by the CPT book as evaluation or reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures.

The purpose of the annual exam includes screening for disease, assessment risk of future medical problems, promoting a healthy lifestyle, and to update vaccinations. Aspects of the annual exam may include all or some of the following:

1. Review of History
2. Checking Vital Signs
3. General Appearance
4. Heart Exam
5. Lung Exam
6. Head and Neck Exam
7. Abdominal Exam
8. Neurological Exam
9. Dermatological Exam
10. Extremities Exam
11. Males: Testicular and Prostate Exams
12. Females: Breast and Pelvic Exams
13. Counseling
14. Routine Laboratory Tests
15. Immunizations

Does an Annual Exam also include a Well Woman Exam?

Yes.  The annual exam also includes the components of a Well Woman Exam.  If a patient is seen by her primary care physician (PCP) for an annual, the provider will also include the pelvic and breast exam and a pap smear collection.  If the patient elects to have the Well Woman Exam performed by her Gynecologist, the PCP must document that the Pelvic and Breast exams and pap smear collection were deferred and will be performed by a Gynecologist.

Incorrect Billing Procedures

1. What if you run out of time? If the patient is seen for an annual and the well woman exam portions are not done during the same visit, the provider may need to see the patient again in order to complete the comprehensive exam.  This second visit is merely a continuation and is not billable.

2. Can you bill an annual with a V72.31 Annual Gynecological Exam diagnosis and get paid separately? No.  If you have already billed out an annual in a given year (V70.0) then you cannot charge another annual with a different diagnosis.

3. What if the patient did not want the Well Woman Exam portions done during the regular annual? If the patient did not want the pelvic/breast exam and pap smear collection during the routine physical but later decided to not see the Gynecologist and comes back for these screenings you still cannot bill for these separately.  They are already included in the annual.  The patient may be seen but it cannot be billed.

Requirements of Coding and Billing an Annual Well Woman Exam to Medicare

Medicare does not cover preventive services such as an annual (besides the AWV) but certain Well Woman Exam screenings are reimbursed either every two years or annually.

Covered Services

Medicare covers the following screening exams in conjunction with a Well Woman Exam:

1. G0101 Cervical or Vaginal Cancer Screening; Pelvic and Clinic Breast Examination

a. G0101 is reimbursed by Medicare every two years unless the patient is considered high risk and then it is allowed on an annual basis.
b. According the CMS website, the ICD-9-CM Codes billable with the G0101 are V76.2, V76.47, V76.49, V15.89, and V72.31.  Select the appropriate codes.

i. V76.2 Special screening for malignant neoplasms, cervix
ii. V76.47 Special screening for malignant neoplasms, vagina
iii. V76.49 Special screening for malignant neoplasms, other sites
iv. V15.89 Other specified personal history presenting hazards to health
v. V72.31 Routine gynecological exam

2. Q0091 Screening Papanicolaou Smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory

a. Q0091 is reimbursed by Medicare every two years unless the patient is considered high risk and then it is allowed on an annual basis.
b. Per the CMS website, the ICD-9-CM Codes billable with the Q0091 are V76.2, V76.47, V76.49, V15.89, and V72.31.  Select the appropriate codes.

3. 82270 Fecal Occult Blood Test

a. 82270 can be billed on an annual basis.
b. Per the CMS website, the appropriate code varies by carrier.  An applicable code is V76.51 Special Screening for Malignant Neoplasms; Colon.

High Risk Factors and Frequency

High Risk Factors determine whether or not a patient may have the G0101 and Q0091 on an annual basis.  If a patient is considered high risk then these screening tests may be done annually.

According to the CMS Website the following factors are listed as high risk factors for screening pap smears and pelvic exams:

1. Cervical High Risk Factors
a. Early onset of sexual activity (under 16 years of age)
b. Multiple sexual partners (five or more in a lifetime)
c. History of a sexually transmitted disease (including HIV infection)
d. Fewer than three negative pap smears within the previous 7 years
2. Vaginal Cancer High Risk Factors: DES (diethylstilbestrol) exposed daughters of women who took DES during pregnancy
3. Personal History of Health Hazards: If a patient has a specified personal history presenting hazards to health then apply the V15.89 diagnosis and the appropriate health history hazard (example: V10.3 History of Breast Malignancy).  Any V15.89 diagnosis is considered high risk and also eligible for the yearly G0101 and Q0091.

Advanced Beneficiary Notices (ABNs)

An Advanced Beneficiary Notice is a Medicare Waiver of Liability that providers are required to give a Medicare patient for services provided that may not be covered or considered medically necessary.  ABNs do not apply to services that are specifically excluded from Medicare coverage, such as an annual.

A completed and signed ABN is key for reimbursement.  It also notifies Medicare that the patient acknowledges that certain procedures were provided and that the patient will be personally responsible for full payment if Medicare denies payment for a specific procedure or treatment.  If there is no signed ABN then you cannot bill the patient and it must be written off if denied by Medicare (translation: Free Services, Lost Revenue).

ABN Criteria

1. The ABN must be given to the patient prior to any provided service or procedure
2. Patient’s name, specific service and estimated charge amount must be listed on the ABN
3. ABN cannot be given to a patient who is under duress or requires emergency treatment
4. Check for specific criteria and download the form at http://www.cms.gov/BNI/02_ABN.asp

Appropriate Medicare Modifiers

Certain Medicare modifiers are required when billing with an ABN.

1. GA Modifier: Waiver of Liability Statement Issued as Required by Payer Policy.  This modifier indicates that an ABN is on file and allows the provider to bill the patient if not covered by Medicare.

2. GX Modifier: Notice of Liability Issued, Voluntary Under Payer Policy.  Report this modifier only to indicate that a voluntary ABN was issued for services that are not covered.

