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Beware the Top-Four Billing Blunders

Your number of dropped claims may be perfectly on target, but if you're not billing for the right expenses, you're still shooting in the financial dark.
Avoid these common CDM traps, says John Russell,CPA, healthcare manager at Eide Bailly in Minneapolis, or you could be shaking hands with lost revenue, audits, and compliance problems.
1. Billing for Equipment Though the problem is improving, acquisition of new medical equipment often prompts department heads or whoever has the authority to make CDM changes to insist on its inclusion as an item in the chargemaster.However, Medicare considers reusable equipment "bundled"into other charges, so putting it in your CDM will only clog up the system.
2. Billing for Routine Supplies Rather than charging individually for basic stock such as undergarments for incontinence or gloves, recognize that these relatively inexpensive items whether or not they fall below the threshold you've set should not be billed separately, and wrap them up into charges for other services.Make sure that your charges for other services rise proportionally to compensate for lost revenue from the supplies, Russell says.
3. Billing of Outpatient Procedures in Multiple Locations If you provide services for the same patient in different parts of your facility, designate where each was performed and bill it with the appropriate revenue code, or you could be begging for compliance problems.For example, Russell says, you administer IV therapy to a patient in the emergency department (ED), observation, and an outpatient services area during one visit.Make sure you've marked each location on the claim, added revenue code 260, and split the charges apart for your provider summary report.This guideline applies even if the services are continued.
4. Self-Administered Medications Medicare generally doesn't reimburse for self-administered medications, so if you're sending a patient home with drugs, make sure you're charging them.Though an advance beneficiary notice (ABN) isn't required to charge the patient, Russell recommends informing her up front of her financial responsibility.Even if a medication is relatively inexpensive, make sure you're charging the patient anyway, because while it may seem a negligible issue now, repeat performances have the potential to create compliance nightmares.
 

- Published on 2003-05-01