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
List of Medical Modifiers for Durable Medical Equipment DME Billing Services | Modifiers
Jul28

List of Medical Modifiers for Durable Medical Equipment DME Billing Services | Modifiers

searched terms: List of Medical Modifiers for Durable Medical Equipment DME Billing Services Keypoints: Make sure you have identified medical necessity for a DME Durable Equipment Item Make sure you have documented the necessity Make sure you have a delivery receipt that the patient had received the DME Item Make sure you are reporting the right DME Item Make sure you are reporting the right place of service Make sure you have checked with your payer how they want you to report the DME Item on your Claims SEE Example of HCFA 1500 Claim Form on How to Use DME Durable Medical Equipment Modifiers CLICK HERE!   List of Medical Modifiers for Durable Medical Equipment DME Billing Services RR — RENTAL. (USE THIS ‘R’ MODIFIER WHEN DME IS TO BE RENTED) This modifier is used for DME items that are rented, and will be used for equipment in the following categories: Inexpensive or other Routinely purchased DME (IRP), Frequent or Substantial Servicing (FS), Certain customized items, Other Prosthetic and Orthotic Devices (P & O), Capped Rental Items (CR), Oxygen and Oxygen Equipment. KH — DMEPOS ITEM, INITIAL CLAIM, PURCHASE OR FIRST MONTH RENTAL This modifier is used for a capped rental DME item. When using the KH modifier, you are indicating you are billing for the first month of the capped rental period. KJ — DMEPOS ITEM, PARENTERAL ENTERAL NUTRITION (PEN) PUMP OR CAPPED RENTAL, Month four to fifteen This modifier is used for capped rental DME items. When using the KJ modifier, you are indicating you are billing for months four through thirteen/fifteen of the capped rental period. KI — DMEPOS ITEM, SECOND OR THIRD MONTH RENTAL This modifier is used for capped rental DME items. When using the KI modifier, you are indicating you are billing for the second and/or third month of the capped rental period. searched terms: List of Medical Modifiers for Durable Medical Equipment DME Billing Services   A8 — DRESSING FOR EIGHT WOUNDS. (EFFECTIVE DATE 1/1/2003) Surgical dressing codes billed without modifiers A1-A9 (see Coding Guidelines) are noncovered under the Surgical Dressings benefit. Certain dressings may be covered under other benefits. A5 — DRESSING FOR FIVE WOUNDS. (EFFECTIVE DATE 1/1/2003) Surgical dressing codes billed without modifiers A1-A9 (see Coding Guidelines) are noncovered under the Surgical Dressings benefit. Certain dressings may be covered under other benefits. A4 — DRESSING FOR FOUR WOUNDS. (EFFECTIVE DATE 1/1/2003) Surgical dressing codes billed without modifiers A1-A9 (see Coding Guidelines) are noncovered under the Surgical Dressings benefit. Certain dressings may be covered under other benefits. A9 — DRESSING FOR NINE OR MORE WOUNDS. (EFFECTIVE DATE 1/1/2003) Surgical dressing codes...

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
CPT Unlisted Codes – What are they? Use it when there is no other appropriate code!
May31

CPT Unlisted Codes – What are they? Use it when there is no other appropriate code!

