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Part B Insider (Multispecialty) Coding Alert

PART B FEE SCHEDULE:
Location, Practice Mix Will Define Fee Schedule's Effect on You
Alaska wins big, but Calif. practices see declines.If you take the 2009 Medicare Physician... Read more
PART B FEE SCHEDULE:
Use Simple Calculations to Find Fee Schedule's Impact
This quick tool will allow you to see whether you gain or lose in 2009.Even if mathematic ... Read more
COMPLIANCE:
OIG: Part-Time Docs Can Perform Services at Clinic -- If They're 'Bona Fide Employees'
Know where arrangement could cross the line before you participate.Your physicians may be ... Read more
PART B CODING COACH:
Can You Select the Right Diagnosis Code? Find Out With This Quick Quiz
Best bet: Know when a fifth digit is required and when you can simply get by with a shor... Read more
Part B Coding Coach:
Master Microscope Codes to Bring a Possible $200 Boost to Your Reimbursement
Make proper use of +69990, 92504 to avoid rejection.Your physician has invested training t... Read more
PHYSICIAN NOTES:
Skilled Nursing Facility Audit Shows That SNFs Appear to Bill Properly Most of the Time
Plus: CMS will continue to pay for oxygen supplies, despite potential news to the contrary... Read more
In other news ...
• CMS is getting snippy with oxygen suppliers over the payment changes that take effe... Read more
READER QUESTION:
Exam, MDM Sway Chest Pain E/M Selection
Know how chief complaint factors into code decision.Question: When a patient comes in comp... Read more
Part B Credentialing:
Say Goodbye to 2+ Year Credentialing Period
CMS will institute 30-day billing window as of Jan. 1.You're about to lose 26 months of bi... Read more
Part B Payment:
CMS Halts Pay for IDET, Other Thermal Intradiscal Procedures
New NCD confirms that no Medicare carrier will reimburse you for these procedures.If you w... Read more
Consolidated Billing:
Find Your Way Through the SNF Billing Maze
Consult Stark and consolidated billing rules first.If your physician sees patients in a sk... Read more
Clip and Save:
Overcome Consolidated Billing Troubles With an SNF Contract
Best bet: Use one for every SNF your provider works with and you'll find it easier t... Read more
Part B Coding Coach:
Pay Attention to Preservatives, Payer on Flu Shots or Risk Denials
G codes will ensure that your Medicare claims process smoothlyRemember the different repor... Read more
Physician Notes:
Obama Expected to Name New CMS Chief in the Coming Days
Plus: One New York payer blames technical difficulties for erroneous denials that ma... Read more
In other news ....
• If you've received a few inexplicable denials from your payer, the problem might be... Read more
Reader Question:
Global Period Drives Choice Between Modifiers 25 and 57
Know the right modifier or forfeit your pay when the physician provides a service and an e... Read more
Part B Coverage:
Medicare May Stop Paying Doctors Who Perform 3 'Never Events'
Surgical errors can cost hospitals thousands of dollars -- and in the future, they ma... Read more
Compliance:
OIG Rakes in $20.4 Billion Due to Errors, Fraud in FY 2008
The OIG report shows that the agency is reviewing everything from injections to cons... Read more
Part B Coding Coach:
CPT 2009 Offers Ammo for New Endoscopic Retrograde Cholangiopancreatography Procedure
You won't have to rely on an unlisted code -- and sketchy pay -- after Jan. 1Do ... Read more
Physical Therapy:
Say Hello to A New Code for Canalith Repositioning Maneuvers
Medicare's recent reimbursement decision could affect you.CPT Codes finally delivers a Ne... Read more
Part B Coding Coach:
Streamline Maze of New Orthopedic Codes With These 4 Groupings
CMS prices two new codes at over $1,000 -- will you recoup that pay?You can stop feel... Read more
Physician Notes:
CMS Offers Advice on How to Make the Most of the E-Prescribing Incentive Program
Plus: New data shows that Alzheimer's patients posted the longest non-cancer hospice... Read more
In other news ...
