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Replacing 59 Modifier with X-Codes

28 Apr

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Are you still using Modifier 59? CMS replaced modifier 59 on January 1, 2015.

First, what is Modifier 59? Modifier 59 is used in medical billing to override the National Correct Coding Initiative (NCCI) edits which CMS created in the first place. Some services are included or bundled into other services and should not be billed separately. However, there are circumstances where it is appropriate to bill the services separately and the 59 modifier has been used historically to tell insurance companies this is one of those circumstances.

You can find the complete details on the creation of the new codes at by searching for the MLN Matters article MM8863. Please review this article in detail to gain a complete understanding of the changes.

The new modifiers used to replace the 59 modifier all begin with a letter X.

XE = Separate Encounter, A Service That Is Distinct Because It Occurred During A Separate Encounter,
XS = Separate Structure, A Service That Is Distinct Because It Was Performed On A Separate Organ/Structure,
XP = Separate Practitioner, A Service That Is Distinct Because It Was Performed By A Different Practitioner, and
XU = Unusual Non-Overlapping Service, The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service.

CMS will continue to recognize the 59 modifier, but notes that Current Procedural Terminology (CPT) instructions state that the 59 modifier should not be used when a more descriptive modifier is available. While CMS will continue to recognize the 59 modifier in many circumstances, they may selectively require a more specific X modifier for billing certain codes at high risk for incorrect billing. If you haven’t done so already, it would be a good time to review and adopt the X modifiers.

Billing Buddies ® Bullet Points is brought to you by Billing Buddies. Visit us on the web at I’m your host, Bonnie J. Flom. I have 34 years of medical billing experience and am a Certified Medical Reimbursement Specialist through the American Medical Billing Association. If you have any questions or comments, please email or call or text us at 612.432.2366. Our goal at Billing Buddies is to help optimize and expedite our providers reimbursement so they are better able to serve their clients. If you should need medical billing or training services, please contact us. Have a great day and happy billing.


Effective Follow-up Processes for Medical Billing

25 Apr

Watch our short YouTube video regarding creating effective follow-up policies for medical billing or read our article below.

Following-up on unpaid claims can be one of the most frustrating parts of medical billing. Follow-up really trails the old 80/20 principle. 80% of the claims get paid the first time, but the 20% that don’t get paid the first time takes 80% of your time. The trick to making follow-up more streamlined and efficient is to categorize your outstanding claims within three buckets; contract payers, non-contract payers, and self-pay balances.

Let’s start by reviewing the difference between your contract payer and non-contract payer claims. Contract payers’ claims are claims that you physically have a signed contract with the insurance carrier. Most clinics have between 6-12 signed insurance contracts. For example, a typical clinic would have a Medicare, Medicaid, BCBS and perhaps a couple HMO contracts. Whereas, if you look at any insurance payer list from a clearinghouse, you will see there are thousands of insurance companies; which tells you there are potentially dozens of non-contract insurance companies to which you may bill.

Why does this make a difference? Well, if your clinic has a signed contract with an insurance company, both the clinic and the insurance have mutual obligations to one another. The clinic has agreed to bill a claim, write-off contract adjustments and follow-up on unpaid claims. The insurance has agreed to adjudicate the claim, pay the clinic directly and respond to claim inquiries.

Now, contrast that with a non-contract insurance company. Non-contract insurance companies are not contractually obligated to pay the clinic directly or even to respond to inquiries about claim status. For example, two larger insurers that will not respond to non-contracted clinics are Medica and Blue Cross Blue Shield.

Understanding the difference between contract and non-contract insurance companies is the secret to saving time in the follow-up process. Given the fact that non-contract insurance companies do not have an obligation to respond to the clinic’s request for payment, the clinic is really doing courtesy billing on the patients’ behalf. So, after 30 days, if a non-contract insurance has not paid, you would be wise to bill the patient directly and save your time to follow-up on contract payers where you are contractually obligated to resolve outstanding balances.

Finally, to wrap this up, make a follow-up flow chart for each of the three buckets of outstanding claims; contract, non-contract and self-pay.

If it is a contract payer, at 30 days, call the payer or investigate the claim online. You are looking to resolve this claim as quickly as possible by determining if the balance is due from the insurance, the patient or if the clinic needs to return information. If the balance is due from the insurance, call the insurance and document the Person, Place, Phone number you called, along with the Action Needed and Action Taken. Get a commitment from the insurance to pay and add a note to your system if the balance is due from the insurance. If the balance is due from the patient, send the patient a statement and follow your self-pay flowchart. If the clinic needs to return an item, do that as fast as possible and document it.

If the balance is due from a non-contract insurance, at 30 days, send a statement to the patient and follow your self-pay flowchart.

Finally, your self-pay flow chart should have you sending no more than two regular statements to a patient and then sending a pre-collection letter and turning the claim to a collection agency. Statistics show that if a claim isn’t paid by a patient within 90 days, the likelihood of it getting collected is slim without the help of a collection agency.

