Guidance advice I

[Steve Verno]

Forums are here to provide guidance, not to code, bill or train.

The answers to anyone's question is out there.    Although this is the microwave generation who is accustomed to things available almost immediately.  One must have patience when looking for answers.

Coding questions:

Your answers can be found by opening and reading the CPT. ICD-9-CM or HCPCS Manual.  These books not only contain the codes and modifiers we use, they also contain the guidelines behind coding.  Training can teach you how to use these books properly and how to find a code you need.

Claims questions:

The answers are in many locations.  The claim form information can be found on the NUCC website and via health insurance claims policies.  Submission timeframes can be found in (1)  provider contracts (2)  State insurance laws or (3)  The patient benefit manual or summary plan description. 
  
Health insurance websites can be a cornucopia of information.  If I am on a website and I find a policy or manual, I save it for later reference. I also save the website so I can return for more information.
(One person recently e-mailed me asking where they can find Florida Medicare's LCDs.  My response was to go to the Florida Medicare website.  His intent wasnt to go there and get them himself.  he wanted me to find them and e-mail them to him.  Sorry, Homey dont play dat!)

Laws:

Somestimes, I hear, is it legal to.....? Or, what you are doing is illegal!!!  My so-called illegal act is to use documented signs and symtoms in emergency care coding.  While we are not lawyers, we cant say something is illegal.  In my many years of research, I have yet to find one state that has medical billing laws.  What I have found are laws that regulate insurance (Health, Workers Compnsation, and Auto Accident (PIP Coverage).  Some laws are not easy to find and one has to read the law carefully because they can be very lawyerly in language.  When we read the language, we must understand that we are not lawyers.  We can make a simple layperson understanding.  Legal interpretation is up to the lawyers. 

The internet is chock full of information. The search engine one uses is up to the individual person.  I prefer Google.  How one asks a question depends on whether the answer can be found.  Sometimes someone posts a question about a topic I know nothing about. (Contrary to popular belief, I am not a superstar.  There are many things I dont know about. Ive done alot and seen alot in my years on this planet of an inconvenient truth).  I can google the question and 99% of the time I find an answer but to verify it, I must go back to the books. 

REMEMBER: When you research on your own, you become a much better person.  You learn where to find the answers.  You also become the superstar you want to be.   

[klabrie]

Forums are here to provide guidance, not to code, bill or train.

The answers to anyone's question is out there.    Although this is the microwave generation who is accustomed to things available almost immediately.  One must have patience when looking for answers.

Coding questions:

Your answers can be found by opening and reading the CPT. ICD-9-CM or HCPCS Manual.  These books not only contain the codes and modifiers we use, they also contain the guidelines behind coding.  Training can teach you how to use these books properly and how to find a code you need.

Claims questions:

The answers are in many locations.  The claim form information can be found on the NUCC website and via health insurance claims policies.  Submission timeframes can be found in (1)  provider contracts (2)  State insurance laws or (3)  The patient benefit manual or summary plan description. 
  
Health insurance websites can be a cornucopia of information.  If I am on a website and I find a policy or manual, I save it for later reference. I also save the website so I can return for more information.
(One person recently e-mailed me asking where they can find Florida Medicare's LCDs.  My response was to go to the Florida Medicare website.  His intent wasnt to go there and get them himself.  he wanted me to find them and e-mail them to him.  Sorry, Homey dont play dat!)

Laws:
Somestimes, I hear, is it legal to.....? Or, what you are doing is illegal!!!  My so-called illegal act is to use documented signs and symtoms in emergency care coding.  While we are not lawyers, we cant say something is illegal.  In my many years of research, I have yet to find one state that has medical billing laws.  What I have found are laws that regulate insurance (Health, Workers Compnsation, and Auto Accident (PIP Coverage).  Some laws are not easy to find and one has to read the law carefully because they can be very lawyerly in language.  When we read the language, we must understand that we are not lawyers.  We can make a simple layperson understanding.  Legal interpretation is up to the lawyers. 

The internet is chock full of information. The search engine one uses is up to the individual person.  I prefer Google.  How one asks a question depends on whether the answer can be found.  Sometimes someone posts a question about a topic I know nothing about. (Contrary to popular belief, I am not a superstar.  There are many things I dont know about. Ive done alot and seen alot in my years on this planet of an inconvenient truth).  I can google the question and 99% of the time I find an answer but to verify it, I must go back to the books. 

When you research on your own, you become a much better person.  You learn where to find the answers.  You also become the superstar you want to be.   

I need help with the outpatient facility hcpcs code for billing...can you help me???

[Steve Verno]

Thats a tall order.  Can you simplify it, please.

[llenor]

Good afternoon.
Would someone be willing to share what rate they charge providers for claims submissions in Houston, TX.?
Thanks.

[Steve Verno]

In a previous life I charged 100 pence.   

Im in Florida and I charge 35% of what I collect.  I do specialty work and usually have to work accounts everyone couldnt work or they were close to being dead for being so old.

[cbwallace]

See, that's my whole problem. The instructor's jump into to coding but don't give us instructional use of the manuals. Sometimes you can simply tell me the 'why' it is the way it is and I've got it! But jumping from E/M to radiology then surgery...dear Lord I'm losing it! Teach me one thing at a time!!! If I can't make it through the first section how on earth do you think I'll make it through the second one.

[Steve Verno]

Why doesnt give the whole picture. 

Each section has its own guidance and rules.  Knowing them all will allow you to code properly and you will not open yourself and your doctor to fraud and abuse charges. 

have patience and you will be a model coder.