• Hospice patients with the longest lengths of stay are those with Alzheimer's diseas... Read more
Reader Question:
Verify Location for Synvisc Coding Or Risk Pay
Question: Which diagnosis should I report to support Synvisc administration?Answer: ... Read more
Cpt 2009:
Take Note of Errors in CPT 2009, AMA Instructs
Get out your favorite red pen to delete, add instructions to your new book.If you're scrat... Read more
2009 icd-9 manual:
Blast These Errors From Your 2009 ICD-9 Manual
CPT isn't the only code book with errors -- note these crucial ICD-9 changesTo ... Read more
Carrier Focus:
Never Assign E/M Codes Based Solely on the Length of the Documentation, One Carrier Says
Instead, base your code choice on the documentation's content.Coding an E/M visit based on... Read more
Prolonged Services:
3 Quick Steps Help You Bill Prolonged Services Now That Modifier 21 Won't Apply
CPT deletes modifier 21, but that shouldn't take away your pay.If you're used to add... Read more
Part B Coding Coach:
Fix Your Sights on 3 Can't-Miss CPT 2009
You won't find all of these changes in the 2009 CPT manual.Don't let your guard down... Read more
Physician Notes:
CMS Announces That Medicare Deductible No Longer Applies to 'Welcome to Medicare' Exam
Plus: CMS adds RVUs to immunization administration codes that reflect work preparing... Read more
Reader Question:
Use Open Code for Conversion to Open Procedure
CCI bundles laparoscopic portion into open code.Question: My doctor did a laparoscopic cho... Read more
ICD-10:
Start Your ICD-10 Assessment Process Now, CMS Experts Say
Tip: Contact your vendor to determine steps it is taking toward ICD-10.With all eyes... Read more
Records security:
FTC: Physician Practices Could Be Considered 'Creditors'
Federal Trade Commission pulls in health care entities but extends rule deadline. You may ... Read more
HIPAA:
Medicare Contractors Aren't Properly Overseeing HIPAA Policies, New OIG Report Finds
These surprising results may cause payers to start scrutinizing your HIPAA practices ... Read more
ICD-10 :
Don't Expect Outrageous Transition Times to
Plus: Physicians shouldn't have to bend over backward to change how they document th... Read more
Part B Coding Coach:
Avert Foot Exam Denials in 1, 2, 3 Steps
Swift payment might be as easy as switching your diabetes fourth digit.To get diabetic per... Read more
Physician Notes:
Medicare Owes Millions in Back Pay to Physicians in California, Hawaii, and Nevada
Plus: Congress to consider paying hospices at higher rates for days near the beginni... Read more
Reader Questions:
Correct Order May Help You Combat FluMist Denials -- Or Stop Them Before They Begin
You shouldn't report 90473 and 90471 together, CPT says.Question: We have begun admi... Read more
Medicare Lowers 2009 New Conversion Factor to $36.0666
But budget neutrality adjustment softens the blow, offering 1.1 percent boost.Don't lose h... Read more
HCPCS:
2009New HCPCS Set Introduces Dori-penem, Other Injection Codes
Plus: HCPCS changes codes for Privigen injection, 'Welcome to Medicare' exam.Warning: The ... Read more
2009 Fee Schedule:
Emergency Medicine, Infectious Disease Practices Benefit From New Fee Schedule
But audiologists, radiation oncologists, and diagnostic testing facilities could lose out ... Read more
Refunds:
Tell Florida Payers 'No' for Refunds After A Year
A new law will change one state's overpayment rules.You may know that you should take refu... Read more
Sleep Test or Polysomnography? Here's How to Tell the Difference
Coding these procedures incorrectly could raise a red flag for auditors.They may seem simi... Read more
Physician Notes:
Judge Shoots Down Medicare's Plan to Pay 'Least Costly Alternative' Therapy for COPD
Plus: Permanent RAC program on hold; CMS issues flu resources.Medicare will have to find a... Read more
Reader Question:
Obesity May Not Merit the Use of Modifier 22 in All Cases
If you do append modifier 22 in obesity cases, you should double and triple check your doc... Read more
CPT 2009:
CPT Introduces New Anesthesia Codes, Changes Cataract RVGs
