Tips on Modifier 33

Modifier 33 was added in November 2011. Are you aware of the appropriate times to append Modifier 33?

To help, the AAPC's Coding Edge Magazine published an article titled: "8 Tips to Give You Straight Facts on Modifier 33"

The following are the tips that the article discussed in further detail:

1. Do You Know Where to Find Information on Modifier 33?
2. Do You Know Which Services are Covered?
3. Apply Modifier 33 for Private Payers Only
4. Turn to Modifier 33 for Screening Turned Diagnostic
5. Selected Services Covered In-network Only
6. Apply Modifier 33 to All Eligible Services
7. Cost Sharing Doesn’t Apply for Separate, Same-day Services
8. Designated Preventive Services Don’t Require Modifier 33

To download and view the full article in detail, please go to the following link: 8 Tips to Give You Straight Facts on Modifier 33 (PDF)

Bundling Rules for Radiology

AAPC's Coding Edge Magazine published an article on bundling rules for Radiology.

The article highlighted bundling the following procedures and discussed CPT codes:

• Abdomen CT and Pelvis CT
• Abdomen CTA and Pelvis CTA
• Endovascular Revascularization Studies
• Renal Angiography
• CPT Codes addressed:  Renal Angiography selective: 36251-36252, Renal Angiography superselective 36253-36254, insertion 37191, repositioning 37192, and retrieval 37193.
• AV Shunts for Dialysis

To download and view the full article, please go to the following link: Bundling Rules You Can Take to the Radiologist

Ensure You Are Billing the Proper Place of Service (POS) Codes

The AAPC's Coding Edge Magazine published "Keep Out of Hot Water with Proper POS", an informative article regarding proper Place of Service (POS) coding.

It's important to note that the Office of Inspector General (OIG) has been conducting audits and the proper POS codes are becoming more frequent in the errors they are reviewing.

The article is broken down into the following topics:

• How POS Affects Payment
• Frequent Errors Raise OIG's Ire
• How to Avoid POS Problems
• Clear Guidance on POS Definitions

This article also has an informative list of settings where physician's services are paid at the facility rate.

To download and view the full article, please go to the following link: Keep Out of Hot Water with Proper POS (PDF)

Join Our iPad 2 Giveaway Contest!

Medical Reimbursement, Inc is giving away an Apple iPad 2!  To be eligible for the contest, you must "Follow Us" on one of the three following social media sites where we provide billing and coding advice daily:

• Follow us on Twitter
• Follow us on LinkedIn
• Like us on Facebook

Upon engaging with us on any of the three social media sites listed above, you must also fill out this form to ensure you wish to be entered in our contest.  Full contest details are also available on the form page.

Medical Reimbursement is a physician-founded coding, billing, collections and revenue cycle management company. We currently code and bill for approximately 1,000,000 patient encounters each year. The majority of our clients are large physician groups. We have built long lasting relationships with our clients who represent some of the largest hospitals and academic medical practices in the country. 

10 Tips for Improving A/R

Radiology Today wrote an article titled: "10 Tips for Improving A/R" to help your practice.

The overview of the tips were as follows:

1. Ensure that there are no surprises.
2. Do your homework
3. Gather all the evidence
4. Collect from the patient
5. Document well
6. Understand coverage controversies
7. Use professional billers and coders
8. Befriend the payers
9. Know the law
10. Set collections targets

To view the full article in detail, as well as more Radiology resources & resources listed by specialty, please go to the following link: Medical Reimbursement, Inc. - Radiology Resources

CMS ASC Manual Chapter 14: 50-70

Medicare Claims Processing Manual for Ambulatory Surgical Centers Chapter 14: 5-70 produced by the CMS Covers the following topics:

• ASC Procedures for Completing the Form CMS-1500

• Medicare Summary Notices (MSN), Claim Adjustment Reason Codes, Remittance Advice Remark Codes (RAs)

• Applicable Messages for ASC 2008 Payment Changes Effective January 1, 2008

• Applicable ASC Messages for Certain Payment Indicators Effective for Services Performed on or after January 1, 2009

• Ambulatory Surgical Center (ASC) HCPCS Additions, Deletions, and Master Listing

To view and download the full manual of Chapter 14: 50-70, please go to the following link: ASC Manual Chapter 14: 50-70 (PDF)

Need Assistance With Your Ambulatory Surgical Center?

Medicare Claims Processing Manual for Ambulatory Surgical Centers Chapter 14: 30 & 40 produced by the CMS Covers the following topics:

• Rate Setting Policies
• Where to Obtain Current Rates and Lists of Covered Services
• Payment for Ambulatory Surgery
• Payment to Ambulatory Surgical Centers for Non-ASC Services
• Wage Adjustment of Base Payment Rates
• Payment for Intraocular Lens (IOL)
• Payment for Terminated & Multiple Procedures
• Payment for Extracorporeal Shock Wave Lithotripsy (ESWL)
• Offset for Payment for Pass-Through Devices Beginning January 1, 2008
• Payment When a Device is Furnished With No Cost or With Full or Partial Credit Beginning January 1, 2008
• Payment and Coding for Presbyopia Correcting IOLs (P-C IOLs) and Astigmatism Correcting IOLs (A-C IOLs)

