In Coding
Oct 15th, 2015
When reporting E/M services by time (rather than the key components of history, exam, and medical decision-making), you should use CPT® “reference times” to determine an appropriate E/M service level. The reference time is stated in the final sentence of the CPT® E/M code descriptor (e.g., “Physicians typically spend 30 minutes face-to-face with the patient ...
In CMS
Aug 2nd, 2013
All 32 Pioneer accountable care organizations (ACO) successfully reported quality measures and achieved the maximum reporting rate for the healthcare delivery model’s first performance year, with all earning incentive payments for their quality accomplishments. Only 13 ACOs, however, produced enough savings to share about $33 million with Medicare. Nine ACOs are choosing to either move to ...
Jan 22nd, 2013
Due to new Current Procedural Terminology (CPT®) codes, almost any practice can bill for coordinating the care of patients discharged from a hospital or with multiple chronic conditions, even without having to officially transform into a patient-centered medical home or become a part of an accountable care organization (ACO). A recent article published in American ...
Mar 1st, 2012
Documentation and proper modifier 25 application is essential. By Abraham (Nick) Morse, MD, MBA Providers generally learn from their billing and coding staff that reimbursement for office procedures includes the immediate pre- and post-procedure management of the patient. In my experience, providers sometimes “over learn” this lesson, and conclude that it is never possible to ...
In Billing
Jan 27th, 2012
Two decades of demonstration projects aimed at reducing Medicare expenditures and improving patient care have failed to produce meaningful results, according to a Jan. 18 Congressional Budget Office (CBO) report, “Lessons from Medicare’s Demonstration Projects on Disease Management, Care Coordination, and Value-Based Payment.” The CBO pointed to the fee-for-service payment model as the primary reas...