Genomic billing changes for 2012

Coding for molecular diagnostics billing and genomic billing is in the process of changing radically. Traditionally these laboratory tests are coded and billed using codestacks, meaning a list of several component codes that may include one or many units of each CPT. This was due to the fact that rapid advances in genomic testing have markedly outpaced the development of new coding from the AMA and CMS. Some of the more common CPT codes in the codestacks for molecular pathology (83890–83914) include:

• 83900 Molecular diagnostics; amplification, target, multiplex, first 2 nucleic acid sequences
• 83914 Mutation identification by enzymatic ligation or primer extension, single segment, each segment (eg, oligonucleotide ligation assay [OLA], single base chain extension [SBCE], or allele-specific primer extension [ASPE])

As of January 1, 2012, the American Medical Association (AMA), who develops and owns the rights to the CPT4 codes, has directed that codestacking should be chosen only as a last resort if one of the new more appropriate codes is not available. They have created a new set of tier 1 pathology / laboratory billing codes that analyte specific for the most common molecular pathology tests. If there is no tier 1 code that applies, there are now a series of tier 2 codes that are classified by nine resource level codes determined by the level of resources required for performance and interpretation. This new set of genetic testing billing codes (tier 1 and tier 2) are intended to apply to 85% of the volume of genomic billing.

As of January 1, 2013, the AMA will be deleting the codes for codestacking, so these will no longer available.

Will everyone follow the AMA?

HIPAA technically requires that everyone use a common coding language for electronic communication, which is the AMA’s CPTs. However, many commercial payers are slow to adopt new coding rules…if ever. Even CMS has not adopted the new rules for molecular diagnostics billing yet.

One of the CMS carriers - Palmetto - began a policy to address coding for genomic laboratory billing. They no longer pay codestacks and now require genetic laboratories to submit an application with documentation for the genomics test in order to get approved. Approved tests receive a new code (a Z code) and have a reimbursement level assigned. These approvals are publicly available from Palmetto. To date, no other Medicare carrier has implemented this, but it is likely other carriers will follow or move to the new AMA codes.

Commercial insurance carriers like Anthem, United Healthcare, CIGNA, for the most part have not yet switched over to the new codes and have been paying codestacks, even after January 1, 2012. It is even likely that some payers will continue to accept the old codes after January 1, 2013, but since payers are trying to control the explosion in costs associated with molecular diagnostics billing, they have an incentive to use the new codes.

Anesthesia Billing

The Many Complexities of Anesthesia Billing

As a patient or an anesthesiologist, billing is a central element of any surgical procedure. When patients face any procedure, it can be easy to become overwhelmed with the many confusing terms and billable items. Anesthesia billing can be one of the most complex components of surgery. Although to the patient, anesthesia is just another part of the surgery, it is in fact a completely separate billing issue because of how it is administered. Often, when a bill is received, the anesthesiology billing section leads to endless questions as patients seek to understand the total charges for the procedure.

What Does Anesthesiology Billing Include?

In order to understand the billing portion, it’s best to get a grip on what anesthesiology entails.  An anesthesiologist is a medical practitioner who specializes in managing patients rendered unconscious during a procedure.  This could be a serious surgical procedure, certain exams / tests, and other medical procedures, which require insensitivity to pain.  There are four basic categories of anesthesia:

1. Local Anesthesia:
   Local anesthetics are used to block sensation on a specific part of the body, usually a very small area. The anesthesiologist will inject the anesthetic drug into a small area in order to block nerve sensation prior to a procedure or test.


2. Regional Anesthesia:
   Regional anesthetics are used when it is necessary to block a larger number of nerves for more serious procedures. The most common regional anesthetic is an epidural, which is used during childbirth.


3. MAC / Sedation:
   This type of sedation is used on a smaller scale than general anesthetics and is typically administered via intravenous line.


4. General:
   For procedures where the patient needs to be completely unconscious, general anesthetics are used. These will render the patient completely unable to respond to questions or touch and completely insensitive to pain.

Why Is Anesthesiologist Billing Separate?