3. GY Modifier: Notice of Liability Not Issued, Not Required Under Payer Policy.  This modifier is used to obtain a denial on a non covered service.  Use this modifier to notify Medicare that you know this service is excluded.

4. GZ Modifier: Item or Service Expected to Be Denied as Not Reasonable and Necessary.  When an ABN may be required but was not obtained this modifier should be applied.

Billing a Well Woman Exam

Fee for Service

Since specific well woman screening components of the routine annual exam are covered by Medicare, these are billed out separately.  These screenings are carved out from the provider’s usual fee for preventive service since they are allowable and reimbursable by Medicare.  The remainder balance is the patient’s financial responsibility.  The total fee does not change, only how it is billed and who pays.

The G0101 and the Q0091 are the services that are reimbursed and carved out of the regular annual fee.  The Medicare reimbursement for the G & Q and patient portion equal the same annual fee that a non Medicare patient would be charged.

For example, if the fee for an annual for a non Medicare patient is $235.00 this is the breakdown for a Medicare patient:

It is the same original fee for the but billed out differently.   For additional clarification please refer to ACOG’s Medicare Screening Services PDF. 

Billing Medicare

Following is an example of a typical Well Woman Exam with a signed ABN that is billed out to Medicare:

Reference

Medicare billing policies are constantly changing at CMS and with your local carrier so before your do anything check with them and your coding specialist to make sure you are billing correctly.

The CMS website has a quick reference guide for Medicare Preventive Services which lists applicable tests, diagnoses and frequencies: http://www.cms.gov/MLNProducts/Downloads/MPS_QuickReferenceChart_1.pdf

CPT copyright 2011 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Medicare Billing for a Well Woman – G0101,Q0091,G0438,G0439,99387 & 99397

WEBSITE: Medical Billing Company | Capture Billing

Manny Oliverez, CEO and Co-founder of Capture Billing has been elected the 2012 President for the Leesburg Virginia Chapter of American Academy of Professional Coders

Loundoun County, VA (PRWEB) – Capture Billing & Consulting, Inc., a nationwide medical billing company located in South Riding, Virginia, announces Manny Oliverez as the 2012 President-Elect for the Leesburg Virginia Chapter of American Academy of Professional Coders (AAPC).

AAPC is an organization which provides continuing education and various certifications to coders and medical billers. Over 100,000 of AAPC’s members have access to training, networking and job opportunities in the medical coding field. The diverse certifications available, including Certified Professional Coder (CPC), can be obtained through testing at any local chapter of the AAPC.

Many of Capture Billing’s employees have received their coding certifications through the local chapter of AAPC as well as holding elected positions as the 2011 President and Secretary. President Jackie Ly, CPC and Secretary Michelle Ivanchukov, CPC, CCS-P are both long time active members of AAPC.

“Networking with a variety of professionals in the medical field such as medical billers, doctors, and insurance representatives has furnished me with information I may not have learned in text books”, says Jackie.

“Being on the board of our local chapter of AAPC has enriched my medical billing and coding knowledge. It has been very interesting to meet individuals from different medical specialty backgrounds”, says Michelle.

“I look forward to the challenge of keeping our members educated and current in the complex transition from ICD-9 to ICD-10”, says Manny. “In regards to our company, we will be able to provide the most current coding and medical billing services available to aid our practices in the ICD-10 transition on October 1, 2013”.

Members of AAPC can earn Continuing Education Units (CEUs) by attending monthly chapter meetings, or through workshops, webinars and national/regional events and conferences. To learn more about AAPC or to contact your local chapter visit http://www.aapc.com.

To learn more about the medical billing services Capture Billing offers please visit: http://www.capturebilling.com.

ABOUT CAPTURE BILLING
Capture Billing and Consulting, Inc., a leader in the outsourced medical billing service industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding, and soon will offer ICD-10 training. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provide.

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AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: American Academy of Professional Coders Local Chapter Elected Manny Oliverez of Capture Medical Billing for 2012 President

WEBSITE: Medical Billing Company | Capture Billing

CEO of Capture Medical Billing, Manny Oliverez, is one of ten founders of Healthcare Business Alliance, an organization dedicated to help physicians with the business of healthcare.

South Riding, VA (PRWEB) August 02, 2011 – Capture Billing & Consulting, Inc., a nationwide medical billing company located in South Riding, Virginia, is one of ten healthcare businesses that came together to form Healthcare Business Alliance (HCBA).

HCBA is an organization founded to help physicians stay informed with issues that arise in the constantly changing medical field. HCBA brings together experts in the fields of marketing, real estate, accounting, insurance, law, practice management and medical billing that specialize specifically in healthcare.

Manny Oliverez, CEO of Capture Billing and Consulting, Inc. and one of the ten founding members of HCBA, understands the complexity of running and maintaining a medical practice having run several practices himself.

“When starting HCBA we looked around to see if there was one place for physicians to find the resources and advice they need to operate and expand their medical practices,” says Oliverez. “Not just advice from anyone, but advice from professionals that deal with healthcare issues and physicians on a daily basis. We couldn’t find a “One-Stop” place so HCBA was formed to fill the gap.”

Once a month HCBA hosts an event consisting of relevant and current healthcare topics that help physician members enhance and grow their practices. HCBA also offers a place for physicians to network with other physicians so they can learn from each other and develop beneficial relationships.

