| We all live in our own little world. What we see in front | | | | regulations. Oxygen, as an example, is highly regulated. |
| of us is pretty much all we believe there is. In the world | | | | Much more so than simply setting a broken leg. You're |
| of medical billing, this can be a nightmare waiting to | | | | going to have to jump through more hoops billing the |
| happen when it comes to doctor files. Why? Well, | | | | doctor for the oxygen claim than for the doctor who |
| there are quite a few reasons. We're going to cover | | | | set the broken leg. Again, how does this affect the |
| some basic things you will need to know about your | | | | setup of the doctor file itself? |
| doctor files before setting them up in your DME billing | | | | Each doctor file has a number of fields. One of the |
| system and then afterwards when you're getting | | | | most important of these fields is the category that the |
| ready to bill them. | | | | doctor falls into. This category must be transmitted to |
| The first thing you need to be aware of is that if you | | | | the insurance carrier, either on the paper claim or in the |
| are a medical billing agency, you will most likely be billing | | | | electronic billing format in the doctor record. Because |
| all kinds of claims. They can range from people with | | | | of this, you want to make sure that when you setup |
| broken legs who need wheelchairs to people who | | | | your doctor file for each doctor that you include the |
| have smoked for 50 years and now need oxygen | | | | correct category. What happens if you don't? Simple. |
| because of it. Both bills require not only different pieces | | | | The claim will be denied and for reasons that you can't |
| of information to be sent but different kinds of doctors. | | | | even comprehend, not the least of which is that the |
| Most likely, the patient with the broken leg has gone to | | | | doctor isn't authorized to perform the procedure. It |
| an orthopedic surgeon. The patient with the bad lungs | | | | might seem like a simple and stupid thing, but it's the |
| probably went to a heart or lung specialist. Why does | | | | simple things that usually trip up most claims. |
| this matter when it comes to billing for services | | | | When you're actually billing the claim, after the doctor |
| rendered? | | | | files have been set up, you want to make sure that |
| For starters, these doctors have different kind of billing | | | | you're pulling the right doctor for the patient. The way |
| practices. They also belong to different medical | | | | this is usually done is by a cross reference in the |
| agencies, even though they both fall under the general | | | | patient file to the doctor file itself. This way a screw up |
| blanket of the AMA. Why does this matter? Because | | | | isn't possible, unless the initial cross referencing is done |
| the way each doctor's insurance is set up with the | | | | incorrectly to begin. That's why you need data entry |
| various agencies such as Medicare and Medicaid is | | | | specialists who have to be extremely careful. |
| different. Each is governed by different rules and | | | | |