The biggest cause of confusion in the realm of anesthesiology billing is the fact that they are billed separately from the rest of the medical procedure. The reason for that is simple: in most cases, someone other than the surgeon or doctor performing the procedure will administer the anesthesia, which requires a unique set of billing guidelines. Anesthesia is administered by:

• Anesthesiologist


• Doctor of Medicine


• Certified Registered Nurse Anesthetist (CRNA)


• Registered Nurse Specializing in Anesthesia


• Anesthesiologist Assistants


• Locum Tenens Anesthesiologists


• Medical Residents


• Student Registered Nurse Anesthetist (SRNA)

The Importance of Anesthesia Billing

Because anesthesia is essential to the procedure, it’s important to make sure patients understand billing as they face surgery. In many cases, confusion is caused by a general lack of understanding about and / or appreciation of the service itself. One of the biggest issues leading to this misunderstanding is the lack of personal rapport between the patient and the anesthesiologist. By meeting with the patient ahead of time and explaining how anesthesia works, it’s much easier to eliminate the post-surgery confusion about anesthesia billing. The flexibility of billing and challenges of receiving payment make anesthesiology billing one of the most complex elements of surgical procedures.

California Medical Billing

Medical billing in California is a world unto itself. For anyone who has handled medical billing here, you are well aware of the fact that thanks to an ever changing and more complex coding system in the state, taking care of billing both your patients and their insurance companies has become very time consuming.

Consider how long it can take you to find an employee who understands the current complexities of dealing with insurance companies such as Anthem Blue Cross of California. According to recent data supplied by the AMA, Anthem has a well-earned reputation for paying far less per claim than any other health care insurance company in the state and they show no signs of changing this. Now when you add in the fact that in the latter half of 2013 all doctor's offices here in the state are going to have to face ICD-10 coding, you are going to need a highly trained employee.

After you have spent the money to train such an employee and they suddenly decide that the grass is greener in another office, you are going to be right back where you started. This is where you are likely to find that outsourcing your medical billing to a company like Cobalt Health can really pay off. Not only do we have a highly skilled staff on hand, we have developed our own highly sophisticated contract compliance software. We use this software to look at your insurance policy and determine exactly what your contractually allowed rates are.

Once we have this information, we can then appeal the underpayments and take the necessary steps to ensure that you get paid. And if this isn't bad enough, you are going to have to deal with California Medicaid or as it is more commonly referred to, Medi-Cal. This may be the most difficult medical insurance payer in the country, if not the world. Records show that not only does Medi-Cal have more claims denied than any other company, there are more mistakes made per capita and more "lost" claims than any other insurer in the United States.

When you have to rely on a part of your overall income from patients with Medi-Cal, not only do you have to deal with all of these paperwork problems, you are faced with the fact that the contracted rates paid by California Medicaid are the lowest in the country and are actually lower in many cases than the actual government published Medicaid fees schedule. This means that you have make sure you collect every dollar you can in order to even come close to getting paid for your services.

You are also going to find that in many cases when you are out of network provider for Blue Cross of CA or Blue Shield of CA, they are going to send the payments claimed directly to the patient instead of the provider. This can be a very bad situation as these companies do not send out EOBs and you are likely to have no idea if they have paid or how much they have paid. We will contact the payer after thirty days and find out how much they actually paid the claimant so that we can bill the patient for the full amount before they can decide to spend it instead of paying you the money you are entitled to.

Finally you are going to have to deal with patients who are covered under California Workers Compensation insurance. Once again, you are going to find the CA workers comp is very different from that of most other states. The reason for this is that the fee schedule is far more negotiable than most states and you have options such as a lien process to help you get paid should there be a dispute. You can use the 1997 CPT codes but there are others including CMS clinical lab codes and certain CA workers comp codes that are required in order for you to get paid.

As you can see, hiring a skilled employee is not likely to be the best choice if you want to ensure that you receive maximum compensation for your services. Cobalt Health is a medical billing company that specializes in working with physician's offices, hospitals, diagnostic testing centers and surgery centers. Our range of services is intended to help you realize the highest possible return on your billing utilizing a team of highly experienced coders and employees.

Legislating Digital Medical Billing

There are few things in the healthcare debate that both Republicans and Democrats can agree on. But when it comes to making modest technological advancements that will ensure easier access to patient medical histories and help doctors avoid dangerous drug interactions, elephants and donkeys alike say ‘yes’.

