Enthusiasm...

Happy Easter everyone!  Whatever your beliefs are I hope that you had a great day surrounded by those that you love.  In my own background I am compelled to say "He is Risen!"

I got to spend the day with a good friend today.  Ok, a good, cute friend.  Ok, ok, a good, cute, single friend who asked me to help him do something.  What's the something?  Start a business.  I gladly said "OK!"

As we got so spend our afternoon together today, I realized the pure enthusiasm that he has for what he wants to do, and it dawned on me, there is no better way to be prepared for anything - whether it be learning a new craft, making a holiday dinner, or starting a business.  If you believe in yourself and are willing to put your heart and soul behind whatever you are doing, dedication and success will surely follow.

Now that's not to say that you still don't have to take the time and learn what you are doing.  There is no replacement for knowledge and a good solid business plan.  But if there's one thing that can encourage and uplift you when times get hard, there's nothing like enthusiasm.

So remember as we all start this journey, keep your heads up, a smile on your face, and leap forward knowing that we CAN do this.  Nothing will stop us because we are going to make it!

Until next time,

Thanks,
Lori

http://www.sinclairinkspot.com/
Loretta Sinclair
Author, Medical Billing, Coding and Reimbursement
How to Run Your Own Home Medical Billing Service
Annotation Press, 2007, 2008
Available in print and on Kindle

Marketing Your Medical Billing Service
Sinclair Publications, 2011
available in ebook format only
See http://www.amazon.com/, http://www.barnesandnoble.com/, or http://www.sinclairinkspot.com.market/

Medical Billing, Coding, and Reimbursement
Supplemental Workbook
Sinclair Publications
copyright 2009

A word about confidentiality...

Something came up this week that has hit really close to home with me.  That is patient confidentiality.  I cannot stress enough how important this is.  Someone that I was close to non-chalantly made a comment to me about a recent doctor visit that I'd had.  The problem was I had never told this person about the appointment.  When I asked how they knew about it, they began to back pedal and change the story.    That hurt me on a number of levels.  First, my trust in that office has now been broken.  That is probably the biggest thing for me.  I no longer know if they have my best interests at heart.  Second, it is actually a violation of federal law to divulge something.  Even anything as casual as "how did your appointment go" can get you into some serious trouble.  Now, I don't know what this person knows and what they don't know, or who else knows it.  Even though, by the world's standards, there's nothing that will make the cover of the NYT, it is personal and private to me and I would like to keep it that way.

So, please remember, above all else, if you ever see a name that you recognize, you cannot divulge anything in any way.  Don't go home and mention it to your spouse, tell your kids, blog about it, or yell it from the rooftops.  Whatever you see, stays in the office.  Or, to paraphrase the Vegas commercials:  What happens at work, stays at work.

Until next time,

Thanks,
Lori

http://www.sinclairinkspot.com/
Loretta Sinclair
Author, Medical Billing, Coding and Reimbursement
How to Run Your Own Home Medical Billing Service
Annotation Press, 2007, 2008
Available in print and on Kindle

Marketing Your Medical Billing Service
Sinclair Publications, 2011
available in ebook format only
See http://www.amazon.com/, http://www.barnesandnoble.com/, or http://www.sinclairinkspot.com.market/

Medical Billing, Coding, and Reimbursement
Supplemental Workbook
Sinclair Publications
copyright 2009

When is a contract a good one?

I was asked this question this week, and much to my dismay the answer turned into a "discussion" with a family member, and then ended in a near argument.  The problem is that the person that I was discussing the contract with has absolutely no experience in this field, and no idea what they were talking about.  I had to tell them that I have been doing this for 30 years now, and I know the value of a good deal when I see it.  They did not agree.  So, that led me to try and look at things from their perspective.   The question is:  When is a contract a good one?

The answer:

When it works for you.

Yes, it really is that simple.  If both parties are having their needs met, and both are comfortable with the compensation, then it is a good contract.  Sure, I can give you hints and tips about negotiating a contract.  Is there going to be a better deal out there?  Inevitably.  If you had negotiated harder, could you have gotten more?  Possibly, maybe even probably.

