This book is one of the first of its kind, appealing to the average practice employee who needs to verify that they are billing at the national standard, now required by law. This book meets the HHS and OIG guidelines for teaching compliance elements at the billing personnel level, using practical examples. Learn current coding conventions, billing rules and application advice. This book is ideal for use as a practice-training guide, developed to bring all billing employees, experienced and non-experienced, up to the national standards.
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Editorial Reviews
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"(This book) has a 'good attitude.' . . . it looks at the issues of billing from both sides; from the provider perspective concerning their right to be paid for what they do, and the payor side with respect to what the provider needs to do in order to comply with the rules. It is my opinion that this book should be a requirement for everyone either involved in or considering entering the (medical) billing field. . . I see it as a complete reference tool for the preparation, process and follow through for the entire billing process. . . . I will recommend it to all of my clients." -- Frank Cohen, Health Care Market Research Analyst
"(This book) should be required reading for every office manager, billing manager, all billing personnel and anyone with an ownership interest in a medical practice. It not only gives medical office personnel the tools they need to be effective, it also provides the tools to reduce their personal liability. (New laws) clearly state that anyone who knowingly and willfully makes a false statement related to health care (incorrect coding) has committed a federal crime. (Government Agencies) no longer have to prove intent. (This book) provides the framework for developing and monitoring a voluntary compliance program. It guides you through the billing process from beginning to end and is a very valuable reference book. I will recommend it to all my clients." -- Jill Brown, RN, CPC, CPC-H 1998
"(This book) should be required reading for every office manager, billing manager, all billing personnel and anyone with an ownership interest in a medical practice. It not only gives medical office personnel the tools they need to be effective, it also provides the tools to reduce their personal liability. (New laws) clearly state that anyone who knowingly and willfully makes a false statement related to health care (incorrect coding) has committed a federal crime. (Government Agencies) no longer have to prove intent. (This book) provides the framework for developing and monitoring a voluntary compliance program. It guides you through the billing process from beginning to end and is a very valuable reference book. I will recommend it to all my clients." -- Jill Brown, RN, CPC, CPC-H 1998
Excerpt. © Reprinted by permission. All rights reserved.
From Chapter 4: Coding Late Effects.
When a patient is treated for a condition that is the result of a late effect injury or illness, special coding principles apply. You will first select the residual effect (upper arm pain), or today's diagnosis, then the late effect cause (fracture of the upper arm), then you will select the E-code describing how the arm was broken (fall at home). This type of coding can be tailor made for litigation when not coded accurately. In many situations, auto or work related accidents cause late effect problems with patients. If the Coder does not select the late effect codes correctly, it can create problems between payors.
Coding Example: If you were hurt in an auto accident, and 6 months after you were completely healed you started having problems with an injury from the accident, the auto insurance company may still be responsible for payment. This coverage would continue until the health portion of the auto insurance policy is at a maximum. If you did not provide the reason for the current problem accurately using the code selection process, the appropriate insurer may not accept responsibility. If you did not identify auto insurance they may not accept responsibility, and the health insurer may not accept responsibility if they know that the limits have not been reached for the auto policy. Correct Sequencing of Codes:
1. Residual effect (why the patient is here)
2. Late effect cause (fracture)
3. E-code describing cause of effect (auto accident, fall, etc.)
4. Any other condition that may affect the treatment of today's services. (Chronic conditions, personal history, etc)...
From Chapter 5: Claim Box 14 Date of Current Illness
This field is required for specific visits, not to include annual exams and physicals. It is a required field for the date of the first symptom, injury or pregnancy (LMP - last menstrual period) for the medical service being filed on the claim. For Chiropractic claims enter the date of the initiation of the course of treatment and enter the x-ray date in Box 19. This box is one of the most misused boxes on the entire claim form. Pay close attention to how it is utilized by your practice. If any box in 10 is marked yes, this field is required. If any codes in Box 21 are pregnancy related, the date of the LMP goes in this box to indicate the total number of weeks of gestation.
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Most Helpful Customer Reviews
13 of 13 people found the following review helpful:
5.0 out of 5 stars
An excellent resource for Voluntary Compliance.,
By A Customer
This review is from: Practical Guide to Medical Billing (Spiral-bound)
This book guides you through every aspect of developing and maintaining a Voluntary Compliance program. It begins with forms development to capture the required information and takes you all the way through to retrospective audit. Legal issues are highlighted with special icons to enable you to identify them easily. Seasoned billers and new billers alike will find this book to be a very valuable resource.
14 of 18 people found the following review helpful:
5.0 out of 5 stars
Clearly-written sequencing of claims billing & documentation,
By A Customer
This review is from: Practical Guide to Medical Billing (Spiral-bound)
The author's experience is evident. The process of medical billing, as presented in Ms. Holmes' book, is enhanced by caveats and the how-to of corrective action(s). This is a valuable resource and reference tool.
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