Here are our Unlisted Service or Procedure Codes A service encounter or surgical procedure may be provided that is not listed in this edition of the CPT code book. When reporting such a encounter or service, the appropriate “Unlisted Procedure” code may be used to indicate the service, identifying it by “Special Report” as discussed in the section below.         The “Unlisted Procedures” and accompanying codes for Surgery are as follows: 15999 Unlisted procedure, excision pressure ulcer 17999 Unlisted procedure, skin, mucous membrane and subcutaneous tissue 19499 Unlisted procedure, breast 20999 Unlisted procedure, musculoskeletal system, general 21089 Unlisted maxillofacial prosthetic procedure 21299 Unlisted craniofacial and maxillofacial procedure 21499 Unlisted musculoskeletal procedure, head 21899 Unlisted procedure, neck or thorax 22899 Unlisted procedure, spine 22999 Unlisted procedure, abdomen, musculoskeletal system 23929 Unlisted procedure, shoulder 24999 Unlisted procedure, humerus or elbow 25999 Unlisted procedure, forearm or wrist 26989 Unlisted procedure, hands or fingers 27299 Unlisted procedure, pelvis or hip joint 27599 Unlisted procedure, femur or knee 27899 Unlisted procedure, leg or ankle 28899 Unlisted procedure, foot or toes 29799 Unlisted procedure, casting or strapping 29999 Unlisted procedure, arthroscopy 30999 Unlisted procedure, nose 31299 Unlisted procedure, accessory sinuses 31599 Unlisted procedure, larynx 31899 Unlisted procedure, trachea, bronchi 32999 Unlisted procedure, lungs and pleura 33999 Unlisted procedure, cardiac surgery 36299 Unlisted procedure, vascular injection 37501 Unlisted vascular endoscopy procedure 37799 Unlisted procedure, vascular surgery 38129 Unlisted laparoscopy procedure, spleen 38589 Unlisted laparoscopy procedure, lymphatic system 38999 Unlisted procedure, hemic or lymphatic system 39499 Unlisted procedure, mediastinum 39599 Unlisted procedure, diaphragm 40799 Unlisted procedure, lips 40899 Unlisted procedure, vestibule of mouth 41599 Unlisted procedure, tongue, floor of mouth 41899 Unlisted procedure, dentoalveolar structures 42299 Unlisted procedure, palate, uvula 42699 Unlisted procedure, salivary glands or ducts 42999 Unlisted procedure, pharynx, adenoids, or tonsils 43289 Unlisted laparoscopy procedure, esophagus 43499 Unlisted procedure, esophagus 43659 Unlisted laparoscopy procedure, stomach 43999 Unlisted procedure, stomach 44238 Unlisted laparoscopy procedure, intestine (except rectum) 44799 Unlisted procedure, intestine 44899 Unlisted procedure, Meckel’s diverticulum and the mesentery 44979 Unlisted laparoscopy procedure, appendix 45399 Unlisted procedure, colon 45499 Unlisted laparoscopy procedure, rectum 45999 Unlisted procedure, rectum 46999 Unlisted procedure, anus 47379 Unlisted laparoscopic procedure, liver 47399 Unlisted procedure, liver 47579 Unlisted laparoscopy procedure, biliary tract 47999 Unlisted procedure, biliary tract 48999 Unlisted procedure, pancreas 49329 Unlisted laparoscopy procedure, abdomen, peritoneum and omentum 49659 Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy 49999 Unlisted procedure, abdomen, peritoneum and omentum 50549 Unlisted laparoscopy procedure, renal 50949 Unlisted laparoscopy procedure, ureter 51999 Unlisted laparoscopy procedure, bladder 53899 Unlisted procedure, urinary system 54699 Unlisted laparoscopy procedure, testis 55559 Unlisted laparoscopy procedure, spermatic cord 55899 Unlisted procedure, male...

Read More
2017 Billing for Moderate Conscious Sedation with Surgery Procedure Huge Changes in 2017
May29

2017 Billing for Moderate Conscious Sedation with Surgery Procedure Huge Changes in 2017

Moderate Sedation Changes CPT® 2017 Moderate Sedation Change Codes List The 2017 code set revises this code by removing moderate sedation, also called conscious sedation, from this procedure. Use of moderate (conscious) sedation is no longer considered an inherent (bundled) / part of the procedure and can now be reported separately. Prior to the 2017 change, reimbursement for moderate (conscious) sedation was built into the compensation for the procedure as the anesthesia was administered by the same physician or other qualified health care professional who performed the procedure. This code included conscious sedation as an inherent part of providing the service and was not separately reportable. It has been recognized that practice patterns for some procedures have changed, with anesthesia increasingly reported separately by a provider separate from the one who performs the procedure. For this reason, CPT® 2017 unbundles moderate (conscious) sedation from hundreds of codes. To report moderate (conscious) sedation when provided by the same physician or other qualified health care professional who performs the procedure, see new CPT® 2017 codes 99151, 99152, or 99153. To report moderate (conscious) sedation services provided by a physician or other qualified health care professional other than the provider performing the procedure, see new CPT® 2017 codes 99155, 99156, or 99157. For 2017, existing CPT® codes for moderate sedation, 99143-99150, have been deleted. Here are your Code Descriptions 0200T Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, 1 or more needles, includes imaging guidance and bone biopsy, when performed 0201T Percutaneous sacral augmentation (sacroplasty), bilateral injections, including the use of a balloon or mechanical device, when used, 2 or more needles, includes imaging guidance and bone biopsy, when performed 0293T Insertion of left atrial hemodynamic monitor; complete system, includes implanted communication module and pressure sensor lead in left atrium including transseptal access, radiological supervision and interpretation, and associated injection procedures, when performed 0294T Insertion of left atrial hemodynamic monitor; pressure sensor lead at time of insertion of pacing cardioverter-defibrillator pulse generator including radiological supervision and interpretation and associated injection procedures, when performed (List separately in addition to code for primary procedure) 0301T Destruction/reduction of malignant breast tumor with externally applied focused microwave, including interstitial placement of disposable catheter with combined temperature monitoring probe and microwave focusing sensocatheter under ultrasound thermotherapy guidance 0302T Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation when performed and intra-operative interrogation and programming when performed; complete system (includes device and electrode) 0303T Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation when performed and intra-operative...

Read More