Is is worth losing sleep over?  NO.

If you have negotiated a contract, and you feel it is a good one, then take a deep breath, relax, and let's get to work.  Try not to listen to the advice of others, unless they are an expert in the field.  Then, weigh the advice for what it is worth to you, but in the end, do what you're going to do anyway;  make your own decision.  Let's not compare ourselves to other businesses or other people.  Learn to be a confident individual, knowledgeable, and ready to work.  This is what makes happy self-employed people.

(Hint:  put a time limit in your contracts.  To be renegotiated every 6 months, or year.  That way if you are in something that you don't like or can't handle, you have a back door... something to think about).

Until next time,

Thanks,
Lori

http://www.sinclairinkspot.com/
Loretta Sinclair
Author, Medical Billing, Coding and Reimbursement
How to Run Your Own Home Medical Billing Service
Annotation Press, 2007, 2008
Available in print and on Kindle

Marketing Your Medical Billing Service
Sinclair Publications, 2011
available in ebook format only
See http://www.amazon.com/, http://www.barnesandnoble.com/, or http://www.sinclairinkspot.com.market/

Medical Billing, Coding, and Reimbursement
Supplemental Workbook
Sinclair Publications
copyright 2009

http://www.medicalbillingservice.blogspot.com/

Continuing education... it never stops.

One thing that I can tell you about this business is that it is ever evolving, ever changing, and ever challenging.  I spent my morning researching  a rather complicated issue involving admits, discharges, and same-day readmissions to a rehab facility.  There were so many new regulations since the last time that I researched this same issue some time back that it surprised me.  But, as the face of healthcare changes, so do the rules.  As new and different problems arise, a new regulation is made to accommodate for it.  So, as the commercial says, "Never Stop Learning".  Especially when it comes to your career.

Check with your local insurance companies.  Many offer training online.  Others offer in-person seminars and workshops to help with billing issues, and every insurance company has a provider rep that can help you.  Medicare and Medi-caid have their billing manuals online as well. 

Read.  Read.  Read.  Absorb all of the information that you can.

Never Stop Learning.  The more you know, the more you can make!

Until next time,

Thanks,
Lori

http://www.sinclairinkspot.com/
Loretta Sinclair
Author, Medical Billing, Coding and Reimbursement
How to Run Your Own Home Medical Billing Service
Annotation Press, 2007, 2008
Available in print and on Kindle

Marketing Your Medical Billing Service
Sinclair Publications, 2011
available in ebook format only
See http://www.amazon.com/, http://www.barnesandnoble.com/, or http://www.sinclairinkspot.com.market/

Medical Billing, Coding, and Reimbursement
Supplemental Workbook
Sinclair Publications
copyright 2009

http://www.medicalbillingservice.blogspot.com/

So, what do I do first?

So, the biggest looming question that I seem to get the most, is actually the most simple. 

How do I begin?

Before any major purchase, such as a car or a house, you always set a price range that you will be willing to spend.  A business is no different.  If you are financing the purchase, figure out what payment you are able to pay, or if you are financing the start up yourself through savings or credit cards, what is your limit?  Although it would be nice to go to the bank and get a loan to start your business, unfortunately most lending institutions won't give you money without any collaterol - and with no business, you don't really have anything to put down.  Some people will take out a second mortgage on their house, but in all honesty, this really isn't necessary.  You can either save up yourself, borrow from relatives, or finance with credit cards.  But how much are we really talking about?

Start up costs can be minimal.  You can get a good, reliable software program for under $1,000 these days.  That will be the biggest single purchase to start.  Now it probably will not be the nicest billing program in the world (and believe me, every salesman in the book will be quick to point that out), but it will get the job done in the first year.  Then, when money is coming in and things are rolling, you can convert to a program that is more suited to your needs.   Beyond that, you will need your office set up (preferably an office in your own home until you have money coming in); a small desk and office equipment.  A reliable computer will be your next most pricey purchase, but even those are coming down significantly anymore. 

So my first piece of advice is simple:  Budget and shop.

