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Ask the Experts: Your Top Questions Answered<
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Incident-to Billing for Residents; Colonoscopy Screening Coding; Gross vs. Net Collections; On-staff Billers; Admitting From the Office; Managing Denials; Patients-per-day Norms; Taking Over a Practice INCIDENT-TO BILLING NOT FOR RESIDENTS For private insurers, they call their own shots, although it may still be worth a few more phone calls to try and negotiate a solution, depending on the volume of billing. A: Let me make sure I have this right: The patient comes in, is asymptomatic, but needs a screening colonoscopy just because she is at normal risk and you are coding for the colonoscopy. Correct? If so, use ICD-9 V76.51, Special screening for malignant neoplasm, colon, as the first diagnosis code. Then CPT 45378, Colonoscopy, flexible, proximal to splenic flexure, diagnostic (assuming a non-Medicare patient). If, however, you are asking about getting paid for a visit before the procedure, Medicare and most other payers typically won't pay for E&M visits on the day of or the day prior to surgery unless that is the visit that led to the decision for surgery. Some payers extend this to 30 days. What is relevant here is whether the physician needs to see the patient to determine the need for the procedure or if the procedure is why the patient was referred in the first place. If your physician is doing the E&M visit to evaluate and diagnose the patient and then decides to do the colonoscopy, he should get paid. For the ICD-9, then, you would code the condition the patient came in for. Here is what likely happened: Last year, you charged, say, $100 for a 99212. Insurance paid $80. That equals an 80 percent gross collection rate. This year, you charged $120 and still got paid $80 (or perhaps $84, since you negotiated better rates). That equals a 70 percent gross collection rate. It sounds worse, but, really, you are collecting about the same amount. Conversely, it's easy to make your gross collection rate look great by dropping charges, but it's actually meaningless. Instead, ask for reports on adjusted collections. Are you collecting most of what you are contractually supposed to collect? When it comes to collections, history may be less important than in other areas. More is always better, and everyone should push for more no matter what happened in the past. |
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