Know what payers are looking for in subsequent hospital care claims, and how to give it to them. Medical necessity is the No. 1 consideration when selecting an evaluation and management (E/M) service code. Without medical necessity to support billed services, your practice is put at a serious noncompliance risk. Consider, for example, one payer’s ...
In Billing
Dec 6th, 2018
What Does it Take to Get Paid? AMA Morning Rounds (Dec. 5, Henry) discusses remote patient monitoring (RPM) and the “pitfalls you will want to avoid” as your practice implements this latest telehealth service. The article discusses three “pitfalls” to watch out for: Workflow Requirements Data Key requirements of implementing RPM include the coding and ...
In Coding
Nov 29th, 2018
CPT® guidelines allow you to report E/M services by time—that is, you consider time as the key or controlling factor to qualify for a particular level of E/M service. When reporting E/M services by time, per the CPT® Evaluation and Management (E/M) Service Guidelines: Counseling or coordination of care must dominate (more than 50 percent) ...
In Billing
Nov 28th, 2018
The Centers for Medicare and Medicaid Services (CMS) held an open door forum last week to review the Physician Fee Schedule (PFS) rule for 2019, including proposals that will be deferred until 2021 as part of the Patients over Paperwork initiative. CMS stressed that they will be paying for virtual check-ins with patients and virtual consultations ...
In CMS
Nov 20th, 2018
Monumental changes to Medicare policy finalized in the 2019 Physician Fee Schedule (PFS) final rule warranted a Centers for Medicare & Medicaid Services (CMS) national call, held Nov. 19. Here’s a summary of what you may have missed. First Up: Evaluation and Management Services CMS started out with an explanation of the Patients Over Paperwork ...