Once you have these two things determined, then it is time to move forward...

Until next time,

Thanks,
Lori

http://www.sinclairinkspot.com/
Loretta Sinclair
Author, Medical Billing, Coding and Reimbursement
How to Run Your Own Home Medical Billing Service
Annotation Press, 2007, 2008
Available in print and on Kindle

Marketing Your Medical Billing Service
Sinclair Publications, 2011
available in ebook format only
See http://www.amazon.com/, http://www.barnesandnoble.com/, or http://www.sinclairinkspot.com.market/

Medical Billing, Coding, and Reimbursement
Supplemental Workbook
Sinclair Publications
copyright 2009

http://www.medicalbillingservice.blogspot.com/

Make a Client Smile Tip #2

Make a Client Smile Tip #2:

This Sunday, March 20th, is the first day of spring.  A time of bright colors, blooming flowers, spring showers and hay fever.  Make your clients smile by doing a little something to brighten their day.  Change the color of some of the documents that you send to them to reflect the spring colors.  Bring them a flower, or bunch of flowers, to place in their office.  Or, if you know that someone is a gardner, bring them some flower seeds or bulbs to plant.  Or, if all else fails, and you know you have a hay fever sufferer on your hands, bypass the flowers and bring them a coupon for their favorite antihistamine. 

Anything to make your client smile.

Lori

http://www.sinclairinkspot.com/

http://medicalbillingservice.blogspot.com/

Make a Client Smile Tip #1

Here is a new feature that I am adding to the blog.  I call it my Make a Client Smile tips.  From time to time I will post nice little things that you can do for your clients, or potential clients, that will show them you care, brighten their day, or make them smile. 

Today:  Show them your green!  And, no, I do not mean money. 

Thursday is St. Patrick's Day.  Bring your clients a little something to remind them of the day.  It doesn't need to cost a lot of money.  Cut a big shamrock out of construction paper and slip it in the courier bag.  A card is nice too.  Just a little something green to show your spirit.

Happy St. Patrick's Day everyone.  Make a client smile!
Lori

http://www.sinclairinkspot.com/

http://medicalbillingservice.blogspot.com/

Global Disasters

There is a lot going on in the world today.  With the earthquake in Japan, tsunami, and now radiation leaking, there is a large part of the world that is in dire need.  Some of that need has made its way here to Northern California where I live.  The tsunami hit the far northern coast of California slamming the biggest fishing community with $20 million in damages, and counting.  Santa Cruz has $17 million in damages, and the radiation cloud that has been forming could very well reach the United States, in smaller doses.  The US is also going to be evacuating its own residents from the disaster area, and probably at least a number of the more greviously injured persons for medical care here.  It is possible that some billing departments and coding departments could see some of the impacts of this disaster close up.

I have not seen anything on the news that the ICD-9 has not already accounted for.  For example:

Radiation poisoning has a diagnosis code of 508.0
Adverse effects of radiation is 990

The earthquake would have injuries such as:
crushing injury, 929.9 or
exposure 994.9

tsunami would possibly have:
drowning 994.1

When a natural disaster happens ,there is a way in which we, in this industry, can be prepared within our own profession.  Watch the news.  Keep up on the current events.  When you hear of things happening around you, even if they are across the globe, take the time to see how you would handle them were the claim in front of you today.  It is altogether possible, that it might be tomorrow.

My heart and prayers are with the people of Japan.

Until next time,

Thanks,
Lori

http://www.sinclairinkspot.com/
Loretta Sinclair
Author, Medical Billing, Coding and Reimbursement
How to Run Your Own Home Medical Billing Service
Annotation Press, 2007, 2008
Available in print and on Kindle

Marketing Your Medical Billing Service
Sinclair Publications, 2011
available in ebook format only
See http://www.amazon.com/, http://www.barnesandnoble.com/, or http://www.sinclairinkspot.com.market/

Medical Billing, Coding, and Reimbursement
Supplemental Workbook
Sinclair Publications
copyright 2009

http://www.medicalbillingservice.blogspot.com/

A promise is a promise.

