Medical Billing

Fee schedule has the direct impact on physician’s payment, it will calculate based on three factors. 1)       RBRVS 2)       Geographical practice cost index 3)       Monetary conversion factor Let’s see in detail about RBRVS Its used by Medicare and almost all the public and private payers  RBRVS calculated based on three factors 1)       Physician work accounts 52% 2)       Practice expense 44% 3)       Malpractice expense 4% RBRV = (Total Work)(1+RPC)(1+AST) RBRV + Total work *Specialty Practice cost index*Specialized Training Cost Index. Total Work = Time×(Complexity Index) Complexity index = “sweat factor” Includes Pre- + Intra- + Post-service work Based on surveys of physicians

Correct Coding Initiative (CCI) Modifier: Modifier 59 does not replace modifiers 24, 25, 50, 51, 78 ,79, RT and LT Modifier 59 is not used on Evaluation and Management CPT codes. 99 Multiple modifiers - Use only when more than four modifiers are needed to describe a service. The additional modifiers should be included with the claim (item 19 on paper submissions, or appropriate message or freeform area on electronic submissions).No effect on payment; however, the individual modifiers listed will apply, including any potential effect they may on payment.

AP Determination of refractive state was not performed in the course of diagnostic ophthalmological examination. No effect on payment. AQ Physician providing a service in an unlisted health professional shortage area (HPSA). For dates of service on or after January 1, 2006. AT Acute treatment (chiropractic claims) - This modifier should be used when reporting CPT codes 98940, 98941, 98942 or 98943 for acute treatment. No effect on payment.   CC Procedure code change- CARRIER USE ONLY - Used by carrier to indicate that the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed. No effect on payment. Payment determination will be based on the "new" code used by the carrier.   CR Catastrophe/disaster related . It is required when an item or service is impacted by an emergency or disaster and Medicare payment for such item or service is conditioned on the presence of a “formal waiv

Malcolm Baldrige Criteria for Performance Excellence. Sector Wise: Education Healthcare Manufacturing NonProfit/Government Services Small Business Malcolm Baldrige Healthcare Healthcare industries looking for improve safety and outcome & reducing cost. Health Care Criteria for Performance Excellence · Patient safety and patient loyalty · Health care outcomes for acute myocardial infarction, heart failure, pneumonia, and other conditions · Physician and staff satisfaction and engagement, especially among registered nurses · Revenue and market share · Community service The Baldrige Criteria for Performance Excellence Provide a systems perspective for understanding performance management. They reflect validated, leading-edge management practices against which an organization can measure itself. With their acceptance nationally and internationally as the model for performance excellence, the Criteria represent a common language for sharing