How to Get Paid Treating Medical Obesity for Physician Offices
Aug20

How to Get Paid Treating Medical Obesity for Physician Offices

Upcoming Webinar that many Obesity Physicians and Offices are Still Confused on How to Get Paid for their Obesity Services! You Don’t Want to Miss this Webinar on Obesity Services Reimbursement AUG 31, 2017 Thursday 2:00PM (EST) JOIN THE WEBINAR RIGHT FROM YOUR OFFICE. NO TRAVEL OR HOTEL STAY REQUIRED. What’s Inside the Webinar? Getting Paid for Physician Obesity Services – August 31, 2017 at 2:00PM (EST) – 90 Minutes Live “Obesity, a common and costly health issue, affects more than one-third of adults and 17 percent of youth in the United States. “ –  Centers for Disease Control and Prevention By the numbers, 78 million adults and 12 million children are obese—figures many regard as an epidemic. Being obese increases the risk for heart disease, stroke and type 2 diabetes—the first, fourth and seventh leading causes of death, respectively—and contributes to more than one in five cancer-related deaths. Obesity-related health care spending continues to grow, with researchers estimating medical costs at $147 billion annually, including $7 billion for Medicare prescription drugs. The American Medical Association recognized obesity as a disease in 2013 and the American Academy of Pediatrics recommended obesity prevention, assessment and patient counseling in 2007. Medicare first recognized obesity as a medical condition in 2004 and began covering interventions when scientific evidence demonstrated their effectiveness. In 2011, Medicare issued a Coverage Decision memorandum outlining requirements for intensive behavioral counseling and therapy for beneficiaries affected by obesity. As of January 2012, Medicare and most private insurers cover obesity screening and behavioral counseling. In addition, as of Jan.1, 2014, the ACA requires: No consumer cost- sharing. Most insurance plans in all 50 states are required to cover certain services with no cost-sharing, including obesity screening and counseling for all adults and children. This includes no annual deductible amount, no enrollee copayments or coinsurance.Premium surcharges for being obese are prohibited in most insurance policies in all 50 states, including those sold through exchanges. Learning Objectives Apply Proper Billing and Coding for Behavioral Obesity Services Understand Comorbidity E/M with and Time-based Behavioral Counseling Describe Incident-to Physician’s Billing Describe the role of a Dietician or Nutritionist Understand different scenarios in the practice with Obesity Services (Face-to-Face Individual versus Group) Understand how to identify and bill for TeleHealth Medicine Encounter Describe the role of other Non-Physician Services (NP, PA) Understand the Medicare and Commercial Insurance Documentation, Determination and Utilization Guidelines Who Should Attend this Webinar? Primary Care Providers: General Practice Family Practice Internal Medicine Obstetrics/Gynecology Pediatric Medicine Geriatric Medicine Nurse Practitioner Physician Assistant OTHER SPECIALTY: Gastroenterologists Pain Management Physicians PM & R Physicians Opthalmologists Neurologists Psychiatrists Bariatric Surgeons The presenter will be discussing...

Read More
CMS Medicare Require Global Surgery Reporting for Post-Op Visits for 9 States
Aug16

CMS Medicare Require Global Surgery Reporting for Post-Op Visits for 9 States

CMS Require Global Surgery Reporting for Post-Op Visits Effective July 01, 2017 from 9 States  CMS now require providers who are part of a group practice with 10 or more providers; and are practicing in the State of Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon and Rhode Island to report CPT Code 99024 to indicate a… Please LOGIN HERE to view this content. Or, REGISTER HERE Find this article useful? Please comment below and share what you just found from this website! Go ahead - please click "SHARE"EmailTweetShare on...

Read More
Physician Provider Going Out of Network with the Insurance Company | Think Again
Aug05

Physician Provider Going Out of Network with the Insurance Company | Think Again

Going Out of Network with the Insurance Company, think again (especially when you are a Primary Care Provider)   How long ago have you revisited your contracts? when was the last time you have reviewed your contracts? – maybe 3, 5 or even 10+ years ago?). Three biggest reasons why provider would pursue going out of network: 1. If you are no longer happy with your payers’ contracted rates or because the contracted rates keep on changing; 2. Timely filing limit policy is also one reason; 3. Reimbursement Policy Guidelines (bundling services into one payment); But Before you go out of network, here are the things you might consider and take a look at: 1. As you know, not all your patients have an out-of-network benefits. You have to understand that because of this, your existing patients must be transferred to another provider or facility that accepts in-network benefits. Otherwise, out of network deductible/coinsurance will apply towards your patients’ responsibility; 2. Your patients population will likely decrease due to patients’ being without an out-of-network benefits. 3. Some insurance company would send the payment check for your rendered services made payable to their member or your patient because you are an out-of-network provider (isn’t this so true?); 4. When you are following-up on claim status, some insurance company will not disclose a more detailed information regarding the claim status (especially denial and rejection) not unless the patient (their member) will call them; (reality! – hold time for out-of-network provider on the phone is probably 20 minutes minimum!) – isn’t this true? Who had experienced this? (please share your thoughts below on the comment box); I do think the best action to do it — before terminating your contract with the insurance company is to try to NEGOTIATE first. Our company can help you with the process in negotiating with the insurance payer. Contact us here. Talk to your provider relations manager in the area. Discuss your intention of going out of network and ending your contract. Tell them your reasons why you want to terminate the contract. I know the insurance company will be willing to negotiate your contracted rate or your entire contract as a whole! Especially if they know it will affect their “members” — your patients! Now, if in the end, you still have decided to terminate the contract. Just make sure you inform your patients ahead of time and bluntly explain to them your reasons why you are terminating the contract with their insurance company. Explain it to the patients what and how this will affect them. The financial responsibility they might incur for being out...