New Category II code also changes the way you report cataract pre-op visit.CPT 2009 ... Read more
Part B Mythbuster:
Use Caution When Reporting 90846 for Family Counseling
Medicare carriers require treatment of a mental health condition.Myth: You can repor... Read more
E/M Coding:
3 Tips Are Key to Deciphering 99213 From 99214
Avoid these upcoding mistakes.Do you recognize when your physician documents a 99214 but o... Read more
Icd-9 Coding:
Are Pregnant Patients Being Seen for Other Issues? Find Out When OB Codes Are the Answer
Test your documentation attentiveness with these ICD-9 examples.Subtle differences in your... Read more
Scope Out 3 Can't Miss Tips for ACL Coding
Knee surgeons starting to use pain pumps? Check question 3. As many as 300,000 Ameri... Read more
Physician Notes:
CPT 2009 Includes Category III Codes for Rectal Tumor Excision, Arthrodesis, and More
Plus:  AHIMA supports the move to ICD-10 -- but disagrees with the timeline, asking ... Read more
Reader Question:
Don't Code Built-In Service With Separate Evaluation and Management Code
Brief history and review probably won't qualify for E/M code when your NP administers a va... Read more
CPT 2009:
CPT Makes HPV Code Official; Radically Changes TURP Coding
Hint: You can use one code with a modifier for stages 1 and 2 of TURP.Forget everyth... Read more
CPT 2009:
New Edition of CPT Overhauls Hydration Code Set
Plus: No new modifiers debut in January, although one will be deleted.Get ready for ... Read more
CPT 2009:
CPT Adds New Canalith Repositioning Code, Allowing You to Ditch Unlisted Code for Epley
Plus: Several new surgical codes debut, but it's which codes are missing from CPT 20... Read more
CPT 2009:
CPT 2009 Updates Cardiovascular Device Monitoring Codes
You'll find 21 new codes to guide your electrophysiology coding choices, as well as an in-... Read more
Correction:
ZPICs to Collect Flat Fee, Not Percentage
In last week's issue of the Insider (Vol. 9, No. 37, page 281), we indicated that contract... Read more
ICD-9 Coding:
 Think 'Likely' Diagnosis Trumps Symptoms? Think Again
Look for these phrases in your physician's documentation.Typically, your first-listed ICD-... Read more
Physician Notes:
Transition to ICD-10 Could Cost Large Medical Practice Upwards of $2 Million
Plus: MedPAC brings payment information for physicians, therapists, and other provid... Read more
Reader Question:
CMS Proposed Changing Payment Guidelines for Non-Credentialed Physicians
Under proposed plan, CMS would no longer allow retroactive billing for newly-credentialed ... Read more
Medicare Fraud:
CMS Appoints 'Program Integrity Contractors' to Find Fraud
New Medicare program will zero in on aberrant billing trends in your claims.Just when you ... Read more
Icd-9 Coding Quiz:
New ICD-9 Codes Are in Effect -- Are You Compliant?
Check out your diagnosis coding finesse with 5 quick ICD-9 coding questions.Although the n... Read more
Icd-9 Coding Quiz Answers:
Quiz Answers: Are you Up to Date With the New ICD-9 Codes?
Carriers just started requiring the 2009 ICD-9 codes, but if you don't report them corre... Read more
E/M Coding:
Start Using Time to Up E/M With These Tips
Counseling, coordination of care count toward E/M time.You've got a nifty tool to capture ... Read more
Make the Most of Colostomy Closures -- Here's How
Waiting for pathology results helps to optimize payment.When reporting an enterostomy clos... Read more
Physician Notes:
Upcoding Ophthalmologist Faces $460,000 Settlement, Integrity Agreement
Plus: Competitive bidding program for durable medical equipment may still take effec... Read more
Reader Question:
Hold Claims When Waiting for Physician's Credentials to Come Through
Remember: Medicare credentialing can take 90 days -- or longer -- so apply quickly w... Read more
Asc Payment:
CMS Confirms That Docs in ASCs Should Collect Facility Rate
In the past, Medicare paid ASCs the higher non-facility rate for non-covered proceduresIf ... Read more
Compliance:
OIG: You Can Hire A Contractor to Process Pre-Authorizations
