OB/GYN Billing

As you know, obstetrics and gynecology are technically two separate medical specialties dealing with the female reproductive organs, differentiated by whether the woman is in a pregnant or non-pregnant state.  However, the two specialties are usually combined to form a single surgical-medical specialty which enables the physician to care for his or her patients prior to, during, and after pregnancies.  This creates a broad range of conditions that the practicing OB/GYN will treat and many different procedures that the physician will perform.

As an OB/GYN medical billing specialist, knowledge of the specialty is vital to ensuring that the billing is being handled correctly.  The medical biller must play close attention to detail.  They must understand what is included in a global obstetrical package, and what can be billed separately…for all insurance carriers.  They need to be knowledgeable on how to receive full reimbursement for all medications, injectibles, and devices the physician may use.

The medical biller must also have a complete understanding of Well Woman Exam coding.  The biller must know which insurance plans will pay when a G0101 (Cervical or Vaginal cancer screening), Q0091 (Screening papanicolaou smear), S0610 (New patient-annual gynecological exam), or S0612 (Established patient – annual gynecological exam) is submitted.  Some pay for a specific code, and some with a combination of the codes.  Other payers will pay when submitted with a Preventive Visit (9938*-9939* codes), and others when included with an Office Visit (9920*-9921* codes).  The biller must also know what diagnosis codes are required to be submitted with the above Procedure codes.

The OB/GYN specialty requires knowledgeable billers that have both education and experience handling all aspects of the specialty.  If the medical biller doesn’t understand exactly what the insurance carriers require so that the physician can receive full reimbursement, then the denied claims can accumulate rapidly.  No physician can afford an interruption in cash flow, especially if it is due to inexperience.  Every OB/GYN desires full reimbursement for his or her services, and it is vital to have a qualified biller that is up for the task.

Medical Billing Services & Solutions

Internal Medicine Billing

The billing process for Internal Medicine practitioners is different than many specialties.  The American College of Physicians defines internists as “physicians who specialize in the prevention, detection, and treatment of illnesses in adults."  Internists must be skilled at managing patients who have undifferentiated or multi-system disease processes.  Internists will see patients in the office, at the hospital, in nursing homes, and also in skilled nursing facilities.  In summary, Internal Medicine is a broad specialty with many different aspects, all of which bring something unique to the medical billing process.

As a medical biller, it is important to make sure that you understand all aspects of Internal Medicine to ensure that the job is done correctly.  Since many internists see up to 40 or more patients per day, one simple mistake can result in 200 “simple” mistakes over the course of a week.  Just as the doctor has a background in coding, medical billers must also have a background in coding to make sure that what they are submitting to insurance companies is correct.

Someone handling the medical billing for an internal medicine practice should have a comprehensive education on what constitutes a Level 1, 2, 3, 4, and 5 office visit.  They should also be knowledgeable on ICD-10 changes that will eventually occur.  An Internal Medicine Biller should understand how to handle the billing of hospital charges, nursing home visits, and SNF encounters.  Collecting full reimbursement for immunizations and injectable drugs poses its own challenges.  Properly submitting charges for in house/CLIA waived labs is another aspect of the specialty that is unique.  To top it all off, we haven’t even discussed A SINGLE PROCEDURE yet!

Due to the volume of charges that Internal Medicine Practices produce, if an inexperienced biller is in charge, it can get costly, very quickly.  It is easy to submit claims to the different insurance carriers.  It is not easy to make sure that what was submitted is correctly submitted. 

The key to receiving full reimbursement is having the knowledge of how to submit the charges correctly the first time.  Then the biller must rigorously appeal all denials to make sure that the practice receives full reimbursement.

Medical Billing Services & Solutions

Avoid CO-16 Denials for Missing Information (Immunizations/Injectible Drugs)

As you know, the fall is flu shot season.  When billing for an immunization, such as a flu shot, CMS requires the NDC code to be submitted along with the claim.  We recently submitted a Medical Billing Tip to our software vendor, and won the contest for the month of November.  Granted, this is specific to Kareo, but it may apply to many other medical billing software platforms as well.



Avoiding CO-16 Denials for Missing Information

CMS requires that immunizations and injectible drugs include the 11 digit NDC code be submitted on the claim.  The FDA website and the packaging label generally only list 10 digits.  The NDC code is a unique 10 digit, 3-segment number.  The first segment is the labeler code, the second segment is the product code and the third is the package code.  The configuration will be in one of the following formats:

4-4-2 or 5-3-2 or 5-4-1

The code submitted must use the following format:  5-4-2

Therefore, when you enter the NDC code in the Kareo procedure file, follow the format rule of 5-4-2.

Example:

On a code on the packaging label is 4-4-2, you enter a leading zero in the first segment.

On a code that is 5-3-2, enter a leading zero on the second segment.

On a code that is a 5-4-1, enter a leading zero on the third segment.

This will stop any CO-16 denials for missing information.

Bob Nichols
Medical Billing Services & Solutions
Chesapeake, VA