Answer: Modifier 24 is used to identify E/M (Evaluation and Management) services provided on the same day of the surgery by the surgeon but is unrelated to the surgery. In addition to HCPCS/CPT codes, add the 24 modifier to the E/M service.

• Modifier 25
• Modifier 53
• Modifier 59

Want your Medical Office question featured here? Submit your question in our forum.

_{Photo courtesy of Joy Hicks}

This week's Medical Office Topics

• 4 Ways to Get Paid: Understanding the different methods of payment is essential for the financial management of the medical office. Financial management includes all components of the revenue cycle including accounts receivable.

  Accounts receivables, also known as patient accounts, refers to revenues generated but not yet collected. To ensure cash flow is sufficient for effective management, the medical office has the responsibility to maximize it's revenue potential.

  There are four payment methods that should be considered when developing a financial management strategy... Read more

• 3 Golden Rules to Medical Office Management: The medical office manager is ultimately responsible for the success of the entire staff. Managers are required to distribute the work load, motivate and supervise staff, and coordinate the smooth operations of the office. Of course, when things go well, the medical office manager gets all the credit but when things don't go well they also get all the blame.

  No matter if you are managing the small staff of a physicians office or the billing staff in a hospital, the manager can accomplish the goals of the organization from the medical office aspect using various tactics.... Read more

• 8 Steps to Developing a Winning Upfront Collections Policy: An important part of the revenue cycle is upfront collections. Upfront collections reduce the number of patient accounts that end up in bad debt or collections status. It is easier to collect from patients prior to services being rendered than 60 days later after insurance has finally paid.

  Accuracy and consistency along with a system for determining and collecting patient responsibility is key for your upfront collections policy. When developing a policy for upfront collections for your office, be sure to include the following steps in mind.... Read more

Sign up for my Free Medical Office Weekly Newsletter!

Visit the Medical Office Forum to ask questions or express your opinion!

Diagnosis-Related Groups or DRGs are the basis for per episode payments made to the medical office on inpatient hospital visits.

DRGs are assigned a classification based on a combination of ICD-9 diagnosis codes, CPT and HCPCS procedure codes, complications or conditions present on admission (POA), discharge status, age and sex. DRGs also determine that the number of days, per episode, be within a certain time period which is the average length of stay (ALOS) necessary for adequate treatment.

Under special circumstances, the medical office may receive a cost outlier, which is an adjustment to the DRG payment to exceed the normal payment rate. These circumstances may be due to complications resulting in exorbitant costs from treating a patient that requires more costly care.

The complexity of DRGs can make coding inpatient claims a challenge. Proper claim coding plays an integral part in getting accurate DRG payments and the success of the medical office financial goals.

For more glossary terms, go to the Medical Office Dictionary.

Answer: The CMS-1500 is the red-ink on white paper standard claim form used by physicians and suppliers for claim billing. Although it was developed by The Centers for Medicare and Medicaid (CMS), it has become the standard form used by all insurance carriers.

Any non-institutional provider and supplier can use the CMS-1500 for billing medical claims.

• Physician services
• Physician assistants
• Nurse practitioners
• Clinical nurse specialists
• Nurse midwives
• Certified registered nurse anaesthetists (CRNA's)
• Clinical psychologists
• Clinical social workers
• Home dialysis supplies and equipment
• Ambulance services
• Clinical diagnostic laboratory services

When preparing the CMS-1500, use the following as a guide:

1. Ensure that all data is entered correctly and accurately in the correct fields.
2. Enter insurance information including the patient's name exactly as it appears on the insurance card.
3. Use correct diagnosis codes (ICD-9) and procedure codes (CPT/HCPCS) using modifiers when required.
4. Use only the physical address for the service facility location field.
5. Don't forget to include NPI information where indicated.