There is so many changes happening in the medical industry that has physicians and medical insurance billers stressed out and frustrated. It's getting more and more difficult to maintain a steady revenue due to changes in HIPAA laws, coding changes, government mandates and payer rules. Here are some practical ways to improve your practices revenue flow.
CPT CHANGES IN 2012
Using Modifier 33 (Preventive Services)
What this modifier does is designates that the code you are using is a preventive service which means that the patients receiving these services are receiving them at no cost, (no cost sharing happens when this modifier is used).
These services must be identified before billing so patients are not billed inappropriately which could prompt many phone calls to the office.
New Patients Versus Established Patients
The definition of a new patient is one that has not received any professional services within the past 3 years from the physician or another physician of the same exact specialty. If you have a subspecialty in your practice, make sure you correctly identify when a patient can be billed as a "new" patient; In order to maximize your reimbursement. By doing this you will see a difference in reimbursement of up to 15% to 20%.
Prolonged Evaluation and Management Services
Time that must be spent related to a patients visit is often times separate from the one-on-one or face to face codes that are often used. For code 99358 (prolonged E/M service before/or after direct patient care for the first hour) the wording of "face to face" is not in the description, which can affect code 99359 (each additional 30 minutes).
At one time, these two codes were once limited and could only be used by physicians, they are now available to use by other qualified healthcare professionals. If your practice employs other qualified healthcare professionals, make sure that these codes are being used when it is necessary and appropriate.
Medicare Physician Fee Schedule
Medicare payment rate for the physician's fee schedule was threatened to change for the year 2012. There could have been a possible decrease in the physician's fee schedule of 27.4% this year. This would have really hurt doctors who treat Medicare patients, and would have made it harder for seniors to find physicians.
However on Friday, February 17, 2012 Congress passed an extension of the payroll tax for the rest of 2012.
Many physicians are very busy and don't have the time to evaluate every single change made but it is very important to be proactive in their practice and keep up to date with the ever-changing rules and regulations set forth by different entities. Time that is set aside to research such things will only make the physicians practice more efficient.
If you are using a Medical Billing Service, they should be keeping you up-to-date with the changes of 2012, so that you can just focus on your patients.
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