Listserv Lately 21
by Suzan Hvizdash, CPC, CRN Senior Auditor, Instructor
For this week’s article, I thought I would demonstrate the vast variety of questions that come up daily on the list serve. So, for all those who don’t know if the list serve is right for your area, take a look at the last few weeks of subjects.
| HIPAA Regulations | New patient, two visits on same day |
| Consultation vs. H/P | C-Section w/ Vacuum Extraction |
| Diabetic Education | Book Codes vs. Computer Codes |
| CV Questions | Attempted Central Line |
| Fracture Repair | Failed Lap Choley |
| Office Policy | Accessory Digits |
| -25 Modifier | Billing Help Needed |
| Dx 733.01 | HASC Standardization |
| Certification | Form letter for Consultations |
| Hernia Repair | Questionable billing practices |
| 97033 | Services After Hours |
| HCPCS Codes | 2006 CPT Errata |
| Code 15000 | Item dropped in the OR |
| Scar Revision | Alpha Suffixes for Medicare |
| -22 Modifier | Passed CCS-P |
The list goes on and on.
The subject that I thought to highlight this month dealt with Overpayments. The discussion was lively and extremely informative. I love how much I learn from this list!
The overpayment question was interesting. In summary, can an office set a limit on how small a refund should be when sending it back to an insurance (if self discovered)? Does this dollar amount have to be an across the board decision?
One lister suggested returning any and all money but ask the payer to make the request. Some payers won’t bother with the small dollars. But, sending a payer money without getting a “request for refund” letter may send that money into the abyss. Another comment was to make certain to refund all government payers as quickly as possible. There are also Escheat laws that need to be adhered to when dealing with the state funded programs. In Washington state, it was suggested to make certain that if the payer was Medicaid, have them ask for the money (there’s a form you can complete for this request) as it often gets improperly applied. Premera doesn’t request refunds less than $25, as mentioned by another lister.
This discussion spawned another overpayment question. What if the physician’s office owes the patient a refund? Shouldn’t this also be refunded in a prompt manner. The accounting department seems to think that only if the patient complains does it need refunded. One lister provider a nice book reference to take back to that accounting department. Essentially, returning credit balances in a timely fashion is just one component of an efficient compliance program. Yet another poster gave a website to check the state laws http://www.auditservicesltd.com/uplaws/. Continuing, someone else made mention that if the money isn’t going to the patient, it should go to the state. Again, the Escheat laws of the state could govern these refunds. Most insurance contracts have clauses that indicate how to properly refund their patients when overpayments occur. If you’d like to read the entire chain on this one, you could start at http://health.groups.yahoo.com/group/CRN-L/message/53443.
As always, see you on the list and in the meantime…
Joining the list serve: $0
Asking questions on the list serve: $0
Reading your bi-weekly CRN newsletter: $0
Advice received on the list serve: Priceless
The value of reading your bi-weekly CRN newsletter: Priceless
Until next time,
-- Suzan