Boxes 12 & 13 on the CMS 1500 form are very important but are often overlooked. By overlooked, I mean that most medical billers don’t understand the importance of the boxes and just blindly fill them in.
It is important to understand what these fields ask for and to make sure they are filled in appropriately, because they can seriously affect claims payment if not completed properly.
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The question of whether to outsource medical billing operations or keep the process in-house is one that weighs heavily on many doctors and practice managers. The right answer differs from practice to practice based on a multitude of factors: age of the business, size of local labor market, and state of practice finances, among other considerations.
Aside from clinical services, billing and revenue cycle management are the most important processes of your practice. Your cash flow depends on them, so the decision of how to handle these services shouldn’t be taken lightly. You should do thorough assessments of your practice’s cost, staffing, and volume metrics to determine what’s right for you.
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Many billers do not really understand modifiers or when they need to be used. Modifiers should be added to CPT codes when they are required to more accurately describe a procedure performed or service rendered.
A modifier should never be used just to get higher reimbursement or to get paid for a procedure that will otherwise be bundled with another code.
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Sometimes an office is reimbursed too much money for services provided, which results in an overpayment. The insurance carrier usually makes the overpayment, but sometimes the patient makes it. In either case, it is important that the overpayment be promptly returned to the appropriate person or payer.
If a patient pays more than they are required to, the patient must be notified as soon as the overpayment is discovered. The practice has a couple of options on how to handle the overpayment, but the provider cannot legally hold on to the money indefinitely.
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