Read More
Can a Doctor Waive a Patient Copay | Medical Practice Offices Need to Know
Jul31

Can a Doctor Waive a Patient Copay | Medical Practice Offices Need to Know

If you are participating and contracted with the insurance payers, you cannot legally waive a copayment because your contract (which is a legal document/agreement) is clearly stating and you agree that you need to collect the copay at the time of service or something like that. See, you have a contracted rate with the insurance right? And so this is how it works: Can a Doctor Waive a Patient Copay, Medical Practice Offices Need to Know For Example: If for that visit, CPT  Code 99213, your contracted rate with insurance payer is $77.89 and on that particular claim: They allow $77.89; Paid you $62.89 Applied $15.00 towards the patient’s copay ==> $62.89 (insurance payment) + $15.00 (Copayment of the patient) = YOUR AGREED CONTRACTED AMOUNT OF $77.89 Now, if you did not collect the copay for a processed claim (see above scenario); the contracted/allowed should have been $62.89 and NOT $77.89 – make sense? And besides that. if you don’t collect the copay, you are losing money!   This is the reason you cannot waive the copayment because it is part of your agreed and contracted rate with the insurance payer. I have always advised my clients to collect the Copayment at the time of service, this will also help your daily cash flow. Strategies on How to Effectively Collect Copayments: When they call for appointment, as a courtesy let them know what their benefits are including their copayments; When you call the patient to confirm an appointment, remind them that they have a copay for tomorrow’s visit; Accept  Credit Cards and Debits Cards (avoid personal checks if possible); If they forgot their purse and don’t have their check, offer credit card payment method or direct them to a nearest ATM Machine in the area For stubborn patients, just nicely tell them you are contracted with their insurance company and your contract says you have to collect copays at the time of service; Advise the patient to call their insurance if they still have issue with you collecting their copayment at the time of service   Searched Keywords: waiving copays and deductibles waiving medicare co-payments pharmacy waive copay is it illegal to write off health insurance copays copay collection policy copay waiver form waive copay meaning oig advisory opinion waiver of copay GOT QUESTION FOR ME?   Need Immediate Help?  CHAT WITH US/TEXT/CALL  (888) 822-0862 We have been helping our Physicians Achieve a more Profitable Medical Practice through our Revenue Cycle Management Solutions, Practice Management and Business Development Strategies. We are your Partner for Success. If you are Struggling with your: 1. Revenue Cycle Management 2. Cash Flow 3. Claims...

Read More
DME Durable Medical Equipment Billing Coding Modifier RR, KH, KJ, KI – Rental DME Modifier
Jul27

DME Durable Medical Equipment Billing Coding Modifier RR, KH, KJ, KI – Rental DME Modifier

