Getting Paid for PT/INR Office Testing With CPT Code 99211

Many doctors understand how to code properly for their time spent with a patient, but the waters become murky when it comes to coding for the time that their nurses spend on face-to-face visits. This is largely why CPT code 99211 is often underused.

As a general rule, CPT code 99211 is a "nurse code" that is used to bill for time that your practice's nurses spend with your patients. Some physicians wonder if it is appropriate to use CPT 99211 for face-to-face time spent with patients and, if so, how it should be used.

Using Code CPT 99211

According to the Medicare guidelines, even though CPT 99211 does not require a physician to be present in the room with a patient at the time of the visit, the service must be performed face-to-face with one of the physician's staff and the physician must be immediately available during this time. The visit must also have an impact on the patient's care, such as a change in medical regimen in order to be eligible for CPT 99211 coding.

To determine whether or not a visit can be billed for using code CPT 99211, there are some questions you should ask yourself:

1. Were you, the physician, on site when the visit with the patient was conducted?

2. Was the visit pertaining to a service that was medically necessary and was there a change in medical routine as a result of this visit?

3. Was the patient physically in your office (not on the phone) and did you or your staff have face-to-face contact with the patient during the visit?

Whether or not you can bill using CPT 99211 will depend on the answers to all three of these questions. If you can answer yes to all three of above questions, then the visit you are billing for will likely meet the requirements to capture revenue using code CPT 99211.

The following scenario is an example of when CPT code 99211 could be used effectively for PT/INR testing in your office...

Let's say you have a patient who is taking Coumadin/Warfarin Sodium. This patient comes into your office for a routine PT/INR test. You are in the office at the time of this visit, so the visit meets the first requirement for CPT 99211 coding.

Your nurse performs the PT/INR test and shows you the results of the test while that patient is still in your office. You see that the PT/INR levels shown in the test results warrant a change in the patient's prescription dosage. Because of this, the visit now meets the Medical Necessity requirement for CPT 99211 coding.

Your nurse then returns to the patient and informs your patient of the changes being made to their prescription dosage. The nurse then documents the patient's record while that patient is still in the office. The "face-to-face" requirement has been met, again meeting the requirements for CPT 99211 coding.

Using the scenario above, you would be able to bill for this visit using code CPT 99211. Now let's look at a scenario where you would not be able to bill using CPT code 99211.

The same patient comes into your office for a routine PT/INR test. You are in your office at the time of the visit, meeting the first requirement for CPT 99211 coding. However, the test results come back normal and there is no dosage or medical regimen change. Because of this, the requirements of CPT 99211 are not being met and you will not be able to use this code for billing for this visit.

Here is another scenario where CPT 99211 would not be used...

Let's say the same patient comes into your office for the routine PT/INR test. The patient leaves your office before you review the test results and you call back later to give the patient instructions over the phone. Because the patient was not in the office at the time the results and instructions were provided, the "face-to-face" requirement is not being met and you can not bill using CPT 99211.

Remember, you must be able to answer "yes" to all three of the criteria questions if you wish to bill using CPT code 99211. If you can answer yes to all three questions, then you should, by all means, bill using the CPT 99211 billing code in order to maximize the revenue generated for your practice.

The Definition of "Time" in Regards to E/M Services

To meet the criteria of the "time" code, the visit must meet the following conditions:

· The office visit must be dominated by counseling, meaning that more than fifty percent of the time spent with the patient is spent discussing the diagnosis, the test results and treatment options available to the patient. This time can also be spent on patient education and discussing the importance of treatment compliance on the part of the patient.

· You must document the total time of the visit and must document that more than fifty percent of the visit was spent in discussion with the patient. You also need to document the nature of the patient discussion.

Remember, "time" can not be used as a descriptor for patient observation, visits to the emergency room or preventative medicine services. If a visit with a patient meets the above conditions, you can use the "time" code regardless of the level of history, exam or medical decision making made during the course of the visit.

The Impact on Level of Service

The level of service for the E/M code will not impact your billing if you spend more than fifty percent of the patient visit counseling the patient. Instead, you can choose the time element to qualify the billing of your visit. Just be sure to document that more than fifty percent of the time spent was spent in discussion with the patient so that you can properly capture the visit code.

