On May 23, 2008 insurance carriers were suppose to accept NPI only on all paper & electronic claims. Not only were you required to include the NPI number, but you were required to EXCLUDE the legacy numbers. Some insurance carriers were not ready for the deadline and applied for an extension (like NYS Medicaid). But Medicare was ready and if you include your PTAN (legacy) number on your claims they are being rejected.

For the insurance carriers who were ready for this deadline, you must make sure you do not have the legacy number in the shaded area of box 24J or box 32A & 33A. If your software is set up to automatically print the legacy number in this box you need to remove it. If you submit claims electronically, make sure your vendor has it set up to exclude the legacy number.

For the insurance carriers who were not ready and applied for an extension, you will need to continue including the legacy number until they have complied. This makes things a little messy. You need to make sure you are submitting the claims that require the legacy number with it, and the ones that do not allow it, without. Crazy, but it is what we billing people have to do to make sure the money keeps coming in.

Another little crazy thing to worry about is the NPI number entered in 24J. If you are set up with Medicare as an individual provider (not a group) and you only have a type I NPI, you must leave the NPI part of box 24J blank. You cannot include the individual NPI number here. If you are an individual provider and you put your NPI number in 24J, Medicare may reject your claims.

If you are a group with Medicare then you need to continue putting the rendering providers individual NPI in box 24J and the group NPI (type II) in box 33A. If you are not sure if you are an individual or a group you can tell by your PTAN number. If you only have one PTAN number then you are an individual. If you have a PTAN for the individual provider and a separate PTAN for the practice name then you are a group. Just when you thought it couldn't get much more confusing!

If you want to keep your cash flow steady it is important to make sure you are submitting the claims correctly. If you have any question as to what a particular insurance carrier requires, give them a call. Better to have it right the first time than to have to resubmit!



Article Source: http://EzineArticles.com/?expert=Michele_Redmond

Critical Care is the direct care of the provider rendered to a critically ill or injured patient who requires exclusive attention of the physician. This means a full attention of the physician to the injured or critically ill patient.

Critical Care services will require full personal management by the physician. It is an intervention with life and vital organ systems' critical condition, life threatening and deterioration. It requires the physician's full assessment and manipulation to prevent further life threatening deterioration in the patient's condition.

Critical Care involves High Complexity in Medical Decision Making to assess and manage the life threatening, clinically impaired and injured patient. Vital organs such as but not limited to: central nervous system failure, circulatory system failure, shock, renal, hepatic, metabolic or respiratory system failure.

Critical Care is NOT necessarily rendered in the ICU or CCU. Critical care is always based on the patient's condition as described above. Therefore, a stable patient in an ICU or CCU is not always a critical care service.

The rendering physician must devote his full attention on the patient and must not be interrupted by seeing other patients.

99291 - Critical Care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes

99292 - each additional 30 minutes (in conjunction with 99291)

The following procedures services are bundled in reporting Critical Care Services and are not billable during the critical care service provided on the same day by the same physician:

1. Interpretation of the Cardiac Output Measurements (93561, 93562)

2. Chest X-rays (71010, 71015, 71020)

3. Pulse Oximetry (94760, in computers ECGs, blood pressure, hematologic data (99090)

4. Gastric Intubation (43752, 91105)

5. Temporary Transcutaneous Pacing (92953)

6. Ventilatory Vascular Access Procedures (3600, 36410, 36415, 36540, 36600)

Medical Necessity Documentation:

Proper documentation must be recorded on the patient's records and proof of medical necessity why Critical Care Service is rendered.

Illustration on how to bill Critical Care Service:

Less than 30 minutes

Use the appropriate E/M Code

30 min to 1 hr and 14 min (30-74mins) - 99291 (1 unit)

1 hr 15 min to 1 hr 44 min (74-104 mins) - 99291 (1 unit)

+99292 (1 unit)

1 hr 45 min to 2 hr 44 min (105-134 mins) - 99291 (1 unit)

+99292 (2 units)

Modifier 25 and Modifier 24 can be used to bill with Critical Care Services codes (be guided with other procedures which are bundled with Critical Care Services - see above).


Article Source: http://EzineArticles.com/?expert=Pinky_Mcbanon

You thought Electronic Submission of Claims do not make any mistakes or error? You are absolutely wrong. It sometimes has glitch that you did not realize you have overlooked.

I have seen medical offices who ONLY relies on the Verification report. Well, this is a report being generated after you send your claims electronically. It usually shows you a "pass" or "reject" claims on the report. The truth of the matter is, based on my experience, I can not rely on these verification reports alone.

Getting on top of your Response Report is more essential than just relying on your verification report. What is this called "Response/Return Report"? This is the report that will show you every insurance company's reply or response for all the claims that were submitted to the clearing house and has been received successfully by the insurance payer. Each patient with its date of service will show you "accepted", "adjudicated", "received" payer status report. This is actually your real response report. This is where you can determine if your claims actually reached the insurance payer!

Bottom line, you should see two reports when you submit your claims by electronic, one for verification/confirmation/summary of the claims and the second report which usually takes after 2-3 days would be the Response/Return/Status Report on which it will actually tell you if the claims were received by the insurance payer.

When your claims get denied for untimely filing and your system shows you have submitted the claim electronically. The insurance company will require a PROOF. What proof are you going to give them?

Your Proof is the "response report" that indicates "accepted" or "received by payer". If you don't have this proof. There is no way you can appeal your claim. And your physician will not be happy for not being paid for the services he rendered to his patients.

So be very careful on this. It's important you pay attention on these reports.


Article Source: http://EzineArticles.com/?expert=Pinky_Mcbanon