Physicians Practice - September 2008 - (Page 47) A You can find one here, along with a sample letter to send patients: www.rtacpa.com/healthcare-resources/ forms-and-checklists.html. See item number 27. DOCUMENTATION REQUIREMENTS: NORMAL ENOUGH? Q One of our doctors has a standard progress note form. The physical examination part of that form is titled simply by body system. The doctor commonly hand-writes “normal” next to each system without describing specifically what part is normal. For example, he doesn’t write “lungs are clear, heart rate is normal without murmur, abdomen is soft and nontender,” and the like. Is this adequate documentation to use when meeting criteria for a level three or level four visit? A Please see page 23 of the Medicare documentation guidelines you will find here: www.cms.hhs.gov/ MLNProducts/downloads/eval_mg mt_serv_guide.pdf. It states that “normal” is sufficient for reporting on unaffected systems, though it’s not OK just to say an entire system is normal. Certainly, if he is testing blood pressure, etc., he’ll also want to document concrete findings. TEST RESULT REVIEW CODING own office. While together, we amassed quite a bit of hardware, software, and other electronic gadgets. I am realizing that the price of upgrades and maintenance for all this may be more of a luxury than a necessity. For one thing, as a large group we had inhouse billing. As a soon-to-be solo doc, I am strongly considering outsourcing this service. What should I take into consideration when deciding among outside billing services? Should I look for one that would work off the same software I use? Should I abandon what I have and use whatever system they offer? Q I would like to know what CPT and ICD code to use in case of a visit for test result review. A In most cases, payment for physician management decisions based on lab results are included in your fee under the medical decision-making component of an E&M service; it can’t be billed separately. Now, if you are meeting the definition of an E&M visit, doing some HPI, review of systems, and medical decision making at that visit which is unique, you can bill the E&M. I suspect you are not doing all this, however. You are just telling the patient about the results. SELECTING A BILLING COMPANY A The key factor to consider with outsourced billing is vendor accountability. You need to understand how much they are collecting, whether and how they are working denials, what their cut is, and what you can do in the practice to improve collections. For example, if you lose money because of eligibility problems, that’s something your office needs to fix, not the billing company. It is worth paying more for better outcomes. You also should look at software such as that from Navicure or athenahealth, which essentially do both billing and full revenue-cycle management. Think of these and other similar products as online management software aimed at billing and collections. It’s a step above outsourcing billing with lots of knowledge of payer contracts built in. This may or may not be a better option for you; investigate and decide. Generally, I’d focus less on technology and more on how to retain as much of the money you’ve earned as possible. INDEPENDENT CLAIM REVIEW Q I am in the process of breaking away from a six-physician practice to open my WWW.PHYSICIANSPRACTICE.COM Q I recently received a letter from a company claiming to be an independent claim review agency hired by an employer whose employee was my patient. She was evaluated in our office twice in 2006. Claims were paid. Basically, the agent is demanding either a refund of the claim SEPTEMBER 2008 | PHYSICIANS PRACTICE | 47 http://www.rtacpa.com/healthcare-resources/forms-and-checklists.html http://www.rtacpa.com/healthcare-resources/forms-and-checklists.html http://www.cms.hhs.gov/MLNProducts/downloads/eval_mgmt_serv_guide.pdf http://www.cms.hhs.gov/MLNProducts/downloads/eval_mgmt_serv_guide.pdf http://www.cms.hhs.gov/MLNProducts/downloads/eval_mgmt_serv_guide.pdf http://merage.uci.edu/go/HCEMBA http://merage.uci.edu/go/HCEMBA http://WWW.PHYSICIANSPRACTICE.COM
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