Author Topic: Missng ER levels  (Read 5628 times)

Ashpr

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Missng ER levels
« on: June 11, 2014, 01:53:35 AM »
Hi! I'm doing a training and I got this question that I have no idea what to answer. Please help!

In the course of auditing you note a number of ER and facility-based clinic accounts without an E&M code under the 450 and 510 revenue codes respectively.  After successfully validating a number of missing charges, the client asks you to provide them with a general idea of when ER/clinic accounts without these visit level charges would be acceptable.  Within the context of generally accepted best practices across the industry, what overall feedback might you provide them with in terms of indicating scenarios where the absence of such E&M charges would be expected?

Thanks in advance

DMK

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Re: Missng ER levels
« Reply #1 on: June 11, 2014, 01:02:18 PM »
Why are you asking the forum to do your homework?

Michele

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Re: Missng ER levels
« Reply #2 on: June 12, 2014, 09:49:03 AM »
Unfortunately your question doesn't make sense outside of the context of the course you are taking.  We don't mind assisting people with billing issues/questions but helping with specific homework is not really what this forum is about.  One of the problems that we see with most of these courses is that the material is often irrelevant to real world billing which is what I get when I read your question.  I've been in the industry for 25 years and I have never encountered a situation where I would need to know that.  That is what prompted us to build our online course - to teach students what is really needed to be able to have a career in this field.

Best of luck.
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Ashpr

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Re: Missng ER levels
« Reply #3 on: June 12, 2014, 04:16:28 PM »
DMK... That was rude!
Yes it is a billing question where ER charges are missing for various reasons, and when you have an ER claim without the ER charge level, that's going to be a rejected claim. so I was asking if someone know another reason for the ER not to be charged. I just wanted to be sure of what I ALREADY answered. that it was this, just in case you didn't and apparently don't know the answer. but Thanks anyway. Specially DMK for being so rude. SMH

The only time an E/M level would not be placed on an account is:
1) the patient leaves the ED with no treatment from the dr
2) if the patient is seen in triage by the nurse and only vitals were taken and they did not go back into the room.

These are the only reasons of where the E/M level does not apply

PMRNC

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Re: Missng ER levels
« Reply #4 on: June 12, 2014, 06:37:21 PM »
With all due respect, she asked you a legit question, it was you that said it was a training question. It's important to your training that you do your own work and research.

Linda Walker
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Re: Missng ER levels
« Reply #4 on: June 12, 2014, 06:37:21 PM »

jmgiusti

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Re: Missng ER levels
« Reply #5 on: June 12, 2014, 07:01:10 PM »
As an "apparent" newbie, I read a lot of posts in here, and I appreciate the experts and all of their input, I didn't think the post was "rude". The experts are just requesting that we execute "due diligence" before posting. Ashpr looks like she had done some of that, at least by the last post, but it wasn't shared in the first post where she stated "she had no idea how to answer the question".

Experts, please continue to be stern with us, in this way you ensure that the providers we sign up are getting a person that is research based and analytical, someone they can trust with their revenue cycle as well as someone who knows how to utilize their "resources", such as this forum when they have to reach out to their community for advice.

Thanks again!

Ashpr

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Re: Missng ER levels
« Reply #6 on: June 12, 2014, 07:14:18 PM »
That's what people are doing here research and ask help on things that they haven't found their own answer while research, or what's the point of having a forum for people to ask things that they don't know or are not expert if they can't ask? I just wanted for some other opinions. the problem to not help here is because I used the word "Training"? so I assume it would of be different if I wouldn't use that word. I did my research. just wanted a little advise. but thanks anyways. It always good to find "experts" that send to do your own research instead of help. Have an awesome evening.

Michele

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Re: Missng ER levels
« Reply #7 on: June 13, 2014, 09:07:02 AM »
Hi! I'm doing a training and I got this question that I have no idea what to answer. Please help!

I just wanted to be sure of what I ALREADY answered. that it was this, just in case you didn't and apparently don't know the answer. but Thanks anyway. Specially DMK for being so rude.


We don't mind helping people and since we all do this free I think that is obvious.  You clearly stated this was a homework question that you had no idea how to answer in your first post, then insulted people in your second.  The word training was not the issue.  If you go back and look through the posts you will see that much help has been provided to many 'in training'.
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DMK

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Re: Missng ER levels
« Reply #8 on: June 13, 2014, 01:20:23 PM »
I appreciate the support for, what I thought, was a legitimate question.  The "question" asked was a homework question.  If you had posted what you thought was the correct answer, and were looking for guidance or reassurance that it was the right answer, I would not have posted my response.

It was not intended to be rude.  It was to the point, you said it was a "training" circumstance.

Many people, myself included, post hypothetical questions that we come up within our day to day work.  Hoping that we know the correct procedure.  Sometimes we're right, sometimes not.  Most of the people on this forum are working in the industry.  And you'll notice that the "rules" are different for different insurance companies, different types of practices, and different regions.

In your upcoming career, you'll need to have thicker skin.  You will be questioned by your employer, you will have to learn new sets of rules as the rules change over and over.  It's not personal, it professional.  If you get your feelings hurt every time someone questions you, you will have a hard time in ANY profession.  And more so when there is money (someone's income) involved. 

I am really glad that you stood up and related that you HAD the answer and wanted to verify that it was correct.  But you should have stated that in the first post.  Re-read your original post, and then look at it from the other side.
« Last Edit: June 13, 2014, 04:02:08 PM by DMK »

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Re: Missng ER levels
« Reply #8 on: June 13, 2014, 01:20:23 PM »