HCBA hosts a website with links to a variety of resources, services, daily healthcare news and up-to-date information in the medical billing and coding field. To learn more about HCBA or to become a member please visit: http://www.HCBAlliance.org

To learn more about the medical billing services Capture Billing offers please visit: http://www.capturebilling.com

About Capture Billing

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

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AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Medical Billing Company is Co-Founder of Healthcare Business Alliance – An Organization for Assisting Physicians in the Business of Healthcare

WEBSITE: Medical Billing Company | Capture Billing

Loudoun County, VA – Capture Billing & Consulting, Inc., a nationwide medical billing company located in South Riding, Virginia, has created an online newspaper named Medical Billing and Coding News.

Today’s professionals in the healthcare, medical billing and coding industry use a variety of media outlets to gain knowledge and information about the changes and challenges facing the healthcare industry. Many of these professional have difficulty finding the time to sort through these outlets to find pertinent and useful information.

Capture Billing understands the importance of these educational resources and the limited time professionals have to sift through the immense amount of information available to them. To help with this demand Capture now posts a daily online newspaper that compiles and organizes significant information physicians and healthcare professionals need to operate their practices into one place.

“My staff and I need to stay abreast of what is new and what is changing in the medical billing and coding field. Capture Billing’s online Medical Billing and Coding News has been a great resource for us and we thought other physicians, practice administrators, medical billers and coders in the field would benefit as well” says Manny Oliverez CEO of Capture Billing and Consulting, Inc.

To register for Medical Billing and Coding News, our online newspaper services please visit http://www.paper.li/Capture_Billing/1309807499

To learn more about the medical billing services Capture Billing offers please visit www.capturebilling.com.

ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

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AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Medical Billing Company Creates Daily Online Newspaper

WEBSITE: Medical Billing Company | Capture Billing

What is HIPAA 5010 and Does it Effect My Medical Practice?

Effective January 1, 2012 HIPAA version 5010 becomes mandatory.  All of us in the healthcare industry will need to understand, implement and transition to the new Health Insurance Portability and Accountability Act (HIPAA) version 5010 well before the mandated compliance date.  Testing should begin as soon as possible to avoid any delays in claims payments and rejections.

What is 5010 and how does it affect the Healthcare Industry?

5010 refers to the set of rules implemented and regulated under HIPAA which determines how electronic information is transmitted.  The current standard of electronic transactions and designated code sets is the 4010 version (Version 004010 of the ASC X12 transaction implementation guides), which will be phased out and replaced by 5010.  5010 will allow for more efficient, more improved and larger information exchange.  The 5010 version will also transition the healthcare industry from ICD-9 to ICD-10.

The 5010 code set is expected to save $12 billion according to The Department of Health and Human Services. Cost savings will come from eliminating inefficient manual processing of transactions. These cost savings are mandated by the Affordable Care Act.

Even though the current standard is 4010, multiple systems are still in use by insurance carriers.  The new 5010 rules will now provide greater uniformity in the transmission of information.  Any systems not meeting the 5010 transition deadline of January 1, 2012 will no longer be able to communicate with any insurance companies, seriously affecting the bottom line!  Any disruption of claims payments will adversely impact any medical practice.

Is there a Choice?

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AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: HIPAA 5010: Are You Ready

WEBSITE: Medical Billing Company | Capture Billing

Initial Preventative Physical Exam (IPPE) G0402 is know as the “Welcome to Medicare Visit” to most Medical Billers

What is a Welcome to Medicare visit and how do you bill for it?  Let’s see if I can help and explain and point you in the right direction to gather more information.

A patient who has just qualified for Medicare Part B is allowed this once in a lifetime benefit within the first 12 months of Medicare eligibility.  Medicare calls this exam the Initial Preventative Physical Exam or IPPE but it is more widely known as the “Welcome to Medicare Visit”. This is a great benefit that also includes several exams that are normally not covered. A properly trained front desk staff scheduling appropriate appointments is essential, for both your office and for your newly Medicare eligible patient, to properly utilize these once in a lifetime benefits.

The IPPE is designed for “health promotion and disease detection” per Medicare. The following requirements of the IPPE can found at the CMS website at: http://www.cms.gov/MLNProducts/downloads/MPS_QRI_IPPE001a.pdf

What are the requirements of the IPPE? The following requirements must be met in order to bill for the IPPE:

• Review of medical and social history to include past medical/surgical history; current medications and supplements; family history; history of alcohol; tobacco and illicit drug use; diet; and physical activities

• Review of potential risk factors for depression and other mood disorders

• Review of functional ability and level of safety for hearing impairment; activities of daily living; falls risk; and home safety

• Examination to obtain height, weight and blood pressure; visual acuity screen; measurement of body mass index; and other factors deemed appropriate based on the beneficiary’s medical/social history and current clinical standards

• End of life planning is a required service with the patient’s consent to discuss an advance directive; and whether or not the physician is willing to follow the beneficiary’s wishes as expressed in the advance directive

• Education, counseling and referral based on the previous five components, as appropriate

• Education, counseling and referral for other preventive services in the form of a brief written plan for the beneficiary to obtain a screening electrocardiogram and any other preventive services/screenings covered by Medicare Part B benefits

The IPPE is billed out using HCPCS Code G0402.

Additional once in a lifetime benefits in conjunction with the IPPE

Screening Electrocardiogram (EKG) – Medicare no longer deems the screening EKG as a mandatory service component of the IPPE. However, there is a once in a lifetime screening EKG that is allowed as a result of a referral from an IPPE and must be performed at the time of the IPPE. The screening EKG and IPPE must both be completed before they can be billed to Medicare and the beneficiary will be responsible for any copayment, coinsurance or deductible that is assessed by Medicare.

