It’s that time again! We need you to judge our monthly Medical Billing Tip of the Month contest. Listed below are the three top tips submitted this month (out of the many great ideas we received!). Just read them over and then post on our Facebook page which number is your choice for Medical Billing Tip of the Month. You can also post your choice in the Comments box here on our blog. Either way, be sure to vote before the deadline on Friday, January 4th! The winner will receive a $250 American Express Gift Card and the acclaim of their peers. Here are the candidates:
Tip #1: Sending Claims with Modifier-32
My billing tip of the month is about sending claims with Modifier-32. There will not be any reimbursement if this modifier isn’t used. Using the clinic’s vaccination stock and not being paid for it will cause mental and financial stress. I hope this helps tremendously and promotes an increase in revenue since vaccine prices are increasing and payment for services are fluctuating/decreasing.
Providers who receive vaccines through the Vaccine for Children (VFC) program may use their purchased supply and submit claims using Modifier-32 to receive reimbursement ONLY if there isn’t any VFC supply left or there is a shipping delay. Sometimes there is an urgent reason why the patient needs the vaccine to prevent delay to enroll in school, daycare, etc and the clinic’s supply must be used.
- Use the normal modifier beside the E/M code (ex.-25), BUT beside the vaccine code (ex. 90732) use Modifier-32 Mandated Services first.
- In the “Edit Claim” section of Kareo a second modifier can be added if necessary but most likely one is not needed for vaccines. Paper claims can have the modifier written or typed in the specified area.
- If an issue arises resend the claim with the claim number and call the insurance company to verify if the modifier or the NDC is the issue and inform them of the reason the clinic vaccine was used and if it is no fault of your clinic that caused a delay in shipping.
Tip #2: Self-Auditing in Physician Offices
Auditing is important to evaluate the physician processes to make sure their compliance plan is operating correctly and to identify any inappropriate documentation, coding, and/or billing practices. One of the most important reasons for auditing is to identify any potential areas of concern that could put the physician or practice at a risk for audits.
OIG recommends two types of reviews:
1. Standards and procedures review — Are the standards current, complete, or need updated to reflect any government changes in regulations
2. Claims submission audits — Is coding, billing, and documentation in compliance with payer and government contractors. Are services performed reasonable and support medical necessity?
OIG states self-audits can be used to determine:
• bills are accurately coded and accurately reflect the services provided
• documentation is being completed and correct
• services or items provided are reasonable and necessary
• any incentives for unnecessary services exist.
It is recommended to start with a “baseline” audit after the first three months of implementation. This will identify areas that need improvement, education, and a basis for future audits.
The following are areas to build your foundation for future audits. The five steps are:
1. What documentation needs improvement
• Detail and specificity needed
• Medical necessity
• Components of chief complaint, history, examination, or medical decision making
• 95/97 examination guidelines
2. Possible coding/billing problems with EHR system
• CPT, ICD-9, and HCPCS codes
• CCI edits and LCDs
• Interpretation of grey areas
• New verses established patients
• Medicare guidelines
• Others — front desk, managers, etc.
• Problems identified — How are they resolved?
• How future problems will be identified and reported
• How often will audits will be performed?
• Hire external auditor
Once you have completed the baseline audits, I recommend developing an auditing compliance plan for everyone to follow as a blueprint for documentation, coding, and billing. Our most important goal as coders is to protect our physicians from any potential fraud or abuse; however, this is a team effort and requires the entire office to follow the necessary steps of a compliance plan to be successful.
Tip #3: How to Easily Upload the Fee Schedule in Kareo
Presently we are using fee schedule import spreadsheet, it would be more save our time rather than update into manually. Below are the step by step instructions on importing the Fee schedule in Kareo:
Go to Settings -> Contracts & Fees -> Fee Schedule -> Import Fee Schedule -> Import fee schedule from a file -> click the browse button and select appropriate fee schedule spreadsheet -> click “Yes import the fees as a percentage of the original amount and then click continue -> Click Save button.
Get into the Kareo settings => Contracts & Fees
Here we need to select => Import fee schedule from a file => click the browse button and select appropriate fee schedule spreadsheet which we downloaded from the Medicare website or any other Kareo accounts.
The below is an example downloaded spreadsheet and we can import all these codes with the fee value at once.
We need to mark select the option => Yes import the fees as a precentage of the orginal amount and then click continue => Click Save button
Finally we can see the updated fee schedule in the result tab. We just cross verify and click continue and save it.
Which tip is your top choice? Vote now on our Facebook page or in the Comments box on this blog. You have until Friday, January 4th, to vote! We’ll announce the winner in our January newsletter.