But the arrangement musn't induce referralsIf you abhor the tedious job of performing insu... Read more
Medically Unnecessary Edits:
CMS Finally Publishes Long-Awaited List of Medically Unnecessary Edits
Look to MUE list to find out how many units of any particular code your carrier will... Read more
Compliance:
OIG to Focus on Incident-to Services, Ultrasounds, Unlisted Procedures, And More in 2009
The OIG's 2009 Work Plan indicates that modifier GY, nonphysician practitioner pay, and ot... Read more
Answer 'Yes' 3 Times, Apply Modifier 78
Return to the OR is a must If you want to be sure when you should apply modifier ... Read more
Physician Notes:
CMS Wants to Ensure That You Don't Miss The ICD-10 Boat
Plus: OIG nursing facility guidance offers direction on goals, risks that you could fa... Read more
Reader Question:
Documentation Distinguishes Consult
Keep an eye on "consult and treat" requestsQuestion: What's the difference between a consu... Read more
PART B REIMBURSEMENT:
Owe The IRS Money? Expect A Dip in Your Medicare Reimbursement
CMS reminds practices that the government can place a levy on your Medicare pay if you owe... Read more
THERAPY:
Part B Therapy Goes Under the Microscope With DOTPA
Rehab community airs concerns to CMSYearning for the day when the Medicare outpatient ther... Read more
PQRI:
Frustrated by Low PQRI Pay? We've Got 3 Simple Solutions for You
Hint: You might be surprised to find that your PQRI vendor is interested in helping you ma... Read more
Part B Mythbuster:
Calculate Fees Using Medicare's 'Carve Out' Rule
Applying this modifier alerts Medicare that you know the service.Myth: You can't collect f... Read more
Part B Coding:
Sidestep These 3 X-Ray Scenario Pitfalls
Supercharge your skills by knowing which guidelines to keep handy. Medical coders must be... Read more
Physician Notes:
Department of Justice Nails Physician's Assistant And Medical Biller in Phony HIV Infusion Scam
Plus: Next year physicians will no longer need accreditation to supply durable medical equ... Read more
Reader Question:
Don't Overlap Notes on Worker's Comp And Visits Billed to Medicare
Medicare manual does not address same-day worker's comp visit, but you should ensure that ... Read more
CCI:
No Modifier Will Separate Edit Bundling 92502 Into Sinus Codes
Effective Oct. 1, CCI institutes thousands of edits that change modifier status, and delet... Read more
CCI:
CCI Bundles Moderate Sedation Into Scores of Surgery Codes
Plus: The new version of CCI also swaps several code pairsCCI Version 14.3 blasts an... Read more
Compliance:
OIG Finds 63-Percent Error Rate on Facet Joint Injections -- Here's How to Avoid Problems
Hint: Bilateral injection errors accounted for scores of issuesAccording to a Sept. ... Read more
Part B Mythbuster:
What Constitutes 'Lavage?' It May Be More Than You Think
What to watch to avoid a $500 (or more) mistakeMyth: If your surgeon must retu... Read more
Halt Knee-Related Injection Rejections With 3 Tips
Code 20610 might always need a modifier for Medicare payIf denials for trigger point and j... Read more
Physician Notes:
CMS Approves CLIA-Waived Status for 21 Lab Tests -- Just Remember to Use Modifier QW
Plus: Mass immunization season is upon us -- CMS outlines the facts you need to know... Read more
Reader Question:
Meet These Requirements to Qualify As An Independent Audiologist
Starting Oct. 1, audiologists must be licensed in states that offer licensingQuestion: I r... Read more
Documentation:
CMS Offers You An Extra 6 Months to Prepare for New ABN
Effective March 1, labs and physician practices must use the new combined ABN/NEMBThe Sept... Read more
Part B Quiz:
These 3 Medicare Questions Could Offer You A Challenge
Do you avoid unlisted procedure codes? This quiz may change your mind It's time a... Read more
Part B Revenue Booster:
Boost Your Bottom Line With These 3 E/M Documentation Steps
Tip: Don't miss the endocrine system when you're tallying ROSOne missed documentatio... Read more
Answers To Part B Quiz:
How Did You Fare in Testing Your Part B Billing And Coding Skills?
