Medical Billing And Coding

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Working your way through the FA0 record when doing medical billing is like reading a copy of “War And Peace”. Okay, maybe it’s not that bad, but it is still the most comprehensive record in the whole NSF 3.01 specifications and without it, nobody would have a clue what was being billed. In this installment we continue our review of this record with field number 18.

FA0 field 18, positions 82 - 85, is the units of service. This is probably one of the most critical fields in the whole FA0 record and deserves an extensive explanation.

Units of service are, in English, the number of that particular item that is being billed. Now, while that may sound simple, in reality it gets very complicated. Let us explain.

With most items, the units of service are very straightforward in their reporting. For example, let’s say that somebody is buying a wheelchair. They are buying one wheelchair so the units of service would be 1. Let’s however say that you’re selling a box of test strips that get billed by the strip but you’re still selling just one box. Here is where it gets complicated. Depending on who you are billing, some payers insist on billing 1 box and the cost of the box while others, because they need to know the number of actual units, ask you to do a conversion. To do this, you have to take the number of strips in the box and multiply it by the number of boxes you are selling. Then, that number goes in the units of service.

Rental items get even more complicated. With a rental item, even though you are not actually selling anything, the units of service still have to be reported. In the case of a wheelchair, this is easy because you are renting one wheelchair. But what if you’re renting oxygen along with a tank? The tank is one unit of service because it is one tank but the oxygen units have to be calculated based on how much oxygen goes into the tank. That calculation will be different based on whom you are billing.

The units of service field is one of the main reasons that claims get denied. The reason is that many pieces of software don’t know how to calculate them correctly based on the needs of the particular payer that they’re billing. There are no hard and fast numbers on the percentage of claims that get denied because of units of service errors, especially when it comes to billing oxygen, but the number is quite high.

Also, it should be noted that the price field, which we haven’t gotten to yet, must relate to the units of service that are being reported in field number 18. In other words, if you’re billing 1 box of test strips, then the price must be for 1 box. However, if you’re billing 250 strips, then the price must be for 250 strips. The difference is usually that a box is sold at a discount.

In the next installment in this article, we’ll move on to field number 19.

Michael Russell

Your Independent guide to Medical Billing

Under new Medicare regulations, hospitals will no longer receive higher payments for the additional costs associated with treating patients for certain hospital- acquired infections and medical errors. The new rules will give hospitals a powerful new incentive to improve patient care, according to Consumers Union, the nonprofit publisher of Consumer Reports. [click link for full article]

Government Health IT

Report: EMRs should have anti-fraud features Government Health IT, VA - Aug 10, 2007 However, certain documentation practices, such as data errors, mistakes in coding and confusion regarding billing codes and procedures may result in …

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