It's raining today.  I don't know where all of my readers are, but I am in sunny California.  By this time of the year most of the rain is usually done.  We may get a sprinkle or two, but nothing drenching.  Last night between the time I went to bed and the time I got up this morning at 5:00 am, we got well over an inch of rain.  There were auto accidents all over the place on the freeways.  The roads were a mess.

Now, were I still self-employed, this is a day that I would have been extremely tempted to call my clients and tell them that I could not make my normal courier run and pick their billing up.  I would have loved to stay inside all day and work from the warmth and comfort of my dry home.  But, when you are self-employed, even though you may have options that most people don't, one thing to remember is this:  A promise is still a promise.  If you have told all of your clients that you will pick up on Mondays and Wednesdays, then that is exactly what they expect.  They will have little sympathy for you not wanting to go out in the rain.  In fact, if it is a day that they need to be at work, then they expect you to be at work as well.  You could possibly run the risk of offending your clients if you try to take the easy way out of things.  Now, obviously there will be times when your schedule will have to change.  My advice to you is to make this as little as possible, and only when you really need to.  Think of your deliveries and pick ups as a promise.  Something always to keep.

So, in the rain and foul weather... bundle up, keep dry and warm, be safe on the road, and head out to meet with your clients.  They will appreciate it more than you know.

Until next time,

Thanks,
Lori

http://www.sinclairinkspot.com/
Loretta Sinclair
Author, Medical Billing, Coding and Reimbursement
How to Run Your Own Home Medical Billing Service
Annotation Press, 2007, 2008
Available in print and on Kindle

Marketing Your Medical Billing Service
Sinclair Publications, 2011
available in ebook format only
See http://www.amazon.com/, http://www.barnesandnoble.com/, or http://www.sinclairinkspot.com.market/

Medical Billing, Coding, and Reimbursement
Supplemental Workbook
Sinclair Publications
copyright 2009

http://www.medicalbillingservice.blogspot.com/
http://www.faithfriendshipandfood.blogspot.com/

Taking on too much... don't stop thinking.

When we all first start out in business, we are always excited, energetic, and hungry.  We want that business, and we want it bad.  In fact, many of us are willing to go the extra mile to land that first client.  I know I did.  But one thing that we all need to be careful of is taking on too much.  This is something that I still struggle with.

When I started my business, I had another job as well.  It was part time, and not the full time that most people are working, but it was a job just the same.  I was also a mother to two younger children.  I will tell you that I worked part time outside the home, and full time inside.  Even then, the temptation was there to take on too much.  Whatever people asked me for, I committed to doing it without thinking about it.  My advice to you is to always take a step back and think things through.  You don't want to stretch yourself too thin, with either your business, your day job, or your family.  If you are providing extra services, such as transcription or courier, evaluate the time and effort that it will take carefully before committing.

I was revisited by this same problem again this week.  While I no longer have my billing service, I do have a full time Billing and Collections Supervisor job, am an active author, and the single parent of two college kids.  As if that wasn't enough, I got contacted this last week to ask if I was interested in developing and teaching an online course in medical billing.  While I did not immediately take it, I did not immediately turn it down either.  I am going to take a big step back, evaluate exactly what it is they want from me, and whether or not I have adequate time to shine in this job along with all of my other repsonsibilities.  In other words, STOP and THINK.  You wouldn't think at this point in my life someone would have to remind me of that, but I guess we all need it from time to time.

Until next time,

Thanks,
Lori

http://www.sinclairinkspot.com/
Loretta Sinclair
Author, Medical Billing, Coding and Reimbursement
How to Run Your Own Home Medical Billing Service
Annotation Press, 2007, 2008
Available in print and on Kindle

Marketing Your Medical Billing Service
Sinclair Publications, 2011
available in dBook format only
See http://www.amazon.com/, http://www.barnesandnoble.com/, or http://www.sinclairinkspot.com.market/

Medical Billing, Coding, and Reimbursement
Supplemental Workbook
Sinclair Publications
copyright 2009

http://www.medicalbillingservice.blogspot.com/
http://www.faithfriendshipandfood.blogspot.com/

A lesson from Charlie Sheen...