These modifiers are used for DME Durable Medical Equipment Services Billing: RR – DME Item – RENTAL  Secondary Modifiers: KH, KI, KJ KH — DME Item, FIRST MONTH RENTAL. KI — DME Item, SECOND OR THIRD MONTH RENTAL KJ — DME Item, RENTAL, MONTHS FOUR TO FIFTEEN Always check with your payers, every payer has a different way of billing the DME using these modifiers. Kindly see below DME billing HCFA 1500 images:   Range of Date of Service (From-To): DME Durable Medical Equipment Billing Coding Modifier RR, KH, KJ, KI – Rental DME Modifier   One (Same) Date of Service (From-To): DME Durable Medical Equipment Billing Coding Modifier RR, KH, KJ, KI – Rental DME Modifier     RELATED DME DURABLE MEDICAL EQUIPMENT BILLING (CLICK THE LINKS BELOW)   List of Medical Modifiers for Durable Medical Equipment DME Billing Services | Modifiers DME Modifiers use for DME Durable Equipment Billing | How to Bill for DME Medical Billing DME | DMEPOS EXEMPTIONS for Accreditation and Surety | For Physicians, Non-Physicians, Physical Therapist and Occupational Therapists DME Durable Medical Equipment Billing Coding Modifier RR, KH, KJ, KI – Rental DME Modifier How to Bill for DME L3908 for Medicare of NC   Searched Keywords: DME Durable Medical Equipment Billing Coding Modifier RR, KH, KJ, KI – Rental DME Modifier modifier kh dme modifiers list dme modifier kx dme modifiers 2016 medicare dme modifiers 2016 dme modifiers 2017 modifier bp modifier ms   Need Immediate Help?  CHAT WITH US/TEXT/CALL   We Offer CONSULTING SERVICES and REVENUE CYCLE MANAGEMENT We always OVER-DELIVER! 100% Satisfaction Guaranteed. Or we will return your money!   Medical Practice Consulting, Business Development and Revenue Cycle Management EXPERTISE are in: 1. Pain Management Medical Billing Consultant 2. Orthopedic Medical Billing Consultant 3. General Surgery Medical Billing 4. Obesity Medicine Billing 5. Documentation Review and Claims Audit * Accurate Coding * Evaluation and Management Coding * Medical Necessity * Compliance Plans * CPT Coding Level * CCI Edits Conflicts * Payor Guidelines and Policies (Clinical, Utilization and Reimbursement) * ICD-9, ICD-10, HCPCS Codes * Medicare and Medicaid Guidelines and Policies 6. Anesthesiology Billing 7. Neurology Billing 8. Physical Therapy Billing 9. Physician Insurance Credentialing 10. DME Durable Equipment Billing 11. Workers Comp Billing 12. MVA Claims Billing 13. Chiropractor Practice Medical Billing Medical Billing, Coding, Reimbursement and E/M Questions? We can help you navigate your practice on how to INCREASE REVENUE by looking at additional Services that you can possibly do in your Practice based on your Specialty. Other Services We Offer: Setting up a Medical Practice Revenue Cycle/Reimbursement Management Insurance Credentialing and Contract NegotiationsMedicare Enrollment and Credentialing Chart Auditing Staff Training Compliance Program TESTIMONIALS and RECOMMENDATIONS...

Read More
Type of Service Code for Claims Submission for Medical Provider Services
Jul25

Type of Service Code for Claims Submission for Medical Provider Services

Type of Service Code for Claims Submission for Medical Provider Services   1 = Medical Care Medical services to diagnose and/or treat a medical condition, illness, or injury 2 = Surgical Surgical services provided by a healthcare provider 3 = Consultation Counseling and/or coordination of care with other Physicians, other qualified Healthcare Providers or agencies 4 = Diagnostic X-Ray Diagnostic x-ray provided by a healthcare provider 5 Diagnostic Lab Diagnostic lab provided by a healthcare provider 6 Radiation Therapy Radiation therapy provided by a healthcare provider 7 = Anesthesia Anesthesia services provided by a healthcare provider 8 Surgical Assistance Assistant surgeon/surgical assistance provided by a healthcare provider if required because of the complexity of the surgical procedures 10 Blood The allotment of whole blood, blood plasma, or blood derivatives 11 Durable Medical Equipment Used Used equipment needed for medical reasons to be used by a person that is ill or injured and is ordered by a health care provider for use in the home. 12 Durable Medical Equipment Purchased Purchased equipment needed for medical reasons to be used by a person that is ill or injured and is ordered by a healthcare provider for use in the home. 14 Renal Supplies Supplies to support treatment of kidneys, or bladder functions. (Example: Dialysis Supplies and/or catheters) 17 Pre-Admission Testing Services related to the preparation for admission to establish the patients current health status. 18 Durable Medical Equipment Rental Rental equipment needed for medical reasons to be used by a person that is ill or injured and is ordered by a healthcare provider for use in the home. 19 Pneumonia Vaccine Services provided by a physician or other healthcare provider related to administration of Pneumococcal Pneumonia vaccination. 20 Second Surgical Opinion Second professional opinion sought to verify or confirm the necessity for surgical procedures 21 Third Surgical Opinion Third professional opinion sought to verify or confirm the necessity for surgical procedures 22 Social Work Services related to a systematic way of helping individuals and groups towards better adaptation to society 23 Diagnostic Dental The translation of data gathered by clinical and radiographic examination into an organized, classified definition of conditions present. 24 Periodontics The art and science of examination, diagnosis, and treatment of diseases affecting the periodontium; a study of the supporting structures of the teeth, normal anatomy and physiology and the deviations. 25 Restorative Broad term applied to any restorations to the tooth/teeth structure(s). Anterior teeth include up to five surface classifications – Mesial, Distal, Incisal, Lingual and Labial. Posterior teeth include up to five surface classifications: Mesial, Distal, Occlusal, Lingual and Buccal. 26 Endodontics The branch of dentistry that is concerned with the morphology,...

Read More