Here are links to special guidelines for claim forms both electronic and paper:
Blue Cross Blue Shield
https://www.blueshieldca.com/provider/claims/policies-guidelines/special.sp
Tricare
http://www.tricare.mil/Resources/Claims/MedicalClaims/CompletingClaimForm.aspx
Worker's Compensation
http://www.dol.gov/owcp/dfec/regs/compliance/forms.htm
Thursday, September 24, 2015
Electronic Claims
Do's and Don'ts of Electronic Claims
Do: Use the patient account numbers to differentiate between patients with similar names.
Do: Use correct numeric locations of service code, current valid CPT, of HCPCS procedure codes.
Do: Print an insurance billing worksheet or perform a front-end edit (online error checking) to look for and correct all errors before the claim is transmitted to the third-party payer.
Do: Request electronic-error reports from the third-party payer to make corrections to the system.
Do: Obtain and cross-check the electronic status report against all claims transmitted.
Don't: Bill codes using modifier -22 electronically unless the carrier receives documents (called attachments) to justify more payment.
Internet Resources for Electronic Claims
Do: Use the patient account numbers to differentiate between patients with similar names.
Do: Use correct numeric locations of service code, current valid CPT, of HCPCS procedure codes.
Do: Print an insurance billing worksheet or perform a front-end edit (online error checking) to look for and correct all errors before the claim is transmitted to the third-party payer.
Do: Request electronic-error reports from the third-party payer to make corrections to the system.
Do: Obtain and cross-check the electronic status report against all claims transmitted.
Don't: Bill codes using modifier -22 electronically unless the carrier receives documents (called attachments) to justify more payment.
Internet Resources for Electronic Claims
AAFP's Center for Health Information Technology and resources from the Practice Management site of the American Academy of Family Physicians.
Coding Gateway site to many resources from the American Health Information Management Association (AHIMA).
HIPAA Administrative Simplification Enforcement Tool Available online from the Centers for Medicare and Medicaid Services - CMS.
TRICARE Providers Site includes billing information.
Workers' Compensation related links From the North Carolina Industrial Commission, maintained by Robert W. McDowell.
Journals
Advance for Health Information Professionals Biweekly magazine for health professionals.
CIO Magazine In addition to online articles, contains an extensive set of links to other web resources.
Federal Register Available online from the Government Printing Office.
Healthcare Informatics Online Includes a section on Financial issues, including coding and payment systems.
Healthcare IT News Covers technology and the business of health care.
Journal of the American Health Information Management Association Selected articles are available online.
Agencies, Organizations and Associations
North Carolina Healthcare Information and Communications Alliance, Inc. - NCHICA A "nonprofit consortium of over 200 organizations dedicated to improving healthcare by accelerating the adoption of information technology."
Office of Inspector General, Department of Health and Human Services.
VeriSign Online security services.
Workgroup for Electronic Data Interchange - WEDI A membership organization promoting health related electronic commerce.
Paper Claims CMS-1500 (02-12)
Do's and Don'ts of Paper Claims
Do: Use original claim forms printed in red ink; photocopies and forms generated from ink jet or laser printers cannot be scanned.
Don't: Handwrite information on the document. Handwriting is only accepted for signatures. Handwritten clams require manual processing.
Do: Align the printer correctly so that characters appear exactly in the proper fields. Enter all information within designated fields.
Don't: Allow characters to touch lines.
Don't: Use broken characters (dot matrix), script, slant, minifont, or italicized fonts or expanded, compressed, or bold print. Use fonts that have the same width for each character (proportional).
Do: Keep characters within the boarders of each field. Use 10-pitch Pica or Arial or 10-, 11-, or 12-point type.
Don't: Strike over any errors when correcting or crowd preprinted numbers; OCR equipment does not read corrected characters on top of correction tape or correction fluid.
Do: Complete a new form for additional services if the case has more than six lines of service.
Don't: Use highlighter pens or colored ink on claims.
Don't: Use decimals in Block 21 or dollar signs ($) in the money column.
Don't: Use narrative descriptions of procedures, modifiers, or diagnoses; code numbers are sufficient.
Don't: Use N/A or DNA when information is not applicable. Leave the space blank.
Don't: Use paper clips, cellophane tape, stickers, rubber stamps, or staples.
Do: Enter 6-digit or 8-digit date formats, depending on the block instructions.
Do: Deep signature within signature block.
Don't: fold or spindle forms when mailing.
Do: Enter information via computer keyboard. Use clean equipment and quality ink-jet or laser printers.