So what can we learn from the antics of Charlie Sheen?  The last that I heard from this whole debacle is that he has called his former bosses "yellow bellied cockroaches" or something to that effect.  So, not only are cockroaches one of the lowest forms of life, but there is actually a heirerarchy among them, making the yellow-bellied kind among the worst.  Who knew?

But seriously, before you all start sending me hate mail I want to say that I love Charlie Sheen as an actor.  He has done some amazing stuff and I have been a fan for a long time.  But this week, I believe that he has made some significant mistakes.  And, specifically related to being self-employed and to marketing, he has burned his bridges. 

When you are self employed, not all situations work out.  There will  be clients that love you, and clients that hate you.  That's just the way that it is.  Not everyone is going to love you or your business the way that you do.  We all just need to accept that.  But, when things don't work out, I highly recommend that you refrain at all costs from calling your clients, or former clients, "yellow bellied cockroaches", or cockroaches of any kind, for that matter.  First, it shows a lack of respect for other human beings, and is extremely unprofessional.  It is possible that perhaps they might have need to contact you again in the future for another reason, and if you leave any client on bad terms, not only will you lose that client for any potential future business dealings, but you will also lose that all-important and priceless referral.

So, Charlie:  I loved you in Platoon.  Two and a Half Men has made laugh more times than I can tell you.  But I cannot in any way, recommend your business practices to the average person.  I wish you all the best.

Until next time,

Thanks,
Lori

http://www.sinclairinkspot.com/
Loretta Sinclair
Author, Medical Billing, Coding and Reimbursement
How to Run Your Own Home Medical Billing Service
Annotation Press, 2007, 2008
Available in print and on Kindle

Marketing Your Medical Billing Service
Sinclair Publications, 2011
available in dBook format only
See http://www.amazon.com/, http://www.barnesandnoble.com/, or http://www.sinclairinkspot.com.market/

Medical Billing, Coding, and Reimbursement
Supplemental Workbook
Sinclair Publications
copyright 2009

http://www.medicalbillingservice.blogspot.com/
http://www.faithfriendshipandfood.blogspot.com/

I may live to regret this... an offer you can't refuse.

I may live to regret this, but I am going to make an offer that I hope you can't refuse.

You see, I have been working on my taxes for two days now. And not only have I been working on them, but I have been trying to organize them too.  I recently painted my bedroom, and hauled all of my tax documents and other writing materials out into the hallway and the garage until I was ready to move them back into my bedroom.  Unfortunately, I didn't label the boxes very well, so it has been a little treasure hunt finding all of my receipts.  I tell you this because this year I did not take my own advice.  There is a chapter in my book Medical Billing, Coding, and Reimbursement that addresses taxes.  I, very clearly, advised everyone to be organized with your taxes and your receipts.  I am a little embarassed to tell you that I have been very disorganized this year, and am still not done finding all of my documents.

All of this to tell you, that as a thank you to my new subscribers (including my Kindle subscribers) I am offering copies of my book FREE.  (I love that four letter F-word).  That's right, absolutely FREE.  Just shoot me an email with your name and address and I will drop one in the mail to you right away, postage free.  In addition, if you refer someone else to join the blog, I will give you a copy of my new book: Marketing Your Medical Billing Service.  Again, absolutely free.  Also, the new referral can get a copy of the first book Medical Billing, Coding, and Reimbursement, FREE.  The marketing book is in an eBook format only, but can be read by the Kindle, Nook, or Adobe Acrobat Reader files.  All of these programs can be downloaded to your comuter FREE (again, my favorite word) from the web sites of the publishers.

Now before you think that I am completely crazy, remember anything that you do for advertizing (givesways, etc.) are all tax deductible for your business.  I am already getting a jump on my 2011 taxes and advertizing.  Hopefully next year I won't be in the same boat.  (For those of you still with me next year, you can remind me of this conversation when I do it again!)  So, let's get cracking.

Send your emails to:

lori@sinclairinkspot.com

or visit my website at:

http://www.sinclairinkspot.com/

Remember to include your name and mailing address.  This offer remains valid until Friday, April 15th, 2011, tax day.

