Medical Billing Forum

Billing => Billing => Topic started by: CharleneF on August 30, 2016, 03:08:43 PM

Title: Billing for Extended TIme
Post by: CharleneF on August 30, 2016, 03:08:43 PM
I am billing for a client who was with a patient for 6 hours doing diabetic education and showing the patient step-by-step process on administer is insulin.

The office initial billed 99215, with 99354 and was denied the 99354. they have since gone back to bill 99354 (1 unit) and 99355 (3 units) - which is currently pending with MCR. They want to hire me to help them monitoring their billing and for me to see if they are getting the max reimbursement back for their services. So with that I am stuck in a few areas.

1. What is the proper way to bill extended time?
2. What is the best way to charge to monitor their billing?
3. What do I charge to review claims to see if they are getting the maximum amount for reimbursement?

Title: Re: Billing for Extended TIme
Post by: kristin on August 30, 2016, 08:32:11 PM
I will try to help, based on what I know about prolonged service codes, and for how to charge for your services. (Hopefully others will jump in with their advice also)

The 99215 is for an average of 40 minutes FTF between provider and patient. You have a provider who spent 360 minutes with a patient. So taking into account the 40 minutes for the 99215, that leaves 320 minutes of prolonged services that need billing. The 99354 accounts for the first 60 minutes of that time. So now you have 260 minutes left to bill. By billing the 99355 at 9 units, you cover the remaining time, and it is legitimate, since you only need 15 minutes of the 30 minutes for a 99355 to bill it. Everything I have read says that the 99355 as an add-on code has NO limit to units that can be billed.

The billing would then be:
99215(1 unit)
99354(1 unit)
99355(9 units)

All of that said, I can see where the claim may need the treatment note sent in, for Medicare to review. If the claim continues to deny, I would absolutely do that, assuming the documentation on time spent is very, very clearly spelled out. There are numerous articles on the internet about how prolonged services should be billed, that you can check out.

As for how to charge for the services the office would like you to perform, my opinion is that you need to do this for an hourly fee. What that hourly fee should be can only be determined by you, but it should be somewhat high, because auditors get paid quite a bit for their services, as do consultants, and that is basically what you would be. You could start out by reviewing their most billed codes, making sure their fees are set correctly, then move into auditing/reviewing a sampling of their claims. Then from there, set up a process to monitor their billing. At some point, you shouldn't need to do that anymore(or can do it maybe quarterly or something), if you have them properly educated on what they can and cannot bill, and you see that they are following your recommendations.
Title: Re: Billing for Extended TIme
Post by: Michele on August 31, 2016, 07:19:40 AM
Ditto to what Kristin said.
Title: Re: Billing for Extended TIme
Post by: CharleneF on September 03, 2016, 08:25:54 AM
Thank you so much - this has helped an awful lot.