• G0403 Complete screening EKG with 12 leads; for IPPE that includes the tracing, interpretation and report (copayment/coinsurance/deductible applies)

• G0404 Screening EKG with 12 leads; tracing only without interpretation and report (copayment/coinsurance/deductible applies)

• G0405 Screening EKG with 12 leads; interpretation and report only, without tracing

See the rules for the IPPE screening EKG provided in the Medicare Claims Processing Manual at: http://www.cms.gov/manuals/downloads/clm104c12.pdf

Ultrasound Screening for Abdominal Aortic Aneurysm (AAA) – patient must receive a referral for an AAA ultrasound screening as a result of an IPPE and must meet the criteria to have this screening ordered. Medicare will pay for this once in a lifetime benefit as long as your patient meets the following requirements:

• Beneficiaries at risk that have a family history of AAA

• Men age 65 to 75 who have smoked at least 100 cigarettes in their lifetime

The HCPCS code for the AAA is G0389 and the beneficiary’s copayment/coinsurance, deductible is waived.

Pneumococcal Vaccine – This vaccine is also considered a once in a lifetime benefit but additional vaccinations based on risk and only once every five years may also be allowed. Beneficiary’s copayment/coinsurance, deductible is waived. This does not need to be billed out with the IPPE but highlighted here because of the once in a lifetime benefit stipulation.

Who should be immunized?
If a beneficiary is uncertain about their vaccination history in the past five years then it is recommended that the vaccine be given. It is also recommended that persons 65 years of age or older and anyone considered high risk be immunized.

Who else is considered to be at increased risk?
According to the Advisory Committee on Immunization Practices (ACIP), that advises the Department of Health and Human Services, the following groups are considered high risk and should receive the initial pneumococcal vaccine or revaccination every five years:

• Persons 2 years of age and older with a normal immune system who have a chronic illness such as: cardiovascular or pulmonary disease, diabetes, alcoholism, chronic liver disease, cerebrospinal fluid leak, cochlear implant

• Immuno-compromised persons 2 years of age and older who have: splenic dysfunction, Hodgkin disease, lymphoma, multiple myeloma, chronic renal failure, nephritic syndrome, organ transplantation, immunosuppressed from chemotherapy or high dose corticosteroid therapy, asymptomatic/symptomatic HIV infection

See additional information at: http://www.cms.gov/AdultImmunizations/Downloads/20102011ImmunizersGuide.pdf

Bill for the Pneumococcal Vaccine with the following applicable codes plus the Administration of the vaccine G0009:

• 90669 Pneumococcal Conjugate Vaccine, polyvalent, when administered to children younger than 5 years, for intramuscular use

• 90670 Pneumococcal Conjugate Vaccine, 13 valent, for intramuscular use

• 90732 Pneumococcal Polysaccharide Vaccine, 23 valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use

o Use diagnosis code V03.82 for just the Pneumococcal vaccination visit
o Otherwise use diagnosis code V06.6 when the purpose of visit was to receive both pneumococcal and seasonal influenza virus vaccines.

Additional information regarding immunization can be found at:
http://www.cms.gov/MLNProducts/downloads/adult_immunization.pdf

Hope this information helps.  Please go to the top of the page and Google +1 me and leave me a message below. I would like to hear your comments, thoughts and what is happening in your medical practice.

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AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: “Welcome to Medicare Visit” aka IPPE aka G0402

WEBSITE: Medical Billing Company | Capture Billing

My friend, David Lee, over at eRecords puts out a monthly newsletter where he shares the latest news, updates and analyses in the world of the HITECH Act and Meaningful Use. He combs through hundreds of articles and facts and picks out ones he believes to be of  interest and the most relevant to physicians and healthcare professionals. David has made it his mission is to keep everyone informed by arming them with the correct information to meet the meaningful use criteria when implementing their certified electronic health records EHR software. Below you will find excerpts from his newsletter I wanted to share with you.

Interesting Facts and Figures

13 and 25. How many RHIOs can meet the basic criteria for the meaningful use of EHR out of 75.  How many are financially viable.  Speaks volumes on the state of HIE/HIO.  Read the coverage here.

7/3. The last day that Eligible Hospital and CAHs can begin their 90-day reporting period in Fiscal Year 2011 for the Medicare EHR Incentive Program.

$5M. Size of the contracted awarded to two companies during ONC’s launch of the Investing in Innovations Initiative (i2 Initiative).  You can read the press release here and we’ll try to keep track of how much impact this will have.

76%. Percentage of Fortune 50 that are either in health industry or with a health division.  A report from PwC, “The new gold rush:  Prospectors are hoping to mine the opportunities from the health industry”, with rosy outlook.

75 and 10,989,838. How far, in miles, paper patient records were found after a tornado hit a Missouri based hospital and total individuals, so far, affected by data breach according to this government web site. In somewhat related news, a proposed rule was issued (pdf) by HHS Office for Civil Rights on strengthening the accounting of disclosures.

24 and 359. Number of certified complete EHRs on 10/15/2010 and 6/14/2011.

Latest Meaningful News

Health IT Policy Committee endorses the recommendation to delay Stage 2 of Meaningful Use. During the meeting held on June 8, Health IT Policy Committee endorsed the recommendation to the delay of Stage 2 roll out by one year until 2014 for those providers attesting to Stage 1 this year.  As a result, providers will have three years, through 2013, to meet Stage 1 meaningful use requirements.   The primary reason for this delay seems to be centered on the original 2013 timeframe not giving EHR vendors enough time to meet Stage 2 requirements.  Ripple effect of this delay should be wide, affecting ICD 10, ACO program and others.  For a more detailed article, please click here.

First Medicare Incentive Payments Made. On May 19, 2011, CMS issued the first round of payments totaling $75 million to providers under the Medicare EHR Incentive Program.  Also, $83 million dollars has been paid to Medicaid providers under the Medicaid EHR Incentive Program.  Of course, the importance of Medicare announcement is that these providers actually met the MU and CQM measure requirements whereas Medicaid payments are under A/I/U.  For the full press release, click here.