If you answered all three questions correctly, you're a Part B ace Are your Part B skil... Read more
What Qualifies As 'More Extensive?' Find Out Now
If same condition prompts initial and follow-up procedures, 58 appliesThe AMA revised CPT ... Read more
Physician Notes:
CMS Offers In-Depth Training Course on How to Properly Use the CMS-1500 Form
Plus: CMS plans to discontinue the competitive acquisition program by the end of the... Read more
Reader Question:
Physician Leading CPR Can Report 92950, As Well As E/M, If Applicable
Emergency defibrillation, however, is probably not billable along with the CPR, so don't t... Read more
Documentation:
CMS: Physician Signature Not Required for Diagnostic Tests
New clarification trumps previous adviceIn an attempt to clear up confusion about who can ... Read more
Speech-Language:
Private Practice SLPs, Say Hello to Medicare Provider Status
A lucky MIPPA provision gives SLPs the ticketIf you're a speech-language pathologist in pr... Read more
Icd-9 Coding:
Master Diagnosis Coding in 3 Easy Steps
Hint: Medical necessity is not necessarily a top priority in selecting a codeIf your... Read more
Billing:
Easily Evaluate Your Billing Procedures With Internal Audits
Start with a baseline audit , then make changes before auditors come knocking Would you... Read more
Split Professional, Technical Components Like A Pro
Purchasing power will change the rules for modifiers 26, TCReporting modifiers 26 (Pro-fes... Read more
Physician Notes:
Practices Still Making Massive Errors Regarding Units of Service Billed, OIG Says
Plus: Don't hold your breath waiting for an answer from CMS' ESRD mailbox -- the ser... Read more
Reader Question:
TMJ Arthrography May Merit 70332
But keep your eye on the diagnoses to confirm accuracyQuestion: What are the differences a... Read more
Compliance:
OIG Puts Brakes on Leasing Space to Other Physicians
Be mindful of anti-kickback rules when leasing spaceYou own a cancer center where your pat... Read more
Compliance:
Unsure What Constitutes Anti-Kickback? We've Got the Facts
Check out these examples of fraudThe OIG notes that the federal anti-kickback law has been... Read more
Fee Schedule:
New CMS Fee Schedule Update Brings Good News for Some Bilateral Surgery Coding Pros
Plus: Medicare releases new sleep study HCPCS codes, changes descriptor on INR... Read more
Consultations:
Wash Away Doubts About Billing A Visit As Consult Or Referral
Details on diagnosis, treatment can help you light the wayIf CPT's many revisions to the c... Read more
Bust Two Myths That Could Make You Leave Postop Scope Dollars on the Table
Your endoscopy coding needs an overhaul if you get these answers wrongGet the lowdown on d... Read more
Physician Notes:
HCPCS Code G0101 No Longer Includes Mandatory Breast Check
Plus: CMS reports high MAC satisfaction rate, and Medicare creates new hurdles for h... Read more
Reader Question:
Separate Session Could Mean You've Earned Billable Control of Bleeding
If you cover all of your bases, you may be able to report bleeding control separately -- b... Read more
Diagnosis Coding:
Transition to ICD-10 Code Set Could Be Just 3 Years Away
The transition won't happen overnight -- but will require some time to learn the ropesYou'... Read more
Part B Mythbuster:
Failing to Report X-Rays During the Global Will Cost You Money
Depending on how many x-rays you write off, you could be losing thousandsMyth: X-ray... Read more
Cardiology:
CCI Rescinds Controversial Policy Restricting Only One PV Intervention Per Vessel
Watch out: You will still have problems with the reinstated policy, experts sayNo mo... Read more
Part B Billing:
Know the Rules About Collecting Deductibles Up-Front
Navigate your way when carriers give you conflicting advice about deductibles, but use bus... Read more
Modifier 25 Isn't Always the Answer for Same-Day E/M Visit
Keep E/M documentation apart to demonstrate the service's 'separate' statusTo report an E/... Read more
Physician Notes:
CMS 'Cooked the Books' And Reported An Inaccurate Error Rate, New OIG Report Indicates
Plus: Practices that are part of CMS' Physician Practice Group Demonstration Project... Read more
Reader Question:
One Size Doesn't Fit All When Reporting Bilateral Procedures With Modifiers
Payer policy reigns when it comes to selecting the right modifierQuestion: We performed a ... Read more