Scheduling Family Visits

It is not uncommon for the family members of some patients to want to speak with you in your office. If you schedule visits with these family members alone without the patient present, you will not be able to bill for the time spent. While this may provide an outstanding level of customer service to your patients and their families, you do deserve to be compensated for your time. Instead of meeting with family members alone, consider scheduling family visits to coincide with a patient's scheduled appointment. If the patient is present during a face-to-face family meeting and the time spent on counseling exceeds fifty percent of the visit, you can capture the revenue for the visit as long as you properly document the progress notes.

Of course it is up to you to decide the proper way for you to discuss patient issues with a patient's family. You do need to be sure, however, that you have the proper privacy forms filled out and that you are authorized to discuss the patient's treatment with his or her family when divulging patient information.

Properly Documenting Your Time

Time can be a significant issue when you are seeing a patient to discuss a variety of concerns. Make sure that you take advantage of the rules that pertain to billing for time. By doing so, you will be able to maximize the revenue coming into your practice and will not go uncompensated for time spent counseling the patients in your care.

Converting to Paperless Records - Keeping With Electronic Health Records

More and more medical practices are converting to electronic health records than ever before. Not only are electronic health records easier to maintain, they are better for the environment and will cost your practice less in the long run.

Many medical practices overlook the costs of keeping paper charts. There are many costs involved with paper charts, such as the cost of the charts themselves and the costs associated with replacing and replenishing charts that wear out from continued use. Some practices spend more than $4,000 each year purchasing medical charts for the office. By converting to paperless record keeping, these practices can save a substantial amount of money over the years.

When you use paper charts, you must purchase new charts and inserts on a regular basis. Then you must pay for photo copy costs, toner, faxes and maintenance on the machines used for your record-keeping purposes. These expenses can add up to more than $2,000 annually. It is not uncommon for a practice to have between $5,000 and $10,000 in record-related expenses each year. If you take that money and invest it in an electronic record system, the system will eventually pay for itself over time.

Added Space and Convenience

Saved money is not the only reason so many practices are investing in electron records management. Imagine, for a moment, that you do not have to dedicate volumes of office space to endless patient files. Imagine that you and your staff will never have to search for a missing patient file. In fact, imagine that filing is a thing of the past for you and your staff.

Consider just how much time you and your staff spend each day filing records and searching for patient files. Consider how much of your practice's building space is dedicated to storing the files that contain your patient records. Now imagine those two factors are no longer an issue for your practice. That is exactly what electronic record keeping can do for your office.

Starting the Conversion Process

In theory, EMR will allow you to replace the paper charts you keep in your office. Of course, this isn't something that will happen overnight. You will need to begin the conversion process one step at a time, and the first step is recycling.

Once you have an EMR system in place, it is time to being the recycling of the paper charts that are used by your office. You can scan older patient records into an electronic database and recycle the older charts you no longer need. As new patients come in, you can begin using the EMR system to keep records for these patients, eliminating the need for paper charts altogether.

Putting Your Extra Space to Good Use

Once your files have been migrated into an electronic format, you will find that you have an abundance of space that is no longer dedicated to storing patient files. That extra space can be converted into additional treatment rooms.

Treatment rooms equate to money. These are the rooms that generate revenue for your practice. If at all possible, try to convert the space that was used for file maintenance into added treatment rooms for your practice.

If the space that was storing your patient records can not be converted into treatment rooms, do not leave the space unused. Instead, try to create work stations for staff to use for authorizations and referrals. Not only will you be saving money by converting your file management to an electronic format, you will also be generating added space for your practice and reducing stress and increasing productivity for your practice's employees.

Medical Billing Incentive Plans That Inspire: 10 Tips for Success

The best performance incentive plans are the ones that work, of course, but what works for employees - cash or days off - might not be what your organization can afford. Incentive plans that are effective at motivating billers must be affordable and targeted to specific results. Most importantly, they must be finite - that is, not a permanent entitlement.

Put careful thought into the design, goals and timing of any incentive plan - big or small. Use these 10 tips to shape your organization's incentives for billers:

1. Recognize that the revenue cycle is a function of many factors
Billing is an operational process, not a desk or a department. Your incentive plan should recognize that everyone in the organization plays a role in the process. Collection rates improve when front office employees remember to ask for copayments from every patient who owes one. Days in accounts receivables can decline if schedulers remind patients who call to schedule an appointment about any copayments or past-due balances. An effective plan influences behavior by tying rewards to specific targets; for example, always producing accurate registrations or always collecting time-of-service payments. Because many staff work in teams, base at least half of the reward on team performance and the remainder on individual achievement. It will give everyone a reason to work together.