I would like to thank all of my current subscribers, and welcome the new ones.  And, I hope your taxes are going better than mine this year.

Until next time,

Thanks,
Lori

http://www.sinclairinkspot.com/
Loretta Sinclair
Author, Medical Billing, Coding and Reimbursement
How to Run Your Own Home Medical Billing Service
Annotation Press, 2007, 2008
Available in print and on Kindle

Marketing Your Medical Billing Service
Sinclair Publications, 2011
available in dBook format only
See http://www.amazon.com/, http://www.barnesandnoble.com/, or http://www.sinclairinkspot.com.market/

Medical Billing, Coding, and Reimbursement
Supplemental Workbook
Sinclair Publications
copyright 2009

http://www.medicalbillingservice.blogspot.com/
http://www.faithfriendshipandfood.blogspot.com/



Major Sectons of the ICD-9 manual

Here are the major sections of the ICD-9 manual.

Preventive Medicine

External Causes

Infectious and Parasitic Diseases

Neoplasms

Endocrine, Nutritional and Metabolic Immunity

Blood and Blood forming organs

Mental Disorders

Nervous System and Sense Organs

Circulatory System

Respiratory System

Digestive System

Genitourinary System

Complications of Pregnancy, Childbirth and Puerpenium

Skin and Subcutaneous Tissue

Musculoskeletal System and Connective Tissue

Congenital Anomalies

Conditions in the perinatal period

Symptoms, signs, and ill-defined conditions

Injury and Poisoning

V-Codes

E-Codes

Until next time,

Thanks,
Lori

http://www.sinclairinkspot.com/
Loretta Sinclair
Author, Medical Billing, Coding and Reimbursement
How to Run Your Own Home Medical Billing Service
Annotation Press, 2007, 2008
Available in print and on Kindle

Medical Billing, Coding, and Reimbursement
Supplemental Workbook
Sinclair Publications
copyright 2009

http://www.medicalbillingservice.blogspot.com/
http://www.faithfriendshipandfood.blogspot.com/



ICD-9 (for now)

Ok, last of the boring stuff, I promise... at least for a while.

The last reference manual that you will need to deal with is the ICD-9.  Exactly like the last two examples (the CPT and the HCPCS) it is separated into two major sections, alphabetical and tabular.  But wherein the last two books dealt with procedures, drugs, and equipment (primarily), the ICD-9 lists diagnoses.  It is an extremely detailed listing of any illness, condition, pre-condition, post-condition, or injury that you could imagine.  Again, like the other two books you never want to code from the alphabetical section, but use that as a reference to get to the much more detailed tabular section.  Below are two page examples.

So why do we need the ICD-9 anyway?  To track healthcare trends, and also to aid the insurance companies in processing your bill.  If your policy excludes certain services, like pregnancy for example, and a claim comes through with a pregnancy diagnosis, that aids the insurance company in the denial of that claim.  Many policies have a different payment rate for Emergency Room services.  A trauma or injury diagnosis will help expedite this.

The government also uses this information to allocate funds for healthcre trends and crises, such as AIDS, or pandemic flus.  The government gets a report of all reported diagnoses (without the names associated with them) so that they can determine what action needs to be taken next (if any) regarding the state of healthcare in the country.

Interestingly, the rest of the world also uses the ICD-9, its successor the ICD-10, and in 2015 will be using the ICD-11.  The World Health Organization tracks global pandemics and other health issues as well.  We are the only country that utilizes the ICD-9 for billing, making conversion to the ICD-10 much more difficult.

Next post will contain a listing of the major setions of the ICD-9 book.  Then on to the nuts and bolts of beginning a home business.