Do: Use original claim forms printed in red ink; photocopies and forms generated from ink jet or laser printers cannot be scanned.
Don't: Handwrite information on the document. Handwriting is only accepted for signatures. Handwritten clams require manual processing.
Do: Align the printer correctly so that characters appear exactly in the proper fields. Enter all information within designated fields.
Don't: Allow characters to touch lines.
Don't: Use broken characters (dot matrix), script, slant, minifont, or italicized fonts or expanded, compressed, or bold print. Use fonts that have the same width for each character (proportional).
Do: Keep characters within the boarders of each field. Use 10-pitch Pica or Arial or 10-, 11-, or 12-point type.
Don't: Strike over any errors when correcting or crowd preprinted numbers; OCR equipment does not read corrected characters on top of correction tape or correction fluid.
Do: Complete a new form for additional services if the case has more than six lines of service.
Don't: Use highlighter pens or colored ink on claims.
Don't: Use decimals in Block 21 or dollar signs ($) in the money column.
Don't: Use narrative descriptions of procedures, modifiers, or diagnoses; code numbers are sufficient.
Don't: Use N/A or DNA when information is not applicable. Leave the space blank.
Don't: Use paper clips, cellophane tape, stickers, rubber stamps, or staples.
Do: Enter 6-digit or 8-digit date formats, depending on the block instructions.
Do: Deep signature within signature block.
Don't: fold or spindle forms when mailing.
Do: Enter information via computer keyboard. Use clean equipment and quality ink-jet or laser printers.
Some Hints:
1. ALL WORK ON A CLAIM FORM IS IN CAPITAL
LETTERS.
2. NEVER USE A DASH EXCEPT ON THE ZIP CODE
3. SURGERY SERVICES ARE BILLED AS GLOBAL
SURGERY. THIS WOULD INCLUDE PREOP
VISITS, HOSPITAL VISITS, HOSPITAL DISCHARGE AND POST OP OFFICE VISITS. THE CHARGE FOR THE SURGERY INCLUDES ALL OF
THESE CHARGES.
Block 14: Date of Current Illness, Injury, or Pregnancy (LMP) This block on the CMS-1500 identifies the first date of onset of illness, the actual date of injury, or the last menstrual period (LMP) for pregnancy. A qualifier code is used to determine which date it is. These codes are:
- 431 Onset of Current Symptoms or Illness
- 484 Last Menstrual Period
Internet Resources for The Paper Claim: CMS-1500 (02-12)
- NUCC Home - http://www.nucc.org/
- CMS-1500 instructions - http://www.nucc.org/index.php?option=com_content&view=article&id=197&Itemid=114
- CMS-1500 Claim Form - http://www.nucc.org/index.php?option=com_content&view=article&id=196&Itemid=112
- Provider Taxonomy - http://www.nucc.org/index.php?option=com_content&view=article&id=14&Itemid=125
- Code Lookup - http://www.nucc.org/index.php?option=com_wrapper&view=wrapper&Itemid=126
- Code Sets - http://www.nucc.org/index.php?option=com_content&view=article&id=22&Itemid=117
- NUCC Announcements - http://www.nucc.org/index.php?option=com_content&view=category&layout=blog&id=8&Itemid=105
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) From the Centers for Medicare & Medicaid Services.
The In's and Out's of Incident to Reimbursement Family Practice Management, November/December 2001.
Making Your Balance Sheet Work for You Online article on accounting methods from Family Practice Management, June 2001.
Manager's Electronic Resource Center Includes online resources and links covering many management topics for health services managers, including Financial Management. Produced by Management Sciences for Health with support from the U.S. Agency for International Development.
Professional paper claim form (CMS-1500) Information site from the Centers for Medicare and Medicaid Services.
Transaction and Code Sets Standards Information site from the Centers for Medicare and Medicaid Services - CMS.
Wisconsin Online Resource Center Select "Business", then "Accounting", to view interactive activities on specific accounting topics.
Agencies, Organizations and Associations
DFL Enterprises, Inc. Commercial site for CMS-1500 forms.
Medicare and Medicaid From the Centers for Medicare & Medicaid Services, formerly the Health Care Financing Administration. Includes a site on Coordination of Benefits Part D and Prescription Drug Coverage - General Information.
