|
Doctor Newsletter No. 5: "Colossus", Part II
|
|
TIPS FOR GETTING YOUR BILLS PAID UNDER COLOSSUS
|
|
Instead of jumping directly into a discussion of "Value Drivers" and "Impairment and Disability Ratings", we would like to focus on the basics, for the purposes of this introduction to dealing with computerized claims evaluation. Believe it or not, our office is still receiving hand-written medical billings from doctors, with nothing more than a patient name, date of service and amount charged. While this may be sufficient for the cash-pay patient who delivers payment at the time service is rendered, it will not suffice as valid documentation in an insurance claim.
|
|
ITEMIZED BILLING
|
|
All itemized billing must contain the following information to be considered within the computer review software.
|
1) Date of Service
2) Amount Charged for Each Modality
3) Current ICD-9 Code for Each Written Diagnosis
4) Current CPT Code for Each Modality
5) Correct Identity of Patient
6) Correct Identity of Medical Vendor
|
|
BILLING INPUTS ARE DERIVED FROM THE DATA FOUND ON THE HCFA80
|
|
The foregoing are basic, minimum, requirements under the computerized review system. The reason we pointed out the fact that CSC was the creator of the HCFA80, was in order to help illustrate that the information required in the HCFA80 has been directly input into the review software. Therefore, in order to further your potential of getting paid, and getting paid timely, it would be in your best interest to begin billing with at least the amount of specificity required on the HCFA80.
|
|
BILLING INFORMATION FREQUENTLY REQUESTED
|
|
In addition to the referenced minimum requirements, the following should be present in your submitted medical billing, in order to prevent requests for supplemental billing information, which will delay payment of your claim:
|
7) Address of Patient, inclusive of Street Address, City, State, Zip Code, and telephone number;
8) Birth Date of Patient;
9) Social Security Number of Patient;
10) Doctor's License Number;
11) Doctor's Federal Taxpayer Identification Number;
12) Address of Clinic where therapy is rendered, not just billing address
|
|
ADDITIONAL BILLING ITEMS COMMONLY OVERLOOKED
|
- Proofread the bill
- Maintain Current CPT and ICD-9 materials
- When gathering patient information, ask how long they have resided at the address given.
- If the patient has lived there less than 2 years, ask if there is a current mailing address that they have used for 2 years or longer. This will minimize delays brought about by the address being unrecognized in the insurer database, or prevent any prejudice caused by claims of former residents of that address that may have been brought in the past.
- Double check the dates of treatment rendered, as billed, against the S.O.A.P. notes. If there are charges on the bill for dates not recorded in S.O.A.P. notes, the file will be red-flagged.
- Check the bill for periodic re-exams. Sometimes the report will reference results found on re-exam, but the billing will show only that an office visit was performed. This discrepancy can cause delay in the review and cost you money, as a re-exam we know is billed higher typically than an O.V.
|
|
For Further Discussion of Colossus
|
|
Watch for future installments of this Newsletter, and how to flag key information in your Med-Legal reports, in order to better your chances of getting paid, timely. Please Note: This newsletter seeks to provide information of possible use to chiropractors. It is not intended on legal advice and should not be construed as such.
|
|
The Law Office of Neal H. Sobol has resolved more than 7000 personal injury claims over the past 14 years, almost all of which involved chiropractic treatment and issues. 2004 was another successful year, with an increasing number of chiropractic doctors referring cases to us from Los Angeles, Ventura, Riverside, San Diego and Orange Counties. If you have not worked with us before, we would be glad to meet with you and provide you with recommendations from other chiropractors as to the quality of service your patients can expect from us, as well as the degree to which we are willing to protect your lien interests in any case referred. We look forward to another great year, and to working more closely with you.
|