Until next time,

Thanks,
Lori

http://www.sinclairinkspot.com/
Loretta Sinclair
Author, Medical Billing, Coding and Reimbursement
How to Run Your Own Home Medical Billing Service
Annotation Press, 2007, 2008
Available in print and on Kindle

Medical Billing, Coding, and Reimbursement
Supplemental Workbook
Sinclair Publications
copyright 2009

http://www.medicalbillingservice.blogspot.com/
http://www.faithfriendshipandfood.blogspot.com/



Major Sections of the HCPCS Coding Book

Here are the major coding sections of the HCPCS coding book:

A0000–A0999 Transportation Services Including Ambulance
A4000–A8999 Medical and Surgical Supplies
A9000–A9999 Administrative, Miscellaneous, and Investigational
B4000–B9999 Enteral and Parenteral Therapy
C1000–C9999 Outpatient PPS
D0000–D9999 Dental Procedures
E0100–E9999 Durable Medical Equipment
G0000–G9999 Procedures/Professional Services (temporary)
H0001–H2037 Alcohol and Drug Abuse Treatment Services
J0000–J9999 Drugs Administered Other than Oral Method
J9000–J9999 Chemotherapy Drugs
K0000–K9999 Temporary Codes
L0000–L9999 Orthotic Procedures
L5000–L9999 Prosthetic Procedures
M0000–M0301 Medical Services
P0000–P9999 Pathology and Laboratory Services
Q0000–Q9999 Q Codes (temporary)
R0000–R5999 Diagnostic Radiology Services
S0000–S9999 Temporary National Codes (non–Medicare)
T1000–T9999 National T Codes est. for State Medicaid Agencies
V0000–V2999 Vision Services
V5000–V5999 Hearing Services

Until next time,

Thanks,
Lori

http://www.sinclairinkspot.com/
Loretta Sinclair
Author, Medical Billing, Coding and Reimbursement
How to Run Your Own Home Medical Billing Service
Annotation Press, 2007, 2008
Available in print and on Kindle

Medical Billing, Coding, and Reimbursement
Supplemental Workbook
Sinclair Publications
copyright 2009

http://www.medicalbillingservice.blogspot.com/
http://www.faithfriendshipandfood.blogspot.com/



What is a HCPCS?

So what is a HCPCS code and what is it used for?  HCPCS stands for Healthcare Common Procedure Coding System.  It is a book that contains a further level of coding than the CPT (Current Procedural Terminology) that we discussed previously.  So what is the difference, and why do we need it?  Well, the CPT codes predominantly  procedures, and the HCPCS will code things like supplies, drugs, temporary codes, and transportation, just to name a few.  It is another essential book to medical billing, and should be reviewed regularly.

Like the CPT, it is divided into two main sections, one alphabetical, and one tabular.  Please see examples below:

HCPCS codes are actually Level II CPT codes.  This means that they are still considered procedure codes, and would go in the boxes for procedures on your claim forms, even though they may be for a neck brace or crutches.

Next we will cover the ICD-9 codes.

Until next time,

Thanks,
Lori

http://www.sinclairinkspot.com/
Loretta Sinclair
Author, Medical Billing, Coding and Reimbursement
How to Run Your Own Home Medical Billing Service
Annotation Press, 2007, 2008
Available in print and on Kindle

Medical Billing, Coding, and Reimbursement
Supplemental Workbook
Sinclair Publications
copyright 2009

http://www.medicalbillingservice.blogspot.com/
http://www.faithfriendshipandfood.blogspot.com/

Happy Valentine's Day

Just a quick moment to wish all my subscribers a Happy Valentine's Day, or as my daughter puts it, Happy Single Awareness Day.  No matter where you are in life, or which path you have chosen, I wish you a great day filled with joy and happiness.

Peace,


Lori

Until next time, enjoy!
Psalm 23:6 "...my cup overflows."

Coming Christmas 2010
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Bionote: Lori is the author of three business books, numerous church skits, and several articles. She lives in Sacramento with her two children, two dogs, and cat. She loves to hear from her readers, so please email your thoughts and questions.

Major Sections of the CPT book

The major headings under the tabular section of the CPT book are as follows:

Anesthesia

Integumentary system

Musculoskeletal system

Respiratory system

Cardiovascular system

Digestive system

Urinary system

Female genital system

Endocrine system

Nervous system

Auditory system

Pathology and lab

Medicine

Evaluation and management

In addition to these sections, there are also sections for Modifiers, Deleted Codes, Medicare updates (Publication 100), and other useful information.  You should spend some time making yourself familiar with this book.  The minor sections (other than alphabetical and tabular) can be very useful in your coding and billing duties.