Tuesday, September 15, 2015
More CPT coding Internet Resources
A site I found to be very useful is the Optum360coding site which is the site of the coding book I have. They have many coding resources on this site.
https://www.optum360coding.com/CodingCentral/
It is important to link ICD codes with CPT codes to establish medical necessity. Here is a link to dummies.com that talks about that and many more frequently faced problems in the coding world.
http://www.dummies.com/how-to/content/how-to-link-cpt-codes-to-icd9-codes-in-medical-bil.html
CPT coding Youtube tutorials.
https://www.youtube.com/watch?v=eWcYDSs_DEQ
http://www.youtube.com/watch?v=9uIPIwaf1dQ&list=PL9CCC48A0ADF75D7C
CPT Tabbing Youtube tutorial which I found helpful to tab your CPT book and save time finding codes. https://www.youtube.com/watch?v=m5NpJEh_Ji4
Other CPT coding Internet Resources are:
AMA Resources
http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt.page
AMA CPT and RVS Codes
https://ocm.ama-assn.org/OCM/CPTRelativeValueSearch.do?submitbutton=accept
AAPC Resources
https://www.aapc.com/resources/medical-coding/cpt.aspx
CMS.gov Site
http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/TransactionCodeSetsStands/CodeSets.html
https://www.optum360coding.com/CodingCentral/
It is important to link ICD codes with CPT codes to establish medical necessity. Here is a link to dummies.com that talks about that and many more frequently faced problems in the coding world.
http://www.dummies.com/how-to/content/how-to-link-cpt-codes-to-icd9-codes-in-medical-bil.html
CPT coding Youtube tutorials.
https://www.youtube.com/watch?v=eWcYDSs_DEQ
http://www.youtube.com/watch?v=9uIPIwaf1dQ&list=PL9CCC48A0ADF75D7C
CPT Tabbing Youtube tutorial which I found helpful to tab your CPT book and save time finding codes. https://www.youtube.com/watch?v=m5NpJEh_Ji4
Other CPT coding Internet Resources are:
AMA Resources
http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt.page
AMA CPT and RVS Codes
https://ocm.ama-assn.org/OCM/CPTRelativeValueSearch.do?submitbutton=accept
AAPC Resources
https://www.aapc.com/resources/medical-coding/cpt.aspx
CMS.gov Site
http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/TransactionCodeSetsStands/CodeSets.html
Procedural Coding Internet Resources
Procedural Coding Internet Resources
ABC Coding Solutions A commercial site with a patented Complementary and Alternative Medicine Billing & Coding Reference system for the accurate reimbursement of complementary and alternative medicine CAM services.
AHA Central Office of the American Hospital Association Includes ordering information for coding materials and resources.
Coding Better for Better Reimbursement Online article from Family Practice Management, January 2003.
CPT® (Current Procedural Terminology) An extensive resource site from the American Medical Association. Some sections require membership/subscription.
FPM Coding Tools Open-access materials available online from the American Academy of Family Physicians.
HCPCS Release and Code Sets Includes Transaction and Code Sets Standards and Quarterly Update. From the Centers for Medicare & Medicaid Services.
Health Information Management Information Center: Billing And Coding Online resources from HCPro A "provider of integrated information, education, training, and consulting products and services in the vital areas of healthcare regulation and compliance."
Medicare Provider-Supplier Enrollment Site from the Centers for Medicare & Medicaid Services. See also the Durable Medical Equipment (DME) Center,
National Correct Coding Initiatives Edits From the Centers for Medicare & Medicaid Services.
Part B News Enrollment Form for our FREE PartB-L Internet discussion forum from Decision Health.
Sample Office Forms Scroll down to access these items available from the web site of the Florida Society of Medical Assistants.
Journals
Advance for Health Information Professionals Biweekly magazine for health professionals.
Federal Register Available online from the Government Printing Office.
Agencies, Organizations and Associations Thursday, September 10, 2015
ICD-10-CM Transition
October 1, 2015 is the compliance date for the ICD-10-CM. Here are some links to PDF resources to help make the transition easier.
ICD-10-CM quick start guide:
https://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10QuickStartGuide20150622.pdf
Infographics
https://www.cms.gov/Medicare/Coding/ICD10/Downloads/CMSICD-10TestingInfographicFINAL2.pdf
Get ready for the October 1 transition with a concise guide to ICD-10 resources from the CMS:
https://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10ResourcesFlyer20150817.pdf
This and more valuable transition information can be found by clicking the link above and then going to the link that interests you.
