HIPAA’s Privacy and Security Rules specify 18 data elements that an individual could use as a means to determine a patient’s identity. The majority of this vulnerable data are easily…
When the President of the United States declares an emergency or disaster under either the Stafford Act or the National Emergencies Act, in conjunction with the Secretary of the U.S.…
Although International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) took effect on Oct. 1, 2015, there still are many gaps in the understanding and use of the code set.…
A patient voices a concern of privacy violation because the provider mistakenly emailed her medical treatment information to unrecognized email addresses. Your Notice of Privacy Practices correctly informs the patient…
Many providers have the belief that HIPAA should be treated like well-regarded advice from your mom: It's better to be safe than sorry. But that mentality is not always the…
The Health Insurance Portability and Accountability Act (HIPAA) requires covered entities to adhere to the most current International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code set as well…
Just how safe is the cloud and can we trust online software to keep sensitive medical billing data secure from a breach? In theory, the cloud is supposed to do…
The ultimate irony of a long standing ICD-10 to Y2K comparison is that – after all the years of debate, disdain and doomsday predictions – it now appears that the…
CMS Issues Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities In response to questions from the health care community, CMS…
The grim message following a breach that has endangered sensitive data belonging to 80 million current and former Anthem health insurance customers is that we can only expect more health care data breaches in the future.
The Centers for Medicare and Medicaid Services’ initial testing of updated medical diagnosis codes that will be required at health care payers and providers next year proved to be successful,…
You often turn to modifier 53 (discontinued procedure) when your anesthesiologist or the surgeon sees some risk that could threaten the patient’s health if the procedure continues. However, Payers do recoil when it comes to reimbursing these claims. Here are three easy steps by the experts to help you to get on the right track for reimbursement.
1) Conquer Electronic Filing Challenges
Gone are the days when you were told to submit paper claims reporting modifier 53 so you can append a written explanation with the claim. With HIPAA and electronic standards, you can do the billing electronically. Once you have billed electronically with modifier 53, the payer might request more information. Thus the note should contain all the information the carrier needs. For failed procedure, the record should state the reasons for the failure. If your physician discontinued the procedure due to the patient’s condition, the record should detail what factors prevented the procedure from going forward.
2) Verify the Timing of Cancellation
Knowing exactly when the case was canceled in terms of the physician’s work will help guide your code choices. If the physician cancels the procedure after induction, the case technically became a surgical procedure. Determine the correct surgical code, such as 45380 for a colonoscopy with biopsy. Then cross to the correct anesthesia code, such as 00810. If the cancelled procedure took place in an outpatient hospital or ambulatory surgical center, some payers require modifier 73 or modifier 74. In those situations, append modifier 73 or 74 to the anesthesia code instead of modifier 53 as modifiers 73 and 74 are specifically for outpatient hospital use.
3) Include the Correct Diagnosis
Indicate the reason for cancellation by reporting the appropriate diagnosis code or codes. For a patient who experiences syncope while still in the...
Say goodbye to form 4010A1 for ICD codes as well, starting in 2012.
Dig into your claim forms now to ensure that the beneficiary’s information is accurate to the letter, or you’ll face scores of denied claims on the new HIPAA 5010 forms.
Why it matters: CMS will deny claims on which the beneficiary’s name doesn’t perfectly match how it’s listed on his Medicare I.D. card when you begin using HIPAA 5010 form — the new Medicare universal claim form starting in 2012.
Include Jr. or Sr. Suffixes
“Whenever there is a name suffix, such as ‘Jr.’ or ‘Sr.’ abbreviations, etc., it must be included with the last name,” said Veronica Harshman of CMS’s Division of Medicare Billing Procedures during an April 28 Open Door Forum regarding the eligibility component of the HIPAA 5010 form.
You can include the suffix either with the patient’s last name or in the suffix field, specified CMS’s Chris Stahlecker during the call.
“The date of birth must also match exactly to what the Social Security Administration has on file,” Harshman said. CMS will use several new error codes on claims once the 5010 form goes into effect. “If you communicate with CMS through a third-party vendor (clearinghouse), it is strongly recommended that you discuss with them how these errors will be communicated to you and how these changes will impact you and your business,” Harshman advised.
Look for Production Systems Next Year
According to the HIPAA 5010 Final Rule, CMS will have a production 5010 system available as of Jan. 1, 2011, Harshman said.
The last day CMS will accept a 4010A1 form will be Dec. 31, 2011. As of Jan. 1, 2012, if you aren’t using the 5010 form, you’ll “lose the ability to receive eligibility data from Medicare,” Harshman said. In...