Category Archives: Office Visit

The front lines in the battle for your A/R

Your front desk staff are the marines of your office. The doctor is the general, the office manager and billers are the lieutenant and sergeants, and you can’t run a successful campaign without them. But your front desk staff are the boots on the ground, first in, last out. Their actions represent the first impression patients get of your office, and they have the last interaction with patients before those patients leave. I know that mostly, by the time you come to this blog for help, the patient has already been seen and you need to know how to get the charge paid.

But I get your emails, I know what you really need.

In a perfect world, insurances would just pay what they were supposed to, patients would send in their checks on time, and we could all leave work at 5:00. This post will help you get a little closer to that perfect world, and it all begins with your front desk. Many offices, family practice and specialists alike, end up seeing patients with insurance that is not on file, termed, or non-contracted. This happens for a variety of reasons. New patient’s tell us they have PPOs when they really come in with HMOs. Established patients forget to tell us that they changed insurance 2 months ago. HMO patients forget that if they change their PCP, they can’t come to us anymore. Howeever, with the proper procedures, the number of patients with these issues that actually get in to see the doctor can be virtually eliminated. I recently had someone contact me to train their front desk, and this is the checklist that we put together to ensure that the doctor will be paid for every service he performs.

When a patient calls in to schedule an appointment…

  1. New patients – Many offices send patients to complete their paperwork online. If you do this in your office, you only need to get the name and phone number when the patient is on the phone.
    1. Name and phone number
    2. Insurance name and id#
    3. Date of birth
    4. Verify insurance
    5. Schedule appointment
  1. Established patients
    1. We have your phone number as (909) 555-5555, is that still correct?
    2. And we have you with BlueCross BlueShield, is that correct?
    3. Schedule appointment

The day before the appointment….

  1. New patients
    1. Call to confirm appointment
    2. If your patient filled out their paperwork online, verify eligibility
  2. Established patients
    1. If patient has not been seen within 30 days, verify insurance (eligibility, deductible, copay)
    2. Call to confirm appointment
    3. Also, please be aware you have a balance of $XX.00. See you on Friday!

When the patient checks in…

  1. We still have your address as 1122 N. Del Sol Lane, is that correct?
  2. Collect any copay/deductible. If you are collecting toward a deductible, charge $50 and tell the patients this will be applied toward their deductible. Anything over that the insurance applies will be billed to their account. Unless the patient is in for a post-op, blood draw, or follow up for an established condition. In that case, the service the doctor performs probably won’t end up with an allowed amount of more than $50.00. We want to be very careful that we don’t charge patient’s more than the insurance allowed amount when we collect toward their deductible.
  3. Copy any new insurance cards

When the patient leaves the office…

  1. Schedule any necessary follow up appointment.
  2. Collect for any additional procedures performed (cash patients)
  3. Put in for any referrals

I have included this Front desk checklist on the links and tools page for you to download. These procedures are small changes that can have a transformative effect on your office and allow your billers to concentrate on what you pay them for. Namely, fighting with the insurance companies. When your billers have to run around after the front desk and try to solve these issues after the fact, it’s too late. As always, call or email with any questions. I love hearing from you.

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Filed under Accounts receivable, Administrations, Authorizations, Billing, Denials, Medical Billing, Office policy, Office Visit

Modifiers 24 and 79

A few months ago we had to do some training on our ophthalmologist account regarding when to bill the 24 modifier versus the 79 modifier in the global period to a surgery or in-office procedure. I figure, if our employees are having questions, some of you might be too, and I want you to get the maximum reimbursement for your services. First, the exact descriptions of the modifiers from the CPT book:

24 – Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Post-operative Period:
The physician or other qualified health care professional may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. This circumstance may be reported by adding modifier 24 to the appropriate level of E/M service.

79 – Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period:
The individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. This circumstance may be reported by using modifier 79. (For repeat procedures on the same day, see modifier 76.)