2. If YOU don't have the money, don't even go there!
Nothing deflates employee morale faster than cancelling a popular incentive program. Keep your incentive programs cost under control by capping individual distributions at $100 per month or less. An exception might be when the incentive program is meant to replace part of employees' salaries. In most cases, you'll find that relatively modest incentives- $25 or $50 a month-are appreciated by employees and will inspire them to better performance.

3. You get what you pay for. If you incent for speed, you will get it - but also the inaccuracy that comes with higher speed.
Give careful thought to the range of unintended consequences your incentives might inspire. Want to reward a biller for posting claims faster? Don't be surprised if error rates go up because some employees skip important steps in their quest to work faster. Want to reward billers for resolving 100 percent of denied claims within 30 days? Be careful that they don't start reclassifying claims denied for missing documentation, unbundling, medical necessity and other 'noncontractual adjustments' as contractual adjustments (e.g., the contracted allowable discount). Of course, most employees are conscientious. All the same, don't be shocked when people go in the direction in which your incentives push them.

4. Not every account is the same.
Many organizations assign accounts to billers based on payer. That's helpful for building core knowledge about a payer. It's not so great if the new incentive plan holds the person working Medicaid accounts to the same standard as the person working Medicare accounts. Specialty differences also can make a big difference in how long claims remain in accounts receivable - and the work involved in getting claims paid. Before implementing your incentive plan, work with employees to 'weight' the various payers, using Medicare as the standard; they'll have a good sense of the differences. In many states, Medicaid consumes twice as many resources - and time - as Medicare; Workers' Compensation may be three times as hard. The weightings won't be precise, but your incentive has a far better chance of success if performance goals - say, 25 days in receivables outstanding for Medicare, but 50 for Medicaid - are relevant to the payer mix, as well as to your organization and your market. Expect to revise goals over time - a change in your computer systems or payer mix, or new software in the state's Workers' Compensation program - can change things dramatically.

5. Distribute in a timely manner.
Memories are short. Keep the incentives tightly linked to the performance by distributing rewards soon after the end of the monitoring period, no more than 30 days. Because monetary rewards are - sadly - taxable income, you might find it easiest to distribute them as part of the employees' regular paychecks. Make sure to give each employee earning a cash incentive a written statement of the gross amount of the reward. Distribute the statement separately, either with or before payroll distribution, so employees can see what they earned before Uncle Sam and the state took their cuts.

6. Establish clear expectations regarding measurements, including formulae.
A clearly drawn incentive program is immediately understandable and can be easily tracked by participants. If the plan is too complex, billers won't understand what you want them to accomplish. Worse, they question the plan's - and your - fairness. If the indicators and formulae are clear, employees will know what to do reach your intended goals. Spur competition by making and displaying charts of progress on indicators or distribute printouts at each staff meeting. It will make a bigger impact than burying the progress reports in the computer network.

7. Keep in mind...less is more.
The mantra "less is more" isn't just for environmentalists. Small rewards - $25 to $50 per month - can be quite effective. Ask billers to suggest reward amounts; you might be surprised at the relatively modest amounts they consider worthy. The same goes for incentive plan criteria: keep them short and sweet so everyone will understand what they need to do to succeed.

8. Put the plan in writing.
It sounds so obvious, but your plan must be written down and readily available to employees. Hand out copies when you announce the plan and put copies on your organization's intranet or internal server.

9. Evaluate annually.
Review your incentive plan's overall results annually against the performance it is supposed to inspire. In some cases, you may be able to put a cash value on the plan's impact: for example, the number of reduced denials from practice-caused errors times the cost of reworking a denied claim. Once you reach a goal, such as collecting 100 percent of patient copayments at time of service, move on to other targets.

10. Consider non-monetary awards.
The problem with most financial incentive plans is that they become an expectation, which means they are no longer motivating better performance but merely maintaining the status quo. Staff may come to view the additional cash as part of their normal compensation. They may even start depending on it. After the plan expires, morale (and results) can suffer as staff perceive that you took something away from them.

