Billing Compliance FAQs for Healthcare Professionals | Study notes History

Professional Billing Compliance Frequently Asked Questions

Billing

1. Why is it necessary to record the payer denial code/reason on the patient’s account in the

billing system?

2. Can a physician bill for sutures removed during an office visit that were originally placed by

a different physician? How should the suture removal be reported?

3. The resident admits a patient to the hospital and the attending is called to ok the admission

and give orders for the patient’s care. The attending sees the patient the next morning and

takes the history and performs an examination. Can the attending bill for a hospital admit, if

so what date would be used?

4. Why can't I just make it simple and charge the same level for all my patients?

5. Can someone other than the attending physician sign the superbill/encounter form for the

physician?

6. How long after identifying an overpayment from a federal payer should a refund be issued?

7. Can I bill for consultation with the patient’s family?

8. Must I have different diagnosis codes when billing an E/M and a on the same visit?

1. Why is it necessary to record the payer denial code/reason on the patient’s account in

the billing system?

It is an appropriate audit trail. It ensures appropriate follow-up action is taken. It tracks and

establishes trends of potential billing and/or coding problems.

2. Can a physician bill for sutures removed during an office visit that were originally

placed by a different physician? How should the suture removal be reported?

If the physician/group who is removing the sutures did not place the sutures, then the suture

removal would be considered part of the E/M (Evaluation & Management). The ICD-10 for

suture removal would be used. If the physician originally placed the sutures it is not

separately reportable. There is not a separate code that describes removal of sutures when

the removal is not performed under anesthesia.

3. The resident admits a patient to the hospital and the attending is called to ok the

admission and give orders for the patient’s care. The attending sees the patient the

next morning and takes the history and performs an examination. Can the attending

bill for a hospital admit, if so what date would be used?

Yes, the attending can bill for the admission. It should be charged on the day the attending

actually saw the patient. The CPT description of the hospital admission (99221-99223)

requires that the physician is to complete a history and an examination. Even if the resident

Partial preview of the text

Download Billing Compliance FAQs for Healthcare Professionals and more Study notes History in PDF only on Docsity!

Professional Billing Compliance Frequently Asked Questions

Billing

Why is it necessary to record the payer denial code/reason on the patient’s account in the billing system?
Can a physician bill for sutures removed during an office visit that were originally placed by a different physician? How should the suture removal be reported?
The resident admits a patient to the hospital and the attending is called to ok the admission and give orders for the patient’s care. The attending sees the patient the next morning and takes the history and performs an examination. Can the attending bill for a hospital admit, if so what date would be used?
Why can't I just make it simple and charge the same level for all my patients?
Can someone other than the attending physician sign the superbill/encounter form for the physician?
How long after identifying an overpayment from a federal payer should a refund be issued?
Can I bill for consultation with the patient’s family?
Must I have different diagnosis codes when billing an E/M and a on the same visit? 1. Why is it necessary to record the payer denial code/reason on the patient’s account in the billing system? It is an appropriate audit trail. It ensures appropriate follow-up action is taken. It tracks and establishes trends of potential billing and/or coding problems. 2. Can a physician bill for sutures removed during an office visit that were originally placed by a different physician? How should the suture removal be reported? If the physician/group who is removing the sutures did not place the sutures, then the suture removal would be considered part of the E/M (Evaluation & Management). The ICD-10 for suture removal would be used. If the physician originally placed the sutures it is not separately reportable. There is not a separate code that describes removal of sutures when the removal is not performed under anesthesia. 3. The resident admits a patient to the hospital and the attending is called to ok the admission and give orders for the patient’s care. The attending sees the patient the next morning and takes the history and performs an examination. Can the attending bill for a hospital admit, if so what date would be used? Yes, the attending can bill for the admission. It should be charged on the day the attending actually saw the patient. The CPT description of the hospital admission (99221-99223) requires that the physician is to complete a history and an examination. Even if the resident

is the one to admit the patient, the attending cannot code the admission until he/she has had a face-to-face encounter with the patient. In this case, it would be the next day. CMS Medicare Claims Processing Manual

4. Why can't I just make it simple and charge the same level for all my patients?

Not every patient is the same, nor is the amount of time and service provided the same. Become familiar with components requirements of the evaluation and management services and it will become second nature to assign the appropriate level code and be reimbursed for the work effort.

5. Can someone other than the attending physician sign the superbill/encounter form for the physician? No. The attending physician's personal signature confirms two essential facts to initiate Billing: (1) The attending was directly involved in the patient care services. (2) The selected level of CPT codes and ICD-10 codes are supported by the attending’s documentation in the medical record. 6. How long after identifying an overpayment from a federal payor should a refund be issued? Medicare states overpayments should be refunded within 60 days of discovery. A provider can be assessed interest of 12.625% verify if not refunded within that time period. 7. Can I bill for consultation with the patient’s family?

In certain types of medical conditions, including when a patient is withdrawn and uncommunicative due to a mental disorder or comatose, the physician may contact relatives and close associates to secure back ground information to assist in diagnosis and treatment planning. When a physician contacts the relatives and associates for this purpose, expenses of such interviews are properly chargeable as physician’s services to the patient on whose behalf the information was secured. If the beneficiary is not an inpatient of a hospital, Part B reimbursement for such an interview is subject to the special limitation on payments for physicians’ services in connection with mental, psychoneurotic, and personality disorders.

A physician may also have contacts with a patient’s family and associates for purposes other than securing background information. In some cases, the physician will provide counseling to members of the household. Family counseling services are covered only where the primary purpose of such counseling is the treatment of the patient’s condition. For example, two situations where family counseling services would be appropriate are as follow: 1) where there is a need to observe the patient’s interaction with family members;

Billing Compliance FAQs for Healthcare Professionals, Study notes of History

Related documents

Partial preview of the text

Download Billing Compliance FAQs for Healthcare Professionals and more Study notes History in PDF only on Docsity!

Professional Billing Compliance Frequently Asked Questions

Billing