Billing and Coding

MSMS members qualify for free reimbursement assistance. With more than 20 years experience, Stacie J. Saylor, CPC, CPB, is the MSMS Reimbursement Advocate who has direct contacts with every health plan in Michigan. Helping thousands of MSMS member physicians, Stacie has helped to recover as little as $30, and as much as $50,000.

Additionally, Stacie can provide help on clarifying the appropriate use of codes or modifiers for billing insurance companies. With Stacie and MSMS on your side, you have the peace of mind knowing that your coding practices are up-to-date and appropriate for the level of care delivered.

If you have any questions, feel free to contact MSMS Reimbursement Advocate, Stacie J. Saylor, CPC, CPB, at 517-336-5722.

AMA Downcoding Resources

Effective January 1, 2021, major changes were made to the evaluation and management (E/M) services Current Procedural Terminology CPT^® code set and reporting guidelines to reduce documentation burdens, simplify coding, and allow physicians to spend more time with patients. Unfortunately, some health plans are disputing E/M levels for submitted claims and implementing E/M downcoding programs that inappropriately—and often automatically, through claim editing algorithms—reduce payment for provided services.

The AMA has created a new resource to support physician practices in navigating such payer E/M downcoding programs. The document offers examples of downcoding scenarios, sample plan communications, guidance on reviewing remittance advice to identify downcoding, and documentation tips to support successful appeals. Also included are sample downcoding appeal letters, which are available in an editable format on the AMA website.

Locum Tenens

Locum tenens is a physician who fills in for another physician for a period of 60 days or less.

It is a longstanding practice for a physician to retain a substitute physician to take over his/her professional practice when the physician is absent for reasons such as illness, pregnancy, vacation, or continuing medical education, and for such physician (the regular physician) to bill and receive payment for the substitute physician’s services as though he/she performed them. The substitute physician often has no practice of his/her own and may move from area to area as needed. The regular physician generally pays the substitute physician on a per diem or other fee-for-time compensation basis with the substitute physician having the status of an independent contractor, rather than of an employee, of the regular physician.