As the most recent healthcare bill goes for an up-or-down vote in congress this week, medical professionals wait to see if digital medical billing will soon be a mandated practice. But we at Cobalt Health are asking a different question. If you are still using paper-based medical records, what are you waiting for?

With experience in the latest front office software, Cobalt Health can completely overhaul your computer systems so everything from scheduling to patient registration to medical records and charts are right at your fingertips. And if you already have a computer system in place, we can connect it with other major practice management systems so you get the most comprehensive information available.

The complexities of medical billing can be as confusing as the medical practice itself. That’s why we offer surgical, orthopedic, ENT, otolaryngology, cardiothoracic and even laboratory billing.

Digital medical records are faster, easier to process, offer less confusion and can help prevent poor treatment. But beyond these conveniences, digital medical records offer something essential to your practice: security. Ensuring that medical records remain confidential is not only important to your patients and to the integrity of your healthcare center; it is also the law. All Cobalt Health systems are equipped with the latest security measures, making sure your data systems are in full compliance with all HIPAA regulations.

With safe, affordable solutions from Cobalt Health, there is no need to wait for congress to tell you to update your medical records. You can switch to the safer, easier choice and get ahead of the curve today.

Why Your Office Needs to Outsource its Medical Billing

What is the primary purpose of your medical practice? Why did you become a doctor? For most, the answer to both questions is "to help others". The patients needs and your dedication to serving those needs should come first. Of course, you should be compensated for using your skill set and perpetuating goodwill, yet do you have the time to keep track of medical billing management in the office? You could have present staff devote time towards patient billing, yet the process is highly meticulous and medical collections really should be a full-time process. Have you thought about outsourcing the duty of medical collections to professionals?

Think about the comprehensive job a dedicated and concentrated medical billing company could perform. What are some of the things they can do for your medical practice?

- medical coding
- editing and checking the validity of medical claims
- printing and mailing of patient bills
- fielding patient calls and contacting insurance agencies

Those are just a few jobs a medical billing company can address.

Now, let's discuss you. Would you like to make sure you are properly compensated for duties performed? Would you like to gain more time to focus on your core profession? Would you rather not deal with billing questions and medical coding? These questions relate to factors, which you and many doctors have to deal with each working day. As previously stated, the most important aspect of your job is addressing the needs of your patients. The health field is meant to serve mankind; all other business matters are important, yet should not interfere with your primary focus. Medical billing agencies exist to help with the 'business' side of health care.

Would you like to see more money? Would you like to deal with fewer headaches? Would you rather focus on your profession rather than administrative duties? Would you like experienced and highly trained professionals conducting medical billing coding, patient billing, and the like? Do not hesitate to better the state of your office; outsource your medical billing needs to professionals who want to help you better serve others.

How a Medical Billing Service Can Help

The process of medical billing can be stressful for the parties involved. It can be a meticulous effort for medical offices, and stressful for patients and their health carriers if a bill arrives in error. Medical billing services work as a third party to ensure proper coding, medical office payment, and professional communication with patients' health care providers.

The following blog post addresses some of the ways medical billing assistance can help your office.

- Doctors and their office workers get paid through a patient's health care provider. If medical claims are done incorrectly, then the entire process is slowed down, which results in a delay of payment. Medical collection services make sure doctors are paid on time.

- Rules and regulations associated with medical claims and insurance policies can frequently change. Medical billing services stay abreast with changing policies to ensure the process is done correctly and in a timely manner.

- Doctors and their workers need to pay meticulous attention to their patients' needs rather than spending time on making sure associated payment papers are done correctly. Patient billing services provides the extra time for doctors to do their job in the best way possible.

- Medical claims services also send original and repeat notices to clients. If a client does not respond in a particular frame of time, then the medical billing providers can alert the doctor's office or refer the account to a collections agency. This is another portion of the billing process the doctor's office can evade while performing their core duties.

- Some medical collections providers offer consulting services to doctors' offices. Patient claims management consulting can involve credentialing, reviewing and negotiating insurance contracts, and developing and optimizing superbills.