Anesthesia Billing

Here's a question on anesthesia billing we received

Regarding billing for anesthesia services:

Some insurers seem to want the start and stop times in Box 19 (Medicare, for example) while others want it in the shaded area above Date of Service. Is there one place it can go that will make everyone happy?

Box 24G seems like it should always be minutes of anesthesia, except for special cases (such as 99140, etc.), but some examples online show people putting units in that box (15 min = 1 unit). Can you confirm that it should almost always be actual minutes?

Thanks.

Michele answered:

Hi,

I checked with several insurance carriers including Medicare, Wellmark, and Aetna. They all state that anesthesia minutes are reimbursed under units. If you submit the claim with the actual minutes they convert them into units. Some carriers have specific requirements regarding including the start & stop time as well in specific boxes on the CMS (like box 19). Unfortunately there is not one standard that you can follow for all companies. If you want to get reimbursed you must follow their requirements. I hope that helps.

Medicaid Billing

With all the Medicaid HMOs Medicaid billing has become very confusing. In NY many Medicaid patients have two ID cards but show only one when they come in the office. This results in many questions and incorrect billing. We recently received this question.

My question is in regards to Medicaid. I live in Nevada and one of our Dr's does a lot of Medicaid patients. They come in several forms First health (mdc)BXBS (mdc) and Smart Choice. (mdc) The cards all look the same Medicaid Nevada Medicaid Check up. Are they all billed to the same place with the same payor ID # which is in Reno? Thanks for your help. Linda

I answered her as follows

I am not extremely familiar with NV Medicaid but it sounds to me as if it is the same as here in NY. Medicaid offers Managed Care Plans in place of straight Medicaid that the patient chooses. They are offered thru other commercial insurers. Those managed care plans are billed individually to the insurance carrier that sponsors it. For example, we have a Blue Choice Option Medicaid plan which goes to BCBS, there is a United Health Care option which goes directly to UHC. Then if the patient just has straight Medicaid (didn't elect a managed care plan) the claims are billed to Medicaid. You can probably get a list of plans and addresses from the Medicaid office.

Hope that helps,

Chiropractic Coding

We recently had a question on billing codes 95851 &/or 95832 in a chiropractic office. My advice to this office was:

Well, for chiropractors, in my experience, most insurance carriers only allow the manipulation codes (98940-98943) or they have a global allowance for a chiropractic visit. However, there may be some commercial carriers who do allow for chiropractors to bill for modalities and/or range of motion testing. I can’t really tell you for sure when it will be covered. What I would recommend is including on bills for patients when the testing is performed, (you may want to use the 59 modifier to indicate distinct procedural service) in addition to the other codes (exam or manipulation). The best way to find out is to bill it. Another option is to contact provider reps for your largest insurance carriers and ask them if you are allowed to bill those codes.

Ionic Detox Foot Bath Billing

We ran into another question that we haven't had any experience with yet. Thought someone might have an idea to share. Here's the question.

Hi Alice.

I was wondering if you happen to know what the appropriate way of coding an Ionic Detox Foot Bath? I haven't been able to find a CPT code for it and although I'm pretty sure it's a non covered service, I'm being instructed by the Chiropractor I work for to bill it as a 99211. Is this correct? My understanding of that E & M code would not include using it to bill a service such as the Detox Foot Bath, nor do I think that it is an appropriate substitution. If I am correct in my assesment, is there an appropriate code that it should be billed under?

Thanks!


Michele answered this one as follows:

Hi,

I tried to find an appropriate code but didn’t have any luck. I do know that the 99211 is not appropriate since and E&M code is for an office visit for the evaluation and management of a patient’s condition which requires that some decision making is made. The following description is for the 99211 and is only regarding the E&M componenet:



• An E/M service must be provided. Generally, this means that the patient's history is reviewed, a limited physical assessment is performed or some degree of decision making occurs. If a clinical need cannot be substantiated, 99211 should not be reported. For example, 99211 would not be appropriate when a patient comes into the office just to pick up a routine prescription.



In my opinion the Detox Foot Bath doesn’t meet that criteria, unless more is being done than you indicated. However, I would look at the modality codes to see if there is one that more closely describes.the foot bath, or you could use the unlisted modality code, however that is not usually covered.



Hope that helps.

Michele

Tier Billing - Can you help?

We recently received this question.

Do you know the term tier billing and what it is ? The doctor that i work for says we can use this with Medicare billing but i have not been able to find any information on this.

We couldn't find any information on this. Can anyone else explain tier billing?

Thanks for your help.

DME Claims Denied For NPI Issue

Many providers are experiencing strange denials on their Medicare DME claims and when they call to check on them, they are being told to call the EDI department - even if they aren't submitting the claims electronically. Seems strange, but it's actually accurate.

The problem begins there. The customer service people with Medicare DME do not explain why the denials are occurring very well and you end the call scratching your head still not sure how to get the claims paid.


If they would just tell you in plain English what the problem was and how to fix it, it wouldn't be so bad. Well after my staff made several phone calls I finally picked up the phone myself and made a call to Medicare DME Region A. I finally figured out the problem after a hunch I had which was a complete miracle that I could piece this together. It certainly was not because they were explaining it well.

The problem is that the provider's national supplier number must be linked to the NPI number. This can be done fairly simply by going to the NPI enumerator web site, logging in, and adding the supplier number as one of the identifiers. It's a simple enough solution.

If you are receiving these strange denials I would recommend not even calling the DME carrier at first. I would check to see if you have your supplier number linked to your NPI number and if not, do so. If it already linked then you are having a different issue. Otherwise, once it is linked, just resubmit your claims!

Charging Patients For Deductibles, Copays, and Coinsurance Amounts

Many offices lose money by not collecting all of the money that is due to them from patient responsibilities. Some do it by choice, and others because they don’t have a system for their patient billing. They don’t even realize that the patient’s aren’t paying the portion they owe.

In any case, it is important to know that you could get into trouble. With Medicare, it is illegal to not bill the patient for their portion, whether it is the deductible or the coinsurance. It is also illegal to bill for more than Medicare allows you to, so you must make sure you understand what the patient’s portion is. If Medicare finds out that you are billing Medicare for services, but not billing the patient’s for the patient responsibility, you can be investigated for Medicare fraud.

Of course there are exceptions. If a patient has a financial hardship you can waive the patient responsibility, but you must document this in the patient’s chart. And you can’t claim that every Medicare patient that you treat has a financial hardship. There are also other ways around this. You must bill the patient for their responsibility, but there is no law on how far you have to go to collect it. So if you send them a patient statement and they do not pay the bill, there is nothing that says you have to send a second one. As long as you can show that you billed them.

With commercial insurances, there is usually a clause in the contract that you sign that states you will bill patient’s for all copays and/or any other patient responsibility. If the insurance carrier finds that you are not charging the patients, they can consider it a violation of your contract with them and terminate your participation. They do not usually go any further than that, such as investigate for fraud, unless there are other violations going on as well.

If you have a couple of patients, friends, relatives or people with true financial difficulties that you are not charging that will probably not hurt you. But if you pretty much across the board don’t charge your patients, you could get into some trouble. Some people have a difficult time charging their patients. These laws are a good excuse for them. “I don’t want to have to charge you, but if I get caught I could be removed from the insurance carrier’s panel or investigated.”

If you have not been charging your patients, you will be surprised how much your receivables can go up when you do. It doesn’t seem like much, but it really adds up.