Until next time,

Thanks,
Lori

http://www.sinclairinkspot.com/
Loretta Sinclair
Author, Medical Billing, Coding and Reimbursement
How to Run Your Own Home Medical Billing Service
Annotation Press, 2007, 2008
Available in print and on Kindle

Medical Billing, Coding, and Reimbursement
Supplemental Workbook
Sinclair Publications
copyright 2009

http://www.medicalbillingservice.blogspot.com/
http://www.faithfriendshipandfood.blogspot.com/

Inside the CPT Book

Today we will take a peek inside the CPT book.  It is the book that contains all of the outpatient procedure codes that are used for both professional (Physician reimbursement) and technical (facility reimbursement) billing.

The book is divided into two major categories, tabular and alphabetical.  The tabular section has all of the procedure codes in numeric order.  So, if you have the procedure number and need to look up the description, this section would be used.  See the example below:

In addition to being numeric, the tabular section is also divided by Specialty Type, (for example, Medicine, or Lab).  Notice the tab on the right hand side of the page above with the word Radiology.  This particular page contains radiological services.

The other section, probably the more utilized of the two is the alphabetical index.  It is an alphabetical listing of all procedures, with the corresponding codes.  So, here you can look up the name of the procedure, or the area of the body where it is to be performed, and it will give you the corresponding procedure number.  It is important to note that you should NEVER code from the alphabetical index, but rather use this as a tool to guide you to the appropriate section in the tabular portion of the book.  The tabular portion contains a greater degree of descrpition, as well as rules for when you should apply certain codes, and when you should not.

In my next post, I will give you a complete listing of all of the numerical sections in the CPT book.

Until next time,

Thanks,
Lori

http://www.sinclairinkspot.com/
Loretta Sinclair
Author, Medical Billing, Coding and Reimbursement
How to Run Your Own Home Medical Billing Service
Annotation Press, 2007, 2008
Available in print and on Kindle

Medical Billing, Coding, and Reimbursement
Supplemental Workbook
Sinclair Publications
copyright 2009

http://www.medicalbillingservice.blogspot.com/
http://www.faithfriendshipandfood.blogspot.com/

A Word About Pre-Existing Conditions

Can an insurance company exclude services for pre-existing conditions?

Then answer is both yes and no.

When you sign up with an Employer Group Health Plan (EGHP) during the initial enrollment period (usually the first 30 days of employment) then they take you the way you are, warts and all.  Your family members are also covered without restrictions as well.  If you enroll during this period, an insurance company cannot exclude any conditions from your coverage or care.

However, if you do not enroll within this initial coverage period, then the insurance company has the right to ask for either a health check up, or to review medical records (often times both) and can exclude any condition they think they may be held liable for.

Common pre-existing conditions are: chronic back problems, cancer, heart conditions, and carpal tunnel.  The list can be endless.

If you purchase a private policy, this rule does not apply.  With a private policy (including disability policies) they can exclude any condition they wish.  It would then be up to you if you choose to purchase the policy or not.  Other conditions within the polcy may be too restrictive, or may not provide the coverage that you need.

The lesson here is to ask questions, know your insurance coverages, your policy limitations and exclusions, and your rights. Understand what you are looking at, and what you are signing.  A policy is no good if it doesn't cover the things you need it to.  Otherwise you are just flushing money away.

Until next time,

Thanks,
Lori

http://www.sinclairinkspot.com/
Loretta Sinclair
Author, Medical Billing, Coding and Reimbursement
How to Run Your Own Home Medical Billing Service
Annotation Press, 2007, 2008
Available in print and on Kindle

Medical Billing, Coding, and Reimbursement
Supplemental Workbook
Sinclair Publications
copyright 2009

http://www.medicalbillingservice.blogspot.com/
http://www.faithfriendshipandfood.blogspot.com/