Watch Out What You “BILL” For

Ever wonder how easy it is to get into trouble with Medicare? From that last post I put up called “Hospital Reveals Probe Regarding Hyperbaric Services” it should make you wonder right?  

I write this post with the hopes that those working in hyperbaric medicine, especially in a hospital setting pay very close attention to the details of a patients treatment record.  Any HBO tech will claim they have absolutely nothing to do with billing for HBO services but when it is explained to them that the treatment record in the patients chart is what determines what is or is not billed to Medicare/CMS I am sure that eyebrows will raise up.


Most HBO techs are used to treating patients at 2.0ATA for 90 minutes at pressure with the assumed compression time and decompression time of 15 minutes each. Let’s try that again; 2.0ATA for 90 mins + :15 mins compression + :15 mins = 120 mins Total Treatment Time. When billing for HBOT for CMS/Medicare this would amount to c1300 x 4 because Medicare pays for each :30 minute segment of HBOT. C1300 is the code designated for billing hyperbaric segments.

Because HBO techs are used to this code being billed four times for each treatment, it is easy for them (maybe out of habit) to continue to bill for 4 segments for every treatment. This is where you will run into problems because I know for a fact that there are patients that do not get just 4 segments, some get 5, and some can get 1 or even 2 segments for various reasons. One reason could be that a patient cannot clear their ears and wants out of the chamber, another could be that the patient gets very claustrophobic in the chamber and demands to be decompressed.

One way to ensure that complacency does not set in when it comes to the HBO treatment record is to manually audit all HBO patients records for a week and compare what is in the treatment record to the superbill and to the hospitals charge entry system report (this is a report that is generated based on the number of segments entered into the hospitals billing system), this report is familiar to all program directors and front office managers, or staff.

Another thing to look out for: treatment pressures not actually reached but patient is treated at that pressure anyways.  EXAMPLE: Patient cannot clear their ears and the HBO tech stops compressing and keeps the patient at .5 ATA for the prescribed length of the treatment vs aborting the treatment based on what any normal physician would do in order to sort out the patient inability to equalize their ears. In this situation most hyperbaric chambers with an odometer would not even log that a treatment occured because the odometers are set to click over at 10PSI on the chambers “Actual Pressure Gauge”, now what do you write in the chamber log? Remember that the chamber log is an official document to prove that HBO treatments were actually performed and is a requirement for every hyperbaric chamber.

Lastly, it is important to stress that simply missing a segment or adding an extra segment to a patients treatment record, superbill, and charge entry system when it did not actually occur is considered by the Federal Government as FRAUD and can result in an investigation such as the one in my last post (“Hospital Reveals Probe Regarding Hyperbaric Services” ).  These investigations focus not only on the hospital system but on the staff running the department and especially the staff that is running the hyperbaric treatments. More to come soon…………….



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