iMAXX Medical Billing Solutions Knowledge Hub

iMAX Medical Billing Knowledge Hub

CPT Coding for Laboratory Panels

A laboratory panel is a package of tests that often are ordered together. Each panel code (80047-80076) includes multiple tests. When all the tests included in the panel are ordered, report the panel code. If any test defined as part of the panel is not performed, report the code(s) to describe the individual tests performed. CPT® instructs: …panels were developed for coding purposes only and should not be interpreted as clinical parameters. The test are listed with each panel identify the defined components of the panel. These panel components are not intended to limit the performance of other test. If

Incident to Provider Cannot Change Plan of Care

When a non-physician practitioner (NPP) performs an incident to service, that NPP must follow the plan of care as prescribed. He or she may not independently change the course of treatment. This requirement appears in Chapter 15, Section 60 of the Medicare Benefit Policy Manual, as shown in bold text: … to have …[a] service covered as incident to the services of a physician, it must be performed under the direct supervision of the physician as an integral part of the physician’s personal in-office service. As explained in §60.1, this does not mean that each occasion of an incidental service performed by a nonphysician

Take Time to Understand Time-based Codes

Without a thorough understanding of the guidelines, calculating time may land you in hot water. When time is the controlling factor in a patient’s visit, be sure to capture the appropriate time-based service code. Per CPT®, unless there are code or code-range-specific guidelines, parenthetical instructions, or code descriptors to the contrary, the following standards apply to time measurement: A unit of time is attained when the midpoint is passed. For example, an hour is attained when 31 minutes have elapsed (more than midway between zero and 60 minutes). A second hour is attained when 91 minutes have elapsed. When codes

Medicare Cards Dropping SSI Numbers in 2018

Nearly 58 million Americans pack Medicare cards, and because their Social Security number is on the card, this puts them at great risk of fraud and identity theft. Medicare is planning to replace the cards as mandated by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to protect beneficiaries. New cards begin mailing April 2018, and that gives providers a year to convert their systems. In the works for years, the Centers for Medicare & Medicaid Services (CMS) has developed the randomly-assigned Medicare Beneficiary Identifier (MBI) as a replacement. By congressional fiat, all cards must be replaced by April 2019. The new, unique MBI

What’s the difference between a Claim Denial and Claim Rejection?

Insurance claim denials and rejections are one of the biggest obstacles affecting healthcare reimbursements.  Too often the terms “claim rejection” and “claim denial” are used interchangeably in the billing world. This misunderstanding can create very costly errors and can have a significant, negative impact on your overall revenue cycle.  Proper education and management of accounts receivable and workflow are essential for timely cash flow. Let’s spend a little time defining the terms and differences between a claim rejection and a claim denial. Claim Rejections Claims Rejections are claims that do not meet specific data requirements or basic formatting that are rejected by

Opioid Addicts Share Their Story

The below link features patients from Cornerstone Project in Dayton, Ohio who share their stories.

Real-Time Data for Denials Management Aids Practice’s Lagging A/R

Urgent Care Now improved A/R days by 18 percent and collections by 30 percent after gaining real-time access to claim denials management data. Without transparency throughout the claim denials management process, healthcare organizations are leaving a significant portion of potential revenue on the table. Limited access to timely claim denial and reimbursement data can prevent providers from recouping revenue that is rightfully theirs. As a result, providers are passing up an opportunity to recover reimbursement for up to 63 percent of denied claims, a recent Change Healthcare study revealed. Urgent Care Now in New Jersey used to be one of

36% of Providers Never Address Patient Financial Responsibility

Providers reported a rise in uncollected self-pay revenue, but only 23 percent said they always discuss patient financial responsibility, a survey showed. August 29, 2017 – Healthcare organizations are struggling to collect full patient financial responsibility, especially with the rise of high-deductible health plans. Yet, 36 percent of providers report never discussing a patient’s ability to pay prior to delivering care, a recent survey of over 230 providers and 1,000 adults revealed. The survey from West showed that healthcare organizations are seeing uncollected self-pay revenue increase because of high-deductible health plans. About 80 percent of individuals said that affordability is their

How to encourage patients to post online reviews

Studies have shown that a majority of patients are now using online reviews as a first step to finding a new doctor, and nearly 65% of people form an opinion by reading anywhere from one to six reviews. According to BrightLocal’s Local Consumer Review Survey, 70% of consumers will leave a review for a business if asked, so encouraging patients to leave positive reviews for a practice not only helps to build a solid reputation, but also helps to buffer the occasional negative review. That’s why it is absolutely essential that doctors strengthen their online reputation. “Doctors need to get

Rags to riches to rags: How a booming addiction treatment biz goes bankrupt

Stephen Fennelly was at the top of his game and it seemed like there was nowhere to go but up. After rough times in Connecticut – including arrests for narcotics possession, larceny and weapons offenses – the former home builder had conquered his drug problem, hung up the hard hat and donned a sharp suit. The new Fennelly was the passion-driven chief executive of a swiftly expanding addiction treatment empire in California. Solid Landings Behavioral Health started out in 2009 with a handful of workers and rode a cresting wave of opioid addiction – and ballooning insurance coverage – to what