Tag Archives | collections

Moving Your Practice Past Industry Benchmarks

I often get the question, “What should my monthly numbers be?” My first response is, taking into account collections among other things affecting their practice, “What are your minimum requirements, annual goals, and what amount of time and energy are you willing to put in, in order to reach those results?” This is not the […]

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No Correct Coding Initiative Bundle? Find Modifier Details in MPFS.

Question: Sometimes I cannot find my two-code pair in the CCI edits. How do I know which code would be considered a column 1 code and which would be considered a column 2 code, so that I could put my modifier on the correct code?

Answer: If the codes are not listed, the codes are not bundled per the Correct Coding Initiative (CCI). You would not need a CCI modifier, such as 25 (Significant, separately identifiable evaluation and management service by the same physician on  the same day of the procedure or other service), 57 (Decision for surgery), or 59 (Distinct procedural service), to override the edit when appropriate.

A private payer could have a black box edit. You would need to check with a rep for a recommendation.

Watch out: Just because a code does not have a bundle in CCI does not mean a modifier is out of the picture. While you won’t need a CCI modifier to override the edit, you might need apayment modifier.

You can find Medicare’s other allowed modifiers for any given CPT code in the Medicare Physician Fee Schedule (MPFS). Columns Y-AC indicate if modifier 51 (Multiple procedure), 50 (Bilateral procedure), etc. apply.

To determine which code receives modifier 51, you need to know the code’s relative value units, which are also listed in the MPFS. Private payers may not adjust claim items in descending order as Medicare’s Outpatient Code Editor software does. If you append modifier 51 to a higher valued item, the private payer may apply the adjustment based on your coding, costing you payment. You should instead list the items in descending relative value order from highest to lowest. Append modifier 51 to the lower priced procedure as necessary. The insurer will then apply the typical 50 percent,…

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Surgery Coding: Look at Service Date Before Appending Modifier 59

Make sure your documentation supports the additional substantial complexity of the hernia repair and mesh.

Question: A patient presented for a colectomy for colon cancer. The physician also discovered that the patient had a ventral incarcerated hernia that required a

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Collections: Banish Co-pay, A/R Problems

5 tips help you recover deserved pay.
Collecting money from patients, especially during a recession, can be challenging. If your front desk is responsible for collecting copays and sometimes old balances, its success or failure has a dramatic impact on the practice’s bottom line.
Check out five ways you can improve your front desk collection efforts:
1. When […]

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  3. Overcome ‘Forgot the Checkbook’ Excuses With This Checklist   When you get the old “I forgot my…
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Time Your Surgical Collections Right by Referencing Payer Contracts

Find out if you’re legal in collecting patient portion before providing the surgical service.
Don’t be too hasty in collecting a patient’s copay and deductible up front.
“While in theory, the practice of collecting deductibles up front may sound good, you should check your carrier contracts to be sure you are allowed to do this before requesting […]

Related articles:

  1. Checklist: Collect Surgical Deductibles Up Front to Improve A/RThis 3-step checklist will boost your bottom line. With fewer…
  2. Medical Billers: Test Your Collections Know-How Here This nifty tool tells you if collections cluelessness is…
  3. 10 Carrier Contract Negotiation Tips Carrier contract negotiation is often a long, difficult process….
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