Modifier Errors:
Don't Let Modifier 59 Misuse Take A Bite Out of Your Reimbursement
One carrier reminds practices to heed the rules when using modifier 59 to separate CCI edi... Read more
Compliance:
Trying to Save Medicare Money? Be Careful When Sharing Savings
New advisory opinion reiterates the OIG'sYou've cut back on your surgical costs, saving Me... Read more
Part B Payment:
CMS Halts Payment for Some Post-Op Infections, Failure to Control Blood Sugar
Expansion of Medicare's list of "never events" worries practices nationwide that tre... Read more
Modifier Decision Tree:
Go With the Flow to Make Your Modifier 59 Decisions Easier
This handy chart can help you decide whether modifier 59 applies to your claimYour physici... Read more
Submit Clean Epidural Steroid Injection Claims Every Time -- Including the Fluoro
Payer policies reveal which conditions indicate medical necessity You need to get up t... Read more
Physician Notes:
Medicare Launches Pilot Program to Put Personal Health Information in Beneficiaries' Hands
Plus: New ICD-9 codes formally released, including several new diagnosis codes that ... Read more
Reader Question:
No Patient Present? Don't Expect Payment From Medicare
CMS' face-to-face E/M billing requirement could nip payment in the bud when you meet with ... Read more
Part B Claims:
Even Non-Par Providers Must Submit Claims on Patient's Behalf
Those who opt out may not be subject to claim filingSo, you've decided to no longer partic... Read more
Part B Quiz:
Answer These 5 Questions to Test Your Expertise
Is a modifier required when reporting 20610? The answer may surprise youIt's time ag... Read more
Compliance:
Take 6 Steps to Shore Up Your HIPAA Compliance
Don't let harsher enforcement catch you by surpriseIf your HIPAA compliance has gathered d... Read more
Part B Quiz Answers:
Can You 'Balance Bill' Medicare? Check Your Answers Here
Discover how you fared in our coding and billing challengeAre your coding and billing skil... Read more
Modifier Quiz:
 Save Modifier 76 for True Repeat or Risk Overpayment
Modifier 59 might apply even when you use the same codeYou could mislabel a modifier 59 pr... Read more
Physician Notes:
Congress Delays Trigger Bill, Staving off Potential Reductions in Medicare Spending
Plus: Only 10 percent of ALJ hearings take place in person, and medical practices se... Read more
Reader Question:
Only Report What Shows on the Encounter Superbill
Billers shouldn't be adding services to your claims without your permissionQuestion: Our o... Read more
Part B Appeals:
Part B QICs Missed 58 Percent of Appeals Deadlines, OIG Says
54 percent of QIC appeals included wrong information If you-ve been relying on the Medi... Read more
Part B Appeals:
Stay on Top of the Part B Appeals Process With These Quick Tips
Five steps may separate you from suffering a denial and forfeiting your due reimbursemen... Read more
Part B Participation:
Not Every Practice Is Eligible to 'Opt Out' of the Medicare Program
Determine whether you are eligible to opt out -- and whether you should Planning to st... Read more
Technology:
Look for E-Prescribing Bonus This January
HHS officials encourage physicians to adopt e-prescribing asap Electronic prescribing c... Read more
CPT Challenge:
 Are You Ready for These 3 Cataract Coding Scenarios? Test Yourself
Surgery on both eyes on different dates means two global periods -- and hundreds in reimbu... Read more
Physician Notes:
MedPAC Releases Snapshot of the Average Medicare Patient
Plus: HIPAA violation of $100,000 stuns health plan If you've ever wondered just ... Read more
Reader Question:
Medicare Considers Interpreter's Service 'Incidental'
T1013 won't fly with Part B payers Question: Which diagnosis code should I use with T10... Read more
PART B PAYMENT:
Congress Officially Delays Physician Pay Cuts Until 2010
Lawmakers overturn presidential veto just in timeIf you were starting to break a sweat in ... Read more
PART B PAYMENT:
Medicare Bill Offers Reprieve to Therapists, Labs, DME Providers
Two percent bonus for electronic prescribing looks appealing to manyDespite the fact that ... Read more
ICD-9 CODING:
Sort Through the Diagnosis Coding Maze to Accurately Report Lyme Disease
Don't let reimbursement slip through your fingers for this increasingly prevalent summerti... Read more
