Since it is no longer just the dermatologist doing biopsies here’s some helpful information on how to bill and the distinguishing point about how to code.  There are codes for each and you can’t do both at the same time.

The article has some interesting items to consider when billing for biopsies and is worth taking a minute to read over as today there are more biopsies done in the office than ever before.

It is important to understand what a biopsy is, according to billing practices. The biopsy involves taking a sampling of a piece of skin, whether it is a lesion or some sort of dermatitis, in order to diagnose the condition.

“We should not confuse (the biopsy) with removing a lesion. You do not biopsy a lesion and remove it at the same time, because then you are miscoding. The biopsy is a distinct animal,” Ms. Ellzey says. “You cannot say it is a Chihuahua when it is a German shepherd.”

The entire article can be read at the link below.

http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Biopsy-billing-an-important-revenue-source-for-der/ArticleStandard/Article/detail/671669?contextCategoryId=40158&ref=25

 Medical claim processing is a sore spot with almost all physicians today and to submit on paper without software today is a nightmare.  At EZClaim we have several choices, depending on the size and number of claims your practice submits.  Take a look at our website and see which one is a good fit for your needs.

The report from the AMA states eligibility is one of the big areas for denial and this goes beyond just whether or not a patient is insured or not, as policies are more complex today, it may be a portion of the claim that is not eligible.   By using a clearinghouse service, you can be assured that your claims are correct in format; however denials go beyond just getting the numbers correct and we also offer our services to help.  With the complexity we all deal with today, billing on paper is almost a thing of the past.

This is what was published in Reuters this week:

CHICAGO, June 14 (Reuters) - Claims-processing errors by health insurance companies create billions of dollars in unnecessary administrative costs, slow down payments to doctors and frustrate patients, the main U.S. doctor’s group said on Monday.

The American Medical Association said one-fifth of all claims are mishandled by health insurers.

 Currently, the health care system spends as much as $210 billion annually on claims processing, according to the report issued at the AMA’s annual meeting. Doctors have long complained about excessive paperwork required to satisfy insurance companies.  The AMA described mishandling as claims processed with errors - underpaid, overpaid or incorrectly unpaid.

http://www.reuters.com/article/idUSN1422071220100614

Do you get confused with how to code diabetes?  Are you coding for Diabetes 1 or type 2?  Below are a few hints that might offer some advice on how to get the coding done right.

When you read through the codes and use of insulin it can be a little confusing.  One of the big items to watch for is the difference between adults and juvenile use.  You can also visit the entire article source for additional information if needed.

Type 1 diabetes: results from the body’s failure to produce insulin, and presently requires the person to inject insulin.

Type 2 diabetes: results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency.

Gestational diabetes: is when pregnant women, who have never had diabetes before, have a high blood glucose level during pregnancy. It may precede development of type 2 DM.

Diabetes Mellitus:- Codes under category 250 diabetes mellitus, identify complications/manifestation assocatied with diabetes mellitus. A fifth -digit is required for all category 250 codes to identity the type of diabetes mellitus and whether the diabetes is controlled or uncontrolled.

Fifth digits for category 250: The following are the fifth digits for the codes under category 250 are

0 – type II or unspecified type, not stated as uncontrolled

1 – type I juvenile type, not stated as uncontrolled.

2 – type II or unspecified type, uncontrolled.

3 – type I juvenile type, uncontrolled.

NOTES: Type I diabetes mellitus is also referred to as juvenile diabetes. If the type of diabetes mellitus is not documented in the medical record the default is type II.

Diabetes mellitus and the use of insulin:- All type I diabetes must use insulin to replace what their bodies do not produce. However, the use of insulin does not mean that a patient is a type I diabetic. Some patients with type II diabetes mellitus are unable to control their blood sugar through diet and oral medication alone and do required insulin. If the documentation in a medical record does not indicate the type of diabetes but does indicate that the patient uses insulin, the appropriate fifth digit for type II must be used. For type II patient

Diabetes mellitus and the use of insulin:- All type I diabetes must use insulin to replace what their bodies do not produce. However, the use of insulin does not mean that a patient is a type I diabetic. Some patients with type II diabetes mellitus are unable to control their blood sugar through diet and oral medication alone and do required insulin. If the documentation in a medical record does not indicate the type of diabetes but does indicate that the patient uses insulin, the appropriate fifth digit for type II must be used. For type II patient

Use of insulin: Insulin should also be assigned to indicate that the patient uses insulin. Code V58.67 should not be assigned if insulin is given temporarily to bring a type II patient’s blood sugar under control during an encounter.

 http://www.articlebuster.com/2010/03/diabetes-medical-coding/

Medical billing is one area that represents constant change.  If it is not the insurance carriers, we have new provisions with Medicare to keep on top of, such as no consultation code with Medicare.  If you are providing medical billing services to clients, this meeting could be one you might want to put on your calendar.

