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| An Example for Billing |
To Look For Reimbursible Dollars Amount:General BillingSupper Bill Sheet helps tremendously. Sample websites include:
A super bill is a form used by medical practitioners and clinicians that can be quickly completed and submitted to an insurance company or employer for reimbursement. A perfect superbill must be efficient and easy to read for a fee for service medical house call practice. It contains your personalized medical practice information at the top right hand side. Fields include a line for patients name, social security number, date of birth, diagnosis, date of service, doctors UPIN number. Service entries include New/Established patient visit, injections/medications, laboratory, pulmonary, IV infusion, cardiology, procedures and other services. These services are customized to your need. Nowadays, many professionals do not work directly with insurance companies. That is, they are do not sign up to be a part of a medical panel or part of an insurance panel; they work as independent consultants. As such, a need arose to provide patients and clients with a document that could be submitted to insurance companies that would allow clients to be reimbursed by their insurers. A superbill can be prepared for you at the time of an office visit, or if you see your medical practitioner frequently, it can be prepared for you weekly or monthly. The superbill should contain the following elements:
Once you receive your super bill, check it for accuracy (make sure the dates/times of your visit and the amounts you paid are correct). Then simply submit the document to your insurance company for reimbursement. Your insurance company MAY reimburse you depending on the level of coverage you have. Prior to starting work with a clinician who uses super bills, you should contact your insurance company and say, "I want to work with an out-of-network provider, how much will you reimburse me?" The only way to know for sure what your insurance company will pay is to ask them directly, or better yet, get it in writing via fax or email. Quickest way is still using Medicare website: http://www.cms.hhs.gov/PFSlookup/02_PFSSearch.asp . Please be aware that should you choose to submit a super bill, you are releasing medical information that is protected by law. This means you are waiving some of your rights to privacy and confidentiality. Your insurance company will have and keep a record of your diagnosis as part of your permanent medical file. These files can be used by insurance companies to set your rates and to allow or disallow further treatment. What CPT codes do I use to bill a visit to a patient's home or to an assisted living facility?Home visits are billed using codes 99341-99350. Visits to domiciliary care facilities are billed using CPT codes 99324-99337. For specific code information, including, Approximate Medicare Allowable Charges, see our booklets, "Making House Calls a Part of Your Practice," or "Making Home Care Work in a Medical Practice." These booklets are updated annually. How do I bill for hospice?Effective April 1, 2002, CMS implemented the following changes in reporting services for hospice beneficiaries. All bills submitted to Medicare carriers for patients enrolled in a Medicare hospice program must contain one of the following modifiers: What codes do I use to bill a prolonged visit?Prolonged Evaluation and Management Services are now covered for house call codes. For example, if an initial house call Level 4 (CPT 99344) has >90 minutes with the patient, both 99344 and 99354 could be billed. If a subsequent house call Level 4 (CPT 99350) has >90 minutes with the patient, both 99350 and 99354 could be billed. Additional hour increments could be billed using CPT 99355. "15511.1 PROLONGED SERVICES AND STANDBY SERVICES (CODES 99354-99360) A. Required Companion Codes. Pay prolonged services codes 99354-99355 when they are billed on the same day by the same physician as the companion evaluation and management codes and: What codes are used to bill for certification and re-certification?The HCPCS code for initial certification of home health care patients is G0180. This code applies only to new orders and there should rarely be more than one bill for a particular patient during any 60-day interval. Code G0179 is used when a physician re-certifies a subsequent episode of care. Typically, this will occur every 60 days in prolonged episodes and may also be used if a patient requires a complete renewal of orders midway through a 60-day interval due to a change in condition. (Be careful not to use this code when certifying medical equipment and other services, and note that it does not apply to the many "change orders" or other documents that a home health agency sends for physician signature throughout the care process).
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