Billing Buddies ® Bullet Points is brought to you by Billing Buddies. Visit our website at I’m your host, Bonnie J. Flom. I have 34 years of medical billing experience and am a Certified Medical Reimbursement Specialist through the American Medical Billing Association. I can be reached by email at or you can call and text me at 612.432.2366. Thank you for listening and happy billing.


The Magic Four Step Process to Collecting Patient Balances

12 Mar

This month’s Billing Buddies topic is how to deal effectively with high patient deductibles.  This information is from the NPCC (National Provider Compliance Corporation).  They have released a Four-Step Process to effectively collect the money that’s due to the clinic and more importantly, realize that collecting this money is helpful to your patients.  Your patients want to have clarification on your payment policies and what is expected of them.

To read the full process, click on this link:  The Four-Step Process.

Below is the brief outline of the process.  It outlines the four areas where you should focus on collecting from your patients.  Remembering, the patients want to know your payment policy and what’s expected of them.


1) The first point of contact is when you are scheduling the patient.  Inform them of your payment policy and if possible, let them know up front that you accept credit cards and the other forms of payments you accept.  Part of the patient stress to seeking healthcare is from not knowing the clinics’ policies or how can they pay for their services.


2)  The second point of contact with the patient is at the arrival for the appointment.  Again, inform them of your payment policies and the forms of payments you accept.  It’s a good idea to get a credit card authorization signed by them in advance to automatically cover deductibles, copays, and non-covered services.


3)  The third point of contact to collect from the patient is immediately after their appointment.  Review with them your payment policy and solidify payment either in the form of a deposit at the time of service or a credit card authorization.


4)  Finally, within 15 days of the insurance determining the patients’ liability, you should present the patient with a statement of the balance due.  This will be particularly effective because the patient should have already received an explanation of the balance due from their insurance company.


By implementing this four-step process, you should be well on your way to reducing the number of unpaid balances and increasing your cash flow.





Bonnie J. Flom

Phone:  952.657.7505

Call or Text: 612.432.2366


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NPPES Outdated?

2 Feb

What is your NPPES?   This is the place where your NPI number(s) are stored and updated.  Insurance companies are starting to deny payment if the address is wrong on one or more of your NPI numbers.  So, what should you do?


1)  Go to and check your individual and group NPI numbers.  Make sure everything looks accurate.


2)  If the information needs to be updated, go to and log in and update your information.  I know… you are thinking… oh great another login I don’t have.  Fortunately, there is a place for those of us who “Forgot Username or Password” and you can have them reset.


If you get stuck, I can do a net meeting and help you. Please give me a call at 952.657.7505.  Thank you and have a great day!

Increase Your Office Efficiency with these Add-On Features

5 Nov

Greetings!   Bonnie Flom from Billing Buddies spent Saturday, November 4th in Irvine, CA at an Office Ally Conference to learn about the newest features (and old features) that can optimize and expedite the cash flow of an office AND save many hours of time.  Below are some add-on products that are integrated in Office Ally as well as a Sample Policy & Procedure manual for your clinic to incorporate these features.   Don’t use Office Ally?  Use this article as a spring board to see what your own software has to offer.  Or, to contemplate the switchover to Office Ally.

If your office uses Billing Buddies for billing services or you have questions on how to implement these time saving features into your practice, please feel free to contact Bonnie directly at 952-657-7505 to implement any of these features.   Billing Buddies does not profit in any of the features listed below.   Our interest is to help our clients become more efficient and save money making the most out of technology.

Add-On Features:

1)  Reminder Mate –   Patient Reminders integrates with the appointment schedule to send appointment reminders to your patients via text, call or email.  Reduce your missed appointments and increase your revenue.

2)  Patient Ally –   Patient Portal allows your patients to complete and fill out their paperwork BEFORE they come into the office.  The paperwork is then saved directly into Office Ally.  (Patient Information Form, HIPAA ‘Forms, Credit Card Authorization Form, Consent to Treat Forms, etc.)

3) Intake ProYour patient didn’t fill out the paperwork at home?  No problem.  This feature gives the office iPads for the patients to complete their forms on iPads and integrate and upload into Office Ally.  No need to enter patient data into Manage Patient anymore.

4) 24/7 EHROffice Ally’s EHR software, 24/7, allows providers to easily document the patients medical records.  It also integrates with the billing process and sends the charges into the billing system, Practice Mate.

5)  AxiaMedAccept, store, process and integrate credit card payments in Office Ally.  You can setup automatic payments via payment plans and have patients pay via their statement all online.  As well as process credit cards in house.  No more waiting for patient checks to arrive via snail mail.

6)  PLDElectronic statements integrate with Office Ally via the service of PLD.  No more printing, stuffing and stamping statements.

7)  TSITSI is the designated collection agency with Office Ally.  (Transworld Systems Inc.) You can send your accounts to them with the click of a button and all the payments post report back to the collection agency automatically.  TSI offers three types of services ranging from pre-collection to collection work.