COMPLIANCE:
Physicians Made $1.5 Million in Place-of-Service Errors During A 2-Year Period, OIG Says
Audit finds that physicians reported the correct POS code on just 15 percent of claims dur... Read more
Part B Coding Coach:
The Difference Between Nerve Block and Destruction May Be Greater Than You Think
Report only destruction with same session/location blockWhen coding for facet joint inject... Read more
PHYSICIAN NOTES:
CMS Moves to Make RAC Program Permanent After Recovering Almost $700 Million
Plus: CMS halts PQRI confusion with new laminated reference tool outlining measures and re... Read more
READER QUESTION:
Achieve the Correct HPI Level Every Time
Differentiate location from context and you-ll be in the clearQuestion: An internal chart ... Read more
PART B PAYMENT:
Senate Votes to Avert Medicare Pay Cut for 18 Months
Power is in President Bush's hands as he considers whether to sign the bill into lawYou-re... Read more
PART B PAYMENT:
2009 Fee Schedule Proposes 5.4 Percent Cut to Medicare Pay
CMS wants comments on the proposal by Aug. 29Lawmakers haven't yet healed the problems wit... Read more
COMPLIANCE ROUNDUP:
OIG Okays Gift Cards for Unhappy Patients, But Questions Excluding Ordering Doc's NPI on Claims
Compliance experts be on the lookout: The OIG is watching when you put your own NPI in the... Read more
ICD-9 QUIZ:
Code the Story of Your Patient's Life With This Quick Diagnosis Quiz
Find the diagnosis codes in this patient's historySometimes it may seem as if there's an I... Read more
Part B Coding Coach:
Get the Skinny on 2009 Migraine Codes Now to Avoid October Denials
Red alert: ICD-9 plans more specific options for chronic migraines, status migranosus and ... Read more
PHYSICIAN NOTES:
Don't Submit Claims With Modifier KX to Medicare for Your Therapy Services
Plus: The OIG finds massive overbilling of some cancer drug units, demanding thousands bac... Read more
READER QUESTION:
Learn Foolproof Drug Wastage Calculation
CMS offers guidance for this tricky taskQuestion: When we code for drug wastage, I-m alway... Read more
PART B PAYMENT:
Ball Is in the Senate's Court After House Votes to Avert Pay Cut
Veto-proof House vote awaits Senate responseWith just a week left before Medicare provider... Read more
PART B PAYMENT:
Find Out How the New Medicare Bill Would Affect Your Practice
Physicians, therapists, suppliers and others cheer the House's efforts in passing the new ... Read more
LABS:
Travel Allowance for Fee Collection Benefits Labs That Bill Part B
Remember: Medicare will pay a travel allowance to draw specimens from nursing home or home... Read more
Clarification:
Physician Accessibility May Be Necessary to Meet Insurance Requirements
In our article, -Shared Visits Can Net 15 Percent More on Some E/M Services, (Insider, Vol... Read more
PART B REVENUE BOOSTER:
3 Tips Sharpen Your Unlisted Coding Finesse
Tip: Don't forget to compare your unlisted procedure to an existing codeYou can streamline... Read more
Part B Coding Coach:
Heed New Transmittal When Documenting, Compiling Critical Care Time
Medicare clears up counseling, concurrent care rules If coders can learn to spot cri... Read more
PHYSICIAN NOTES:
Medicare Adds Four Additional Codes to the Payable ASC List as of July 1
Plus: House of Representatives aims to streamline health information technology system wit... Read more
READER QUESTION:
Look to CPT for Advice When Patient History Is Unobtainable
CPT offers definitive guidance on how to compute history for patients who can't communicat... Read more
CCI:
Version 14.2 Halts Payment of 90769 With Several E/M Codes
Half of the new edit pairs affect anesthesiologistsThe Correct Coding Initiative (CCI) str... Read more
CCI:
Modifier Changes Restrict When You Can Separate Pairs
Check which modifier changes affect youIn addition to adding and deleting code bundles, CC... Read more
CCI Deletes Troublesome Ob-Gyn/Urology Edits
Ob-gyn and urology surgeons have been struggling for more than five years with a set of Co... Read more
COMPLIANCE:
OIG Saves Medicare $2.2 Billion Over 6 Months
With 1,291 exclusions and 293 criminal actions, the OIG cracked downAccording to the OIG's... Read more
CMS:
Start Looking for Those PQRI Checks Very Soon
You reported your PQRI measures--now reap the benefitsIf you thought PQRI was all work and... Read more