You can alleviate many of these issues by sticking to short-term plans-three to six months. Better still, consider a non-monetary incentive plan. Non-monetary awards can work well, and maybe better than cash awards, because they are perceived as more spontaneous and sincere.

Try these ideas to reward billers for reaching goals:
Offer an award - a fancy trophy, or a simple certificate.
Give a bag of popcorn, two movie passes and a note that reads: "Thank you for all of your hard work; Hope you'll relax this weekend!"
Place a rose in a vase on the employee's desk with a note that reads: "For all you do, this bud's for you!"
Send a bouquet of flowers to an employee's home with the message: "Where would we be without you? Thank you!"
Provide complimentary dinner delivery - or make trays of lasagna for everyone; accompany with the note: "Thank you for your hard work - hope you'll take the night off"
Don an apron, and walk around with ice cream sundaes and fixings.
Host a BBQ behind your building - for lunch, or take home.
Allow a casual dress Friday.
When choosing incentives - and there are as many as you can imagine - opt for the ones that best fit your management style and your organization's culture.

Medical Billing And Coding - Start A Business And Work From Home Or Get A Job?

Many people interested in the medical billing field as a career or medical coding profession have wondered whether they should get a job as a biller or coder or start a business and work from home. Many need the security of knowing they're getting a paycheck every week or two and others don't realize exactly what it means or what it takes to start up a medical billing business.

Although I do know someone who started her own business right after getting medical billing training it's not the usual course after one gets their education or training whether from an online school or from their local college or university campus. If you're inexperienced in this field it is much better to go to work for a billing service, hospital, clinic or doctor's office to get some good experience first and then decide what to do.

Even after you get a little or even a lot of experience, starting a business at home requires some upfront money and most of all clients, not to mention all the requirements of local business licenses and overhead. Getting your first client will be difficult without being able to give testimonials from clients you've already done work for. Buying medical billing software can be expensive also and there is a learning curve to contend with. The software is complicated and isn't as easy as just plugging in some numbers. Every insurance company and medical office has different rules to follow and this requires some time to master.

After you have scouted out all the local billing services and talked to people in the human resources departments to find out what jobs come up occasionally you'll know if there are sufficient employment opportunities in your city or town. This will be where you want to start whether you decide after getting some experience whether you want to start a home business or not.

So when mulling over whether to start a business and work from home first or get a job and work for a billing service, hospital, doctors office or other company that needs to hire billing employees, it would be safe to say it's probably not a good idea if you don't have the experience or a client lined up already. If you know a doctor who would be willing to give you a chance and your rates are significantly lower than the billing service he uses you may want to consider it. But take online or on campus courses and classes first to make sure you like the medical billing industry. There is federal money and financial aid available for online courses to save you money upfront. Make sure to research the colleges or online schools to make sure they're accredited by a recognized accreditation association.

Medical Billing - Reduce Your Health Care Costs by Making the Most of Your Doctor's Appointments

You may think as a patient, collector is the last person you want to see at the doctor's office. Why? Patients are afraid to deal with their medical bill that their insurance don't cover. Patients' think medical biller is just to collect payments from them. Patients don't want to find out what their responsibilities to pay the services they received from the physicians.

Biller is the best person to help patients and physicians to understand the benefits of having insurance. They are the one that verifies eligibility, insurance coverage for specific visit or procedures. Patients may not know who's the doctor that participate in their insurance or what facility that has contract with their insurance and this is where medical biller comes in. Medical billing services in doctor's office is a big help in everyday venture. They are there to help physicians and patients to focus on what's important- Health care. Before doctor's see the patients. patient services will collect insurance information, call insurance to verify for coverage, if patient has copay for each visit or even authorized for services. This will eliminate disturbance between doctors and patients time. Doing this ahead of time will be better in office set up. The doctor and patient relationship will focus on the treatment for what is important. It is less waiting time to see the doctor, less time sitting in the waiting room area of the doctor's office. It will put a smile on patient's face.

Now with changing world, there's a multiple physician's specialty, multiple insurance between HMO and PPO rules and policies to deal with. Medical Biller is an expert in dealing with this issues or challenges that comes between patients and doctors. They help in figuring out where patient can go to see a family physician, a specialist, verify what kind of benefits that patient has, what is covered and what is the share of cost for the services. It will give them peace of mind knowing the details of their visit and what to expect after the visit.