Finally, how would your office work if you integrated all of these features into your daily work flow?   Receive a copy of our Sample Policy and Procedure Manual by emailing   And, if you are a Billing Buddies client and want to utilize any of these features or have us assist in creating your very own Policy and Procedure Manual, please contact Bonnie directly at 952-657-7505.  Thank you and as always, make it an awesome day.


This message is brought to you by: Billing Buddies, a medical billing agency that was established in 1994.  We bring quick tips and tricks to health care providers at no cost. Our goal is to keep providers informed so they are better able to serve their clients. If you ever have any billing questions or are in need of a billing agency, please call or text us at 612.432.2366.   Our packages deals are very cost effective and all of our staff are certified through AMBA.  Billing Buddies Video

Best Practices for Combatting Chiropractic Account Receivable Issues

23 Sep

The financial well-being of any medical clinic depends on billing and claim processing. Unfortunately, chiropractic offices have an especially difficult time settling accounts receivable.

Statistics show that chiropractors lose up to 20 percent of their yearly revenue due to bad debts and pending account receivables. While some chiropractors believe this is just the nature of their business and have resigned themselves to these losses, there are ways to combat these issues.

Chiropractors perform vital health care services and should be compensated fairly for these services. Implementing the following practices will ensure that this happens.

  1. Clean up claims. While getting claims out fast is important, making sure they are clean is even more important. If you have to resubmit a claim any effort to get it out quickly will have been wasted.
  2. Focus of verification. The verification process should begin as soon as an appointment is made. Make sure insurance information and eligibility are always high priorities.
  3. Examine every denied claim. By keeping track of why claims are denied you can begin to see patterns. This will allow you to make any changes to future claims which will decrease their likelihood of being denied.
  4. Check code accuracy. Routinely scrub codes before a claim is submitted.
  5. File claims more often. The longer an account receivable is in your system, the less likely it is that it will be paid. Therefore, the more frequently you file claims, the more likely it is that these claims will be paid.
  6. Keep good records. Every time a claim is touched, make sure to document what occurred and what needs to happen next. If clear and complete notes are not taken, each time the claim comes up for review you will have to begin the process over again which wastes precious time and resources.
  7. Expedite claim inquiries. If an insurance company requests additional documentation relating to things like coding or compliance issues, make sure these questions are answered in a timely manner. Again, the longer it takes to answer these questions, the longer it takes to get paid.
  8. Know when enough is enough. Last, but certainly not least, if your chiropractic office is overwhelmed with billing issues, know when it is time to outsource these tasks. No matter what reason you have for keeping your billing in-house, if you aren’t getting paid, it’s time to make a change.


Need billing services or consulting?  Call or text Billing Buddies at 612-432-2366.  Or, email Bonnie J. Flom at   We have 24 years of medical billing experience.






Overworked, Understaffed Billing Departments Spell Big Trouble for Medical Clinics

10 Sep

Medical billing is a tough job. And while medical billers do not treat patients, their performance is directly tied to the success of any medical clinic.

So why is medical billing such a tough job? To begin with, the rules related to medical billing are constantly changing. New coding systems and compliance regulations can lead to delayed or denied claims that significantly reduce an office’s cash flow.

The number of things that can go wrong when it comes to billing is another never-ending battle. Even if a billing staff is able to keep up with new rules and regulations, there are plenty of other issues to deal with. These include things late payments and rejected claims.

All of these things would be a challenge for a huge medical billing staff but the fact is that most medical offices are not able to hire the amount of staff it would take to handle all of these issues. This leads to another issue: staff turnover. Medical billers are under a great deal of stress and this leads to low morale and high turnover. Hiring new staff is not only expensive and time-consuming, suddenly you have put another task on your medical billing staff’s to-do list: training.

While an under-performing medical billing staff can be detrimental to a clinic’s cash flow, it also can mean the loss of current patients and the inability to attract new ones. Look at reviews of medical clinics on the internet and you are likely to read statements along the lines of: “Love my doctor, nurses were great but the billing department was the worst.”

The fact is, many patients will decide not to come back to a particular clinic solely because of their experience with the billing staff. Further, these patients certainly won’t be referring family and friends.

With the rise in social media and online reviews, one patient disgruntled with your billing practices or staff can be broadcast all over the internet. The cost of these reviews cannot be underestimated. Statistics show that 90 percent of people read online reviews and 88 percent say they trust online reviews as much as a personal recommendation.

Staff turnover can have huge financial repercussions for a medical clinic. Unfortunately, it can be difficult to hire and retain quality medical billers. In light of the difficulties related to medical billing, it may be in a medical practice’s best interest to outsource these duties. Only then can a medical clinic be sure that the health of their clinic is not being compromised due to an overworked, understaffed billing department.


Need billing services or consulting?  Call or text Billing Buddies at 612-432-2366.  Or, email Bonnie J. Flom at  We have 24 years of medical billing experience.