CMS has also compiled a consolidated list of Frequently Asked Questions on the EHR Incentive Programs and made that list available through their website. To view this FAQ, click here.

ONC Names Approved Accreditor for EHR Certification Program. ONC has named American National Standard Institute (ANSI) as the ONC-AA (ONC Authorized Accreditor).  This sole accreditor will be tasked with accrediting ONC authorized EHR certification entities.  Current authorized EHR certification entities include Surescripts, ICSA Labs, SLI Global Solutions, InfoGard Laboratories, CCHIT and Drummond Group.  For the full story, please click here.

Lawmakers seek changes to EHR Incentive Payments for multi-campus hospitals. Rep. Michael Burgess is planning to introduce a bill that would require CMS to provide EHR incentive payments to each campus in a multi-campus hospital system.  Under the current regulation, incentive payments are paid according hospitals Medicare provider numbers, not individual campuses.  If this bill is passed, it would have a significant financial benefit to multi-campus hospitals.  For the full article, click here.

Three Regional Extension Centers reach its enrollment goals. Regional extension centers in Maryland, South Carolina and Massachusetts were the first set of Regional Extension Centers to reach their respective enrollment goals.

ONC announces Health Information Technology Professional (HIT Pro) competency examination. It will be interesting to see how well this “certification” will be received by the industry compared to existing certifications and credentials.  HIT Pro exams parallel the “roles” trained under Work Force development program.  The cost of each exam is $299 but qualified candidates can request 1 free voucher.  Find out more at HIT Pro homepage.

eRECORDS was founded with the vision to power innovations in access, efficiency and quality of healthcare delivery through connected technologies and intelligence.  Their Mission is to be the trusted expert, guide and partner in achieving meaningful use. Worry FreeTM Dashboard, eRECORDS’ flagship product, is the leading solution for Meaningful Use administration, planning and performance management.

To subscribe to David Lee’s “Your Guide to Meaningful Use” monthly newsletter CLICK HERE

Other posts you might like:

1. HITECH Act: Electronic Health Records and Meaningful Use Made Easy
2. Looking for the Meaning of Meaningful Use
3. Meaningful Use Requirements Final Rule is a Massive 864 Pages

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Your Guide to Meaningful Use from eRecords

WEBSITE: Medical Billing Company | Capture Billing

Capture Billing is pleased to announce Stacy White as the new Medical Billing Operations Manager.

Loudoun County, VA – Capture Billing & Consulting, Inc., a nationwide medical billing company located in South Riding, Virginia, brings aboard Stacy White as the newest member of its management team.

Stacy has over 18 years of experience in the medical billing field from a variety of medical specialties. She will be responsible for daily billing operations, maximizing client revenue, and client management.

“I am excited to be working side by side with Dr. John Farrell (owner of Farrell Pediatrics and co-founder of Capture Billing) and Manny Oliverez (CEO and co-founder of Capture Billing). I look forward to absorbing the wealth of knowledge and expertise that both gentlemen bring to the consistently changing medical billing industry” says Stacy.

“We are excited to have Stacy as the newest asset to the Capture Billing team. Her familiarity with coding for a variety of specialties will enhance Capture’s ability to service both current and future clients”, say Manny Oliverez.

Stacy is currently working to obtain her CPC (Certified Professional Coder) and CCS-P (Certified Coding Specialist – Physician Based) certifications in the next couple of months. To learn more about the medical billing services Capture Billing offers please visit www.capturebilling.com.

ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

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AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: New Medical Billing Operations Manager Hired by Capture Billing

WEBSITE: Medical Billing Company | Capture Billing

New Medicare Benefit: Annual Wellness Visits Now Covered

Good news for Medicare patients. Effective January 1, 2011 Medicare started to provide coverage for Annual Wellness Visits. This benefit was included in the Affordable Care Act of 2010. Medicare has come up with two new HCPCS codes for these well visits for medical billing purposes. The codes are G0438 and G0439.

G0438 Annual Wellness Visit, Initial (AWV)

Annual wellness visit, including a personalized prevention plan of service (PPPS), first visit.

G0439 Annual Wellness Visit, Subsequent (AWV)

Annual Wellness visit, including a personalized prevention plan of service (PPPS), subsequent visit. Annual Wellness Visits can be for either new or established patients as the code does not differentiate. The initial AWV, G0438, is performed on patients that have been enrolled with Medicare for more than one year.

What is included in an Initial AWV with PPPS?

- Medical and family history
– List of current medical providers
– Height, weight, BMI, BP and other appropriate routine measurements
– Detection of cognitive impairment
– Review risk factors
– Review of functional ability
– Establish a written screening schedule for next 5-10 years
– Establish list of risk factors
– Provide advice and referrals to health education and preventative counseling services
– Other elements as determined by the Secretary of Health and Human Services

The above list is just a summary. Check out MLN Matters Number MM7079 for additional information and links to other Medicare resources on services that must be provided at the AWV and subsequent AWV. Preventative Medicine codes 99387 and 99397, better known to offices as Complete Physical Exams or Well Checks for 65 and older, still remain a non-covered, routine service from Medicare.

One final thought. Do not bill G0439, AVW Subsequent, in 2011. It will deny. Why? Since the first initial AWV, G0438, for any Medicare patient could only be billed starting on January 1, 2011 that means the first time any Medicare patient could be billed for the subsequent AWV, G0439, would be January 1, 2012. For additional information, specifics and more details visit the CMS or you local carrier’s website or contact them directly. Please drop us a comment or visit us at our Medical Billing Blog for more tips and information on medical billing.