It is coming up next month and will be held in the Washington DC area.  Listed below are some of the topics on the agenda to include the new HIPAA laws, which do including billing and business associates.

To learn more or register for the HBMA 2010 Compliance Conference, visit HBMA’s event page.

 Press Release:

Annual Event Will Help Medical Billing Professionals Develop and Assess Compliance Plans against the Backdrop of Federal Legislation and Regulatory Concerns

LAGUNA BEACH, Calif.–(BUSINESS WIRE)–The Healthcare Billing & Management Association (HBMA), a non-profit educational resource and advocacy group representing third-party medical billers and billing professionals, today announced details of the association’s 2010 Compliance Conference. Taking place at Hotel Monaco in Alexandria, Va., March 9-11, HBMA’s Compliance Conference will help participants to gain deeper understanding of many issues relating to compliance within the healthcare billing industry.

Andrea L. Treese Berlin, senior counsel for the U.S. Department of Health and Human Services, Office of the Counsel to the Inspector General, will be on hand to speak to attendees on OIG-specific compliance issues. Additional conference sessions will include discussions on such critical compliance areas as:

• HIPAA, HITECH and other federal regulations
• Billing company policies and procedures
• Effective monitoring and auditing
• Coding education and training
• Risk assessments
• Billing contracts and negotiation
• On Wednesday, March 10, the conference features a presentation by Attorney Mark Cunningham, titled, “How to ‘Date’ Your Client.” This session offers participants advice ranging from problem areas in client-billing company relations, to issues and recommendations for building a strong relationship with a client. A post-conference session called “Hot Topics in Compliance” will be held on Friday, March 12 and hosted by Louie; Karen Collier, Esquire; Jackie Willett, CHBME and Bob Burleigh, CHBME. This session will address major topical compliance concerns such as human resources, RAC, successful ALJ appeals, ICD-10, enforcement, coding, quality payments and several other industry topics of interest and concern to participants.Conference registration opens at 11:30 a.m. on Tuesday, March 9, and includes a comprehensive schedule of sessions, networking lunches, informal activities like “Compliance Jeopardy,” an evening reception, and a tour of the D.C. area. Bill Finerfrock, HBMA’s legislative consultant from Capitol Associates, will present his “Washington Update” in a Wednesday, March 10 session.

The full press release can be read at the link below:

http://www.businesswire.com/portal/site/home/permalink/?ndmViewId=news_view&newsId=20100208006133&newsLang=en

Whether or not you are aware or not the new HIPAA requirements are on the horizon this week.  The new laws are to enforce privacy options and require a form of “business associate” agreement as the laws are changing to where business associates can now be held responsible in many areas including security breaches.

If you are using an outside 3rd party billing service, these now are affected by the new laws and come under the “business associated” provisions, so perhaps a good idea to check out and do a little housekeeping.   The new laws represent some still penalties.

Seattle, WA, February 14, 2010 –(PR.com)– New HIPAA regulations for Business Associates go into effect February 17, 2010 and most chiropractors qualify as covered entities subject to these new rules. This means chiropractors will have to have a new Business Associate agreement in place to be compliant with the recently changed provisions under the privacy and security rules that impact named covered entities and business associates.

“The first question a chiropractor will ask is: “Am I a covered entity?” Put simply, if you conduct transactions in electronic form, you are a covered entity,” said Strategic Chiropractor CEO, Dr. Tom Necela. A practicing chiropractor, Necela now uses his experience both as a chiropractor, a former Insurance Claims Analyst and Certified Professional Medical Auditor to work with chiropractic practices to improve their business and minimize their audit exposure through better documentation, coding, billing and compliance

To comply with the Business Associate Agreement update chiropractors should:

Make a list of current business associates and vendors
Identify entities with whom the practice shares PHI
Draft new legal agreements for business associates to comply with the new rules
Update HIPAA privacy & security policies

http://www.pr.com/press-release/212790