ICD-10-CM code look-up
http://www.icd10data.com/ICD10CM/Codes
ICD-10-CM quick start guide:
https://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10QuickStartGuide20150622.pdf
Infographics
https://www.cms.gov/Medicare/Coding/ICD10/Downloads/CMSICD-10TestingInfographicFINAL2.pdf
Get ready for the October 1 transition with a concise guide to ICD-10 resources from the CMS:
https://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10ResourcesFlyer20150817.pdf
This and more valuable transition information can be found by clicking the link above and then going to the link that interests you.
ICD-10-CM code look-up
http://www.icd10data.com/ICD10CM/Codes
Tuesday, September 8, 2015
ICD-9-CM Coding Help
Free Codes and Free Code Help
This search engine is awesome for your ICD-9 coding needs
http://www.icd9data.com/
This search engine is awesome for your ICD-9 coding needs
http://www.icd9data.com/
AAPC ICD-9-CM
The ICD-9-CM code set consists of:
find out more at: https://www.aapc.com/resources/medical-coding/icd9.aspx
See the full list of ICD-9 codes at: http://coder.aapc.com/icd9-codes-range
- Volume 1: The numeric listing of diseases, classified by etiology and anatomical system, along with as a classification of other reasons for encounters and causes of injury. This is called the tabular section of ICD-9-CM. Volume 1 is used by all health care providers and facilities.
- Volume 2: The alphabetic index used to locate the codes in Volume 1. Volume 2 is used by all healthcare providers and facilities.
- Volume 3: A procedural classification with a tabular section and an index. This set of procedure codes is used only by hospitals to report services.
find out more at: https://www.aapc.com/resources/medical-coding/icd9.aspx
See the full list of ICD-9 codes at: http://coder.aapc.com/icd9-codes-range
Youtube ICD-9-CM
My favorite Youtube videos on ICD-9-CM are from kaygoodingpcc. They are detailed and give you a good look at ICD-9-CM coding books. Watch all 12 at the link below:
https://www.youtube.com/watch?v=Sert4jvR2LM&list=PLBKwIYw7SmUEOAvNmQtGiMYxTQJILXOgB
Other very informative Youtube videos that I have found are from Ultimate Medical Academy, Michelle Green, and Sam Tyler. Watch all 8 at the link below:
https://www.youtube.com/watch?v=1vqdFANk60M&list=PL50B4DBE10029F420
Here is a great ICD-9-CM video on chapter guidelines, it has a downward look at the book as the narrator is explaining things:
https://www.youtube.com/watch?v=htj93iBnBRY
https://www.youtube.com/watch?v=Sert4jvR2LM&list=PLBKwIYw7SmUEOAvNmQtGiMYxTQJILXOgB
Other very informative Youtube videos that I have found are from Ultimate Medical Academy, Michelle Green, and Sam Tyler. Watch all 8 at the link below:
https://www.youtube.com/watch?v=1vqdFANk60M&list=PL50B4DBE10029F420
Here is a great ICD-9-CM video on chapter guidelines, it has a downward look at the book as the narrator is explaining things:
https://www.youtube.com/watch?v=htj93iBnBRY
ICD-9-CM Coding Guidelines
ICD-9-CM Official Guidelines for Coding and Reporting.
Here is a link to the official ICD-9-CM guidelines:
http://www.cdc.gov/nchs/data/icd/icd9cm_guidelines_2011.pdf
Here is a link to the official ICD-9-CM guidelines:
http://www.cdc.gov/nchs/data/icd/icd9cm_guidelines_2011.pdf
Tuesday, September 1, 2015
American Medical Billing Association
On the American Medical Billing Association site they offer training and certifications. There mission is to provide education, and networking opportunities for there members. individual membership costs $99, and business membership costs $199. AMBA provides assistance for doctor's office and independent medical billers alike.
http://www.ambanet.net/AMBA.htm
Links that I found helpful on the AMBA site are:
CMS, which provides an array of information including HIPAA general information
http://www.cms.gov/
America's Health Insurance Plans, I like the calendar which informs of upcoming Webinars and conferences.
https://www.ahip.org/
RxList, which has a A-Z drug index, symptoms checker, pill identifier, and much more.
http://www.rxlist.com/script/main/hp.asp
http://www.ambanet.net/AMBA.htm
Links that I found helpful on the AMBA site are:
CMS, which provides an array of information including HIPAA general information
http://www.cms.gov/
America's Health Insurance Plans, I like the calendar which informs of upcoming Webinars and conferences.
https://www.ahip.org/
RxList, which has a A-Z drug index, symptoms checker, pill identifier, and much more.
http://www.rxlist.com/script/main/hp.asp
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