Basics

 

If it was a perfect world all patients would not only pay their responsible amounts; they would also pay them on time. As we all know and have experienced not every patient is willing to do this. Unfortunately we must send these patient’s to collections. One suggestion would be that every practice have a minimum balance write-off amount. The cost of sending patient statements begin to add up very quickly so you can be spending more than you are trying to collect.

 

Documentation Suggestions for Physicians

  • Document total time spent with the patient.
  • Be specific and graphic with documentation, paint a picture with your words.
  • Use key terms and standard abbreviations.
  • Draw a picture if necessary.
  • Use LEGIBLE handwriting.*

*It does not matter if everyone in the practice is able to read the physician’s handwriting; if an insurance company or auditor cannot read the physician’s handwriting in the office notes they take the stance that the procedure(s) were not performed.

 

Common Physician Billing Errors

  • Invalid procedure and diagnosis codes billed due to outdated resources.
  • Chief complaint not listed in documentation.
  • No documentation for services billed.
  • Unbundling of procedure codes.
  • Billing services included in global packages.
  • Lack of modifier or use of appropriate modifier.
  • Always billing the same level of service.**

Advanced Beneficiary Notice (ABN)

Medicare requires that all beneficiaries be notified for all situations prior to a service being performed where Medicare payment is expected to be denied. This includes tests performed in a laboratory. The correct ABN must be completed and signed by the Medicare Beneficiary. If/when the ABN is signed and the procedure is approved then a modifier GA must be attached to the procedure. The GA modifier means that the waiver of liability statement (ABN) is on file. The ABN is available in both English and Spanish for you convenience.

 

Further Reading

For further reading on billing basics please visit the U.S. Department of Health & Human Services ABN webpage or read "Thinking of outsourcing your billing functions?" by Physician's News Digest writer Todd A. Rodriguex, Esq.

 

** The billing of different E/M levels will depend upon several factors and documentation.  It is suggested that all physicians and their billing staff read the Evaluation and Management section of their CPT book for further explanation.