As you can see the importance of this position in the flow at the doctor's office or other health care facilities. They help facilitate a better way to handle issues with insurance, file claims in timely manner, verify eligibility before patients get to see the doctor. It eliminate health problems and stress after receiving medical bills. They are there to smooth and ease the flow in the office. It is a better way not to waste time preparing paperwork and use the time in patient care.

Medical Billing Software - 10 Questions To Ask Before Making Your Purchase

Avoid buyer's remorse. Do your homework before purchasing medical billing software for your practice or billing service. Review and think about these 10 questions prior to scheduling software demonstrations. Make your buying decision based on facts rather than emotion.

What are ALL the costs associated with this purchase?

When buying a medical billing software system, the software itself is only one of the costs in the total purchase price. Other initial costs include hardware, installation, and software training. Ongoing costs include software upgrades, technical support or maintenance, and electronic claims billing. These costs vary depending on the type of system.

Some desktop systems require expensive hardware. Web-based medical billing software has fewer hardware costs but higher monthly maintenance costs. Avoid costly surprises by obtaining all this information in writing prior to making a commitment.

Is the software easy to use?

A medical office is a very busy place. You don't have the time to spend on the phone with Technical Support trying to figure out how to bill a claim or reprint a statement. Software should be intuitive and easy to use. Naturally, you have to expect to spend some time learning the nuances of your software, but most functions should be intuitive.

How long has the software been in use?

I ask this question because, there is no such thing as bug free software. The longer the software has been around, the more likely the bigger defects have been worked out.

How long has the company been in business? How many employees do they have?

If a software company is too small, they may not have a staff that is large enough to handle big upgrades or unforeseen system problems. The longer they have been in business, the better.

What type of software training program does the vendor offer?

Online training is best because you can schedule shorter training sessions. Periods of 2-4 hours are ideal for new system users. Avoid the full day, on-site training sessions when possible. They are convenient for the vendor but not cost effective for the practice. The office staff tends to burn out by the end of the day and forget a lot of what has been covered. Most people learn by doing. Don't schedule your training until you are ready to use your system.

How good is the Technical Support?

When I first start working with a new software vendor, I pick up the phone and call Technical Support and start the timer. How long does it take for them to answer your call? Also, beware of companies that rely primarily on email and fax support. Software vendors cut costs by handling their technical support this way but it is very inconvenient and time consuming for you.

What EHR (electronic health records) software does the medical billing software integrate with?

One of my clients decided to buy an electronic medical records software package that did not link to his medical billing software. The salesman told him that it was no problem. They could develop a link for him. A year later, they have no link and his office staff is still entering demographic data into two systems.

The best medical billing software is one that has a built-in HL7 link that will integrate with several different electronic health records systems.

Does the software address the critical needs of your type of practice?

Just because the software works great for Dr. Smith's office down the street, doesn't mean it is automatically the right software for your practice. Let's say Dr. Smith is a specialist and you are a family practitioner. A software feature that allows you to lookup CPT and diagnosis codes by description isn't all that important to him, but it certainly is to you. Make a list of the features in your existing software that you love, what you don't like, and what you'd like to have.

Expensive software is not necessarily better. It's a fact that most people use only a fraction of the features in their software. The question to ask yourself, do I really need all the expensive bells and whistles?

Keep in mind your most basic features: scheduling, HIPAA compliance, electronic claims, patient statements, Aging Reports. Advanced features will include medical coding software, revenue and insurance denial management, automatic EOB posting, and insurance eligibility.

Can you take a test run of the software or is an online demonstration available?

Typically, an online software demonstration doesn't give you the time you need to adequately review a medical billing software system. Don't be shy about asking for access to a sample database to play with. Some software vendors offer downloadable demos that you can install and try out. If that option is unavailable, find out if there is an office nearby that uses the software and ask the office manager to show you the software. Most people are quite agreeable to do this.

Get references.

Most people make purchases based on emotion. Salesmen are salesmen and they will offer you the sun, the moon, and the stars to get you to buy their solution. That's why it is so important to obtain SEVERAL references of practices that have been using the software for at least a year, not just a few weeks. If the vendor can't provide them, walk away.