Many of our doctors do both minor and major surgeries, and we all know that patients need to come back in for follow up care on their various incisions, wounds, and ulcers to make sure everything is healing properly. The insurance companies will not pay for these follow up visits, or any visit done in a certain amount of time after the procedure without the proper modifiers as they consider the follow up visit to be an integral part of the original procedure. This time period is called the global period and the length of time varies depending on the procedure performed.  The issue with this no-payment rule comes in when the doctor diagnosis the patient with something additional during the follow up visit, or the patient needs another procedure. At that point, the doctor needs to do a complete visit including review of systems and exam and make a medical decision, and we can all agree that she should be paid for that. Here is how you get her paid. Modifier 24 goes on the office visit and you make sure you have a primary diagnosis that is different than the diagnosis on the original procedure. If the patient needs any in-office procedures, put a 79 on the procedure and make sure the diagnosis is different than the one on the original procedure. If the patient needs another major surgery in that time period, unrelated to the original, use modifier 79 as the first modifier on the surgery.  Just to avoid confusion, whether you use the modifier 24 or the modifier 79, the modifier would go on the visit subsequent to the surgery or in-office procedure.

To answer a popular question, yes, you can use modifier 79 when you are billing for the same surgery on a different body part. For example, if the patient had a cataract surgery on the left eye in January and he is getting cataract surgery on his right eye in February, you can use the same diagnosis of cataracts, the same CPT code for the surgery, and add the 79 modifier. Here is how that would look:

Date                          ICD9 code            CPT Code    Modifiers

01/13/14                 366.17                    66984             LT

02/18/14                366.17                    66984              79    RT

As for using the 24 modifier, there are all kinds of good, justifiable reasons to bill with that modifier and get your office visit paid separately. Here are just a few:

1) Patient is requesting a refill on medication for her chronic condition (hypertension, diabetes, hypothyroidism, migraines, neuralgia)

2) The patient came in with an unrelated chief complaint on his follow up visit

3) Patient came in for the follow up and the doctor identified symptoms of something else during the exam

This is by no means a comprehensive list, so if you are not sure whether or not your particular patient meets the requirements for using a 24 on the office visit, send me a quick email and I’ll let you know how I would bill it. Here is an example of how a charge like that would look.

Date                          ICD9 code                             CPT Code    Modifiers

01/13/14                  366.17                                    66984             LT

02/18/14                 250.60    362.01                  99214             24

I also have another chart for you (I love charts!) detailing the global period for each procedure. It is LONG. I do not suggest you print this one out, but save it on your own computer for reference. Oh, and, the global period for any given code is either going to be 10 days or 90 days, if it has one at all. FYI. As always, I saved the chart to my Links and Tools page for you.

EDIT: Just a quick FYI, global surgery rules do not apply to assistant surgeons. So, anyone who is billing a code for a provider assisting with a surgery, these rules don’t actually apply to you. Just go ahead and use modifiers 80-82 the way you’ve been doing. In fact, if we do send in a claim with modifier 79 (or 78 for that matter), the claim will actually be returned as unprocessable. Thank you, Adam, for helping to clear up the confusion.

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Filed under Billing, Claims, CPT, Doctor's Office, Follow up, Health Care, ICD9, Medical Billing, Modifiers, Office Visit

Modifier 25 and 59 update

I have an Updated modifier chart for you guys. We have been finding that the insurances are denying the immunization administration (90471) without a 25 modifier on the office visit and a 59 on the 90471. If you were using the old one, please replace it with the updated rules. For a more detailed explanation of how these modifiers work, please see the post from 01/11/13.

And this new chart is fancy and it’s typed and has examples. Hope it helps. I have also had a few inquiries on when to use the modifier 24 and 79, so my next post will be about how to use those effectively. Also, if anyone has a question for us, please do not hesitate to email or comment.

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Filed under 96372, Billing, Claims, CPT, Doctor's Office, Medical Billing, Modifiers, Office Visit