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1. Medicare Eliminates Consultation Codes
2. 2011 Medicare Codes for Flu Shots: Q2035, Q2036, Q2037, Q2038
3. Medicare: Video Helps Explain New Influenza Vaccine Q Codes for 2011

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Medicare G0438 – G0439: Two New Annual Wellness Visit Codes

WEBSITE: Medical Billing Company | Capture Billing

Visualizing the Electronic Medical Practice of 2015

I just read an interesting article on the benefits of electronic health record (EHR) adoption. The article was written by Jeanette Borzo over at Software Advice. I thought it was a good narrative to share with our readers.

In the article, Jeanette depicts a doctor’s office in 2015, the year when financial penalties for failing to adopt EHRs are set to kick in. The article discusses everything from tracking patient health histories on an iPad to automating medical billing and insurance claims.

Jeanette writes, “… Dr. Smith tells the EHR software to send diagnostic and treatment codes to the billing team, who quickly submit an electronic claim to the insurance company.

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AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: What Will The 2015 Medical Office Look Like

WEBSITE: Medical Billing Company | Capture Billing

Coding for Medicare Flu Shots Q2035, Q2036, Q2037, Q2038

New Medical Billing Guidelines

Watch the coding for Medicare flu shots video and learn that as of January 1, 2011 if you bill Medicare CPT Code 90658, for the Influenza Virus Vaccine, you will not get paid. Medicare has established five separate influenza vaccine Q Codes to distinguish between the brand-names of influenza vaccines.

http://www.youtube.com/watch?v=fLoCevIoJ9k

The HCPCS code G0008 Administration of Influenza Virus Vaccine must still be used for the administration of the flu vaccine for Medicare patients.

What are the New Influenza Vaccine Codes?

Q2035 Afluria Vaccine

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)

Q2036 Flulaval Vaccine

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)

Q2037 Fluvirin Vaccine

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)

Q2038 Fluzone Vaccine

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)

Q2039 NOS (Not Otherwise Specified) Vaccine

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Not Otherwise Specified)

Additional information direct from Medicare on medical billing for influenza vaccines can be found at: http://www.cms.gov/MLNMattersArticles/downloads/MM7234.pdf

Other posts you might like:

1. 2011 Medicare Codes for Flu Shots: Q2035, Q2036, Q2037, Q2038
2. Coding for the 2010 Flu Shot: Three Vaccines, One Code
3. Medicare Eliminates Consultation Codes

AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Medicare: Video Helps Explain New Influenza Vaccine Q Codes for 2011

WEBSITE: Medical Billing Company | Capture Billing

New Medicare Influenza Vaccine Q Codes for 2011

Effective January 1, 2011 the Centers for Medicare & Medicaid Services (CMS) will no longer recognize and no longer reimburse CPT Code 90658 Influenza Virus Vaccine, Split Virus for flu shots. CMS has established five separate influenza vaccine HCPCS codes to distinguish between the brand-names of influenza vaccines for governmental tracking purposes. Make sure to use these new codes in your medical billing.

The New HCPCS Medicare Flu Vaccine Codes

Q2035 Afluria Vaccine:

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)

Q2036 Flulaval Vaccine:

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)

Q2037 Fluvirin Vaccine:

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)

Q2038 Fluzone Vaccine:

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)

Q2039 NOS (Not Otherwise Specified) Vaccine:

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Not Otherwise Specified)

Reimbursement Rates

The national average for Medicare payment allowance may vary by geographical location and you will need to check the CMS Fee Schedule for your correct reimbursement rate. HCPCS codes Q2035 & Q2039 do not have national payment limits and will be determined by the local Medicare carrier.

National allowables for the Q2036 is $7.439, Q2037 is $13.253, and Q2038 is $12.593.

Please refer to the CMS Physician Fee Schedule at: http://www.cms.gov/PhysicianFeeSched/01_overview.asp

Additional information can also be found at: http://www.cms.gov/MLNMattersArticles/downloads/MM7234.pdf

For a video on Medicare flu shot coding go to:  What are the Medicare Flu Shot Codes

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Was this Post helpful? If so please recommend us by clicking on the Google +1 Button and sharing with your Facebook Friends. Don’t forget to Comment below. Thanks!  –Manny

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AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: 2011 Medicare Codes for Flu Shots: Q2035, Q2036, Q2037, Q2038

WEBSITE: Medical Billing Company | Capture Billing

HITECH Act and Meaningful Use: Reasons to Implement and EHR

I just got an email from Jonathan Krasner from BEI Healthcare with an interesting article he wrote about things to consider in your Electronic Health Records (EHR) selection that I would like to share.

Here is the text of Jonathan’s post:
While HITECH and Meaningful Use have given practice managers and physicians good reason to look at implementing EHRs, many other trends and themes related to EHRs are beginning to crop up that could also influence decisions to implement, install and use an EHR. Let’s take a look at a few of these:

1. ACOs and PCMH

ACOs (Accountable Care Organizations) and PCMH (Patient Centered Medical Home) are the hot new acronyms of healthcare reform. The central idea with both is to coordinate care across settings and providers. How can that realistically happen if there is no efficient and timely mechanism to document encounters? The short answer: it can’t. Not only are EHRs necessary to document encounters and coordinate care, they are also necessary to produce data showing clinical outcomes. PCMH will not only be pushed by CMS (Centers for Medicare & Medicaid Services); you can bet that payers will be coming out with their own PCMH programs. In order to participate, physicians will have to use an EHR.

2. Payers

In many instances, policies adopted by CMS are replicated in some shape or form by the commercial payer market (see PCMH above). A recent article in Health Affairs stated, “based on personal communications with the firms’ chief medical officers, several payers, notably, Highmark Blue Cross Blue Shield, Well-Point, Aetna, and United HealthCare—have announced programs to better align existing incentive programs with the definition of Meaningful Use. Several smaller payers have expressed interest in developing these types of programs as well. America’s Health Insurance Plans, the health insurance industry group, has voiced strong support for the concept of Meaningful Use and potential alignment around it.” While payers have had EHR incentives in the past, without CMS support these incentives failed to gain critical mass. Another reason why these programs did not receive widespread acceptance was the lack of standardization of EHRs. Both of these issues have changed due to the enactment of HITECH and the Meaningful Use criteria. 

3. Medical Students

Medical students today are being trained on EHRs in medical school. Going to a practice that runs on paper will seem like going backwards to these new providers. These people grew up on online and with smartphones. They are very comfortable and actually prefer these devices. From a recent EON article: “Students have high expectations for EHRs – Having an electronic health record is a very important factor for 70 percent of medical students in deciding where they will practice medicine. In contrast to industry predictions, students believe the benefits to medical practices will be the main driver for EHR implementation, rather than government initiatives. This is largely due to early exposure to EHR systems, as more than half of respondents said they are satisfied with the level of training their program provided on EHR use.” Whether or not you have an EHR could be the deciding factor for a younger physician considering employment in your practice.

4. Health Systems

IDNs (Integrated Delivery Networks) are increasingly touting their use of EHRs in advertising to consumers on radio and TV. Recent ads by Kaiser in the DC area not only tout EHRs as being able to deliver more efficient communication with providers, but also as delivering better outcomes and better health. As an example of this type of advertising take a look at: http://thrivewithkp.org/about-thrive/better-connections-lead-to-better-health. Other IDNs and outside entities such as IBM are also airing similar advertising. Expect these ads to become more frequent as IDNs implement EHRs. They will tout having an EHR as a competitive advantage to lure patients to their networks.

5. State Medical Boards

The ABMS (American Board of Medical Specialties) and the Federation of State Medical Boards have announced their intention to make health IT deployment a standard in their assessment and certification of physician competency. They announced an initiative “to promote the meaningful use of health information technology (HIT) and incorporate them into [its] Maintenance of Certification program”. The board certifies more than 750,000 physicians in the United States. Meanwhile, the Federation of State Medical Boards President and CEO, Humayun Chaudhry, anticipates physicians’ using “electronic health records as a tool to assess ongoing clinical competence for medical licensure.” According to John Pulley, a writer who focuses on government IT, the boards’ endorsements provide another impetus for doctors to adopt electronic medical records. Until now, the question of adoption has revolved around federal financial incentives. Linking adoption to licensure moves the debate’s focus from cost to competence.

6. Consumers

Ultimately, the push to EHRs will be consumer driven. All practices can expect more and more patients asking for electronic copies of their records, and pushing copies of their records to physicians via PHRs. The above noted advertising campaigns and adoption of EHRs by more and more providers will drive awareness of EHRs way up. For instance, CMS has launched a “Blue Button” service that allows 47 million Medicare beneficiaries to electronically view, download and print their complete medical records, Federal Computer Week reported. The feature is available on the MyMedicare website. The option is similar to the Blue Button program on the Department of Veterans Affairs’ MyHealthVet website. Since VA’s Blue Button feature was introduced in August, more than 60,000 veterans have downloaded their medical records.

Other posts you might like:

1. Certified Electronic Medical Records EHR Coming this Fall
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AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: EHR Update: 6 More Things to Consider

WEBSITE: Medical Billing Company | Capture Billing

Scanning medical records makes retrieval fast and easy for medical staff

WASHINGTON, DC – A major problem in the physicians’ office is storage of medical records. These medical records run the gambit from medical billing records such as EOBs, encounter forms, patient registration forms and insurance cards to full thick medical charts. Boxes and piles of these old documents usually fill closets, are under or next to desks, or stacked high in the hall just getting in the way. They can’t be discarded because your staff needs to access them for insurance follow-up or when patients request copies of old medical records. Storage units along with physician basements or garages (which are not HIPAA compliant) may be storage options but are not quickly or easily accessible.

On top of that, those records are legal documents that have to be retained for up to 10 years. This archiving of records can result in what could become hundreds of boxes of documents that will accumulate over the years and take up more and more space. One solution that has become practical and cost effective is to digitize, or scan documents, into electronic storage. Now you can store all those boxes of important documents from the last 5, 10 or 30 years, and the years to come, in one location that does not take up any space, the internet.

The preferred way to store your records is digitally. And the best way to do that is by outsourcing your scanning. With a phone call an electronic document storage company will come out and pick up all your boxes of document. They will scan them into their secure servers and index them for easy retrieval. Documents can be indexed by a variety of criteria; by patient name, date of birth or account number. Once all the records are scanned the original paper records can then be shredded.

The scanned records are immediately available for viewing at your location usually through a secure web portal that you can access with a standard web browser such as Microsoft’s Internet Explorer. You are not only able to view the records but you can also print the entire record or just one page. Each of your locations can have access to the records through the encrypted, password protected, web portal. The cost of such a service is typically, a fee per page or chart, and then a monthly access and storage fee.

Can you scan documents in your own office? Sure, but lets look at the cost. Even a small practice will need a high speed scanner. A scanner from the local office supply store may be good for scanning insurance cards but it cannot handle the volume of medical records that will need to be digitized even in a small office. Good scanners that can handle 90 pagers per minute, front and back, start at about $6,000. Add to that the cost of a file server with lots of storage. That sever should be equipped with multiple hard drives (RAID) incase one hard drive fails.

A tape drive for daily backups is a must. Expect to pay between $3,000 to $5,000 for a decent server. You still have to purchase a software database in which to store your files on the computer. At one end of the scale a simple database from a small company such as E-Drawer can be had for about $2,000. On the other end, Captaris offers an outstanding product but will set you back about $25,000. Hold on, you are not finished yet. Don’t forget you still have to have a technician install and add your system to your computer network. Then you will have to maintain the system and pay a person to scan. For a larger practice you may have to purchase two scanners and pay for more staff. The originals will have to be shredded. This may or may not be cost effective.

Scanning is an excellent solution to getting rid of all those boxes full of charts, EOBs, fee tickets and other documents that are stored around the office or off-site that must be retained for years. Many electronic data storage companies make it not only simple but cost effective for small, medium and even large medial practices to outsource their scanning. The archived documents can then be easily accessed by the medical staff via the internet.

About Manny Oliverez

Manny Oliverez is a Certified Professional Coder (CPC) and the Director of  Operations for Capture Billing & Consulting, Inc., in South Riding,  VA and provides outsourced medical billing services for physician offices. If you  would like more information about improving your accounts receivable or  other practice management and billing issues, contact him at  (703)327-1800.

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AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Save Space, Time and Money: Outsource Medical Record Scanning

WEBSITE: Medical Billing Company | Capture Billing

Medical Billing Company creates short animated video to help medical offices understand the HITECH Act, certified EHRs and the financial incentives associated with Meaningful Use.

South Riding, Virginia (Vocus) November 11, 2010 - Capture Billing and Consulting, Inc., a medical billing company and practice management consulting firm, has just announced the release of its educational video outlining the basics of Electronic Health Records (EHR) and Meaningful Use. In this easy to understand and short animated video, Capture Billing simplifies the confusion associated with the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 and sheds light on the basic requirements set forth by the EHR incentive program.

The video provides a simple explanation and background of the HITECH Act, the financial incentives for adopting EHRs, and demonstrates how requirements of the core and menu set objectives must be met to qualify for the incentive money from the government. The financial benefits offered by the Medicare and Medicaid EHR incentive programs include up to $44,000 per eligible Medicare provider and up to $63,750 per eligible Medicaid provider. The government is offering this incentive program to providers to transition to EHRs in order to meet the five healthcare goals set forth by the HITECH Act. These five goals are to improve quality of care, engage patients and families in their care, promote public and population health, improve care coordination and to promote the privacy and security of EHRs.

“The purpose of our educational video is to help physicians, practice administrators and medical office managers understand that the transition to EHRs, although challenging, is not insurmountable. We created this video to let providers know that Capture Billing is ready to begin preparing and transitioning offices to an EHR system to meet the requirements for the Meaningful Use criteria”, explains Manny Oliverez, Director of Operations.

As practices become overwhelmed by the implementation of an EHR system, reimbursement incentives and meaningful use requirements, Capture Billing now provides the perfect solution. Capture Billing will not only provide its elite medical billing services, it will also provide an EHR system and will take on the technical burden of hosting it. In this perfect relationship between Capture Billing and healthcare providers, Capture will also continuously monitor practice requirements for meeting meaningful use in all three stages of implementation and relieve this administrative burden from already busy medical practices.

“Capture Billing’s ultimate goal is to offer a top quality EHR for its medical billing clients. Long after the EHR vendor is gone, as a medical billing company, we will still be providing medical billing services and helping practices continue to achieve meaningful use. We are already there each month providing our medical billing services to our clients so it makes sense to help them achieve the meaningful use criteria and provide them with an EHR” indicates Oliverez. “We will also be ready to help train and transition all offices with the release of the heavily anticipated and confusing ICD-10 diagnosis changes”. Capture Billing is poised to meet the future of healthcare reform head on and really provide medical practices with a one of a kind specialized service.

As the requirements of Meaningful Use will be released in three stages, Capture Billing will continue to provide educational videos for each and every stage to help providers understand the EHR transitional process better, and is a great addition to Capture Billing’s informational Medical Billing Minute Videos.

The video “The HITECH Act: Electronic Health Records and Meaningful Use” is available for viewing at YouTube.

About Capture Billing

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

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AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Capture Billing Video Explains the HITECH Act, Electronic Health Records and Meaningful Use

WEBSITE: Medical Billing Company | Capture Billing

Electronic Health Record Contracts

I just finished reading an article about how to negotiate an Electronic Health Record software license agreement (SLA), by Houston Neal an EHR Market Analyst at Software Advice. I thought it would be a great resource for our readers.

In the article, Houston’s focus is on the five key areas of medical software contracts: the user license, implementation, service obligations, hardware and interfaces and HITECH Act clauses.

If your medical practice is in the process of contract negotiations with your EMR vendor, this is a must read. You can view the entire article at: http://www.softwareadvice.com/articles/medical/the-guide-to-negotiating-an-ehr-software-license-agreement-1102810/.

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AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: Guide to Negotiating an EHR Software License Agreement

WEBSITE: Medical Billing Company | Capture Billing

EHR and Meaningful Use – Get Your Incentive Money

The HITECH Act provides incentive money for physicians to purchase, implement and use certified electronic health records. One of the criteria for receiving government stimulus money is to demonstrate meaningful use of the EHR.

We at Capture Billing have produced a short educational video for physicians, practice administrators and medical office managers to explain the main elements of the HITECH Act. We show though animation how to qualify for the federal government incentive money that is available upon the proper implementation of a certified EHR and achieving meaningful use.

http://www.youtube.com/watch?v=GzeUKKWvC0o

We would like to hear your thoughts and where you are in the process of implementing electronic health records for your practice. Please leave us a note.

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AUTHOR: Manny Oliverez - Medical Billing Company CEO

POST: HITECH Act: Electronic Health Records and Meaningful Use Made Easy

WEBSITE: Medical Billing Company | Capture Billing