To download and view the full CMS ASC Claims Manual on Rate-Setting Policies & Payment for Ambulatory Surgery click the following link: http://ww2.medicalreimbursementinc.com/l/3732/2012-06-08/2746tl (PDF)

Ambulatory Surgical Center Payment Updates to be Implemented in July 2012

Changes to the ASC Payment System and billing instructions for various payment policies to be implemented in the July 2012. An ASC update guide produced by the CMS highlights the following:

• Changes in Manual Instructions
• Funding
• For Fiscal Intermediaries (FIs), Regional Home Health Intermediaries (RHHIs) and/or Carriers
• For Medicare Administrative Contractors (MACs)
• New Category III CPT Codes that are Separately Payable Under the ASC Payment System Effective July 1, 2012
• Instructions for Device Pass-Through Category C1840
• Billing for Drugs, Biologicals, and Radiopharmaceuticals
• Drugs and Biologicals with Payments Based on Average Sales Price (ASP) Effective July 1, 2012
• New HCPCS Codes for Drugs and Biologicals Separately Payable under the ASC Payment System Effective July 1, 2012
• New HCPCS Codes Effective July 1, 2012 for Separately Payable Drugs and Biologicals
• Adjustment to the Payment Indicator for Certain HCPCS Codes Effective April 1, 2012
• Coverage and Business Requirements
• Provider Education

To download and view the full guide, please click the following link: Ambulatory Surgical Center Payment Updates to be Implemented in July 2012

Managing Underpayments in Medical Billing

An article, "Managing Underpayments in Medical Billing: Getting Every Penny You Deserve" published by Kareo, recommends the following tips on how to manage your underpayments

1. Know what you should get paid
2. Seek other sources
3. Deploy alternate strategies
4. Establish a process to ensure payments are correct
5. Examine remittances
6. Evaluate staff motivation
7. Recognize that underpayments may not come from the insurance company

To view the full article and the tips in further detail, please go to our resources page located here: Medical Reimbursement, Inc - Current News Articles

How to Use the Medicare Coverage Database

Do you know what to use to determine Medicare coverage?

A fact sheet was produced by the Centers for Medicare and Medicaid Services highlighting how to use the Medicare Coverage Database.

The document addresses the following topics:

• What is the Medicare Coverage Database (MCD) ? 
• Why would a Health Care Professional, Supplier, or Provider Use the Coverage Database?
• Background: Medicare Coverage and Coverage Determinations
• How Up-to-Date is the MCD?
• How to locate, navigate, and search the MCD 
• Using the Indexes & Reports Feature - National & Local Coverage
• Tips and how to use MCD Downloads
• Additional Resources on the MCD
  
  To download and view the document on the MCD, please go to the following link: How to Use the Medicare Coverage Database (PDF)

The National Provider Identifier (NPI) What You Need to Know

According to the Centers for Medicare and Medicaid Services, The National  Provider Identifier (NPI). The Administrative Simplification provisions of the Health  Insurance Portability and Accountability Act  of 1996 (HIPAA) mandated the adoption of  a standard, unique health identifier for each  health care provider.

To further explain the process, a short fact sheet highlighting the topics below was created by the Centers for Medicare and Medicaid Services:

• What is an NPI?
• Benefits
• Eligibility
• Who Must Obtain the NPI?
• What the NPI does and does not do
• Who Cannot Receive an NPI?
• National Plan and Provider Enumeration System (NPPES) 
• NPI Registry
• NPPES Downloadable File
• Healthcare Provider Categories
• How to apply for an NPI
• Additional Website Resources

To view and download the full fact sheet, please go to the following link: National Provider Identifiers (NPI): What You Need to Know

Global Surgery Fact Sheet

Are you billing the necessary services before, during, and after a surgical procedure?

The Centers for Medicare and Medicaid Services produced a Global Surgery billing guide with guidance on how to properly bill the global surgery package, the fact sheet highlighted the following:

• Definition of a Global Surgical Package
• FAQs
• Is the global surgery payment restricted to hospital inpatient settings?
• How is Global Surgery classified?
• Where can I find the post-operative periods for covered surgical procedures?
• What services are included in the global surgery payment?
• What services are not included in the global surgery payment?
• How are minor procedures and endoscopies handled?
• Global Surgery Coding and Billing Guidelines
• Pre-operative Period Billing
• Day of Procedure Billing
• Post-Operative Period Billing
• Special Billing Situations
• Resources Pages with links to additional resources

To download and view the guide, please go to the following link: Global Surgery Fact Sheet

How to Use The National Correct Coding Initiative (NCCI) Tools

Are you familiar with the NCCI (National Correct Coding Initiative) and how to tell if your coding is up to par?

The guide, "How to Use The National Correct Coding Initiative (NCCI) Tools" Produced by the Centers for Medicare and Medicaid Services highlights the following topics:

• What is the National Correct Coding Initiative (NCCI)
• Who should use the NCCI Web Page, Tables, and Manual
• How Up-to-Date are the NCCI Tables
• Background: NCCI Edits
• Using The NCCI Tools 
• Looking Up 2 Types of Code Pair Edits  
• How to Use the Code Pair Tables 
• Looking up the 3 Provider-Types of Medically Unlikely Edits (MUEs)
• Using the NCCI Policy Manual For Medicare Services
• Resources page with additional websites
• How to Filter NCCI data tables

To download and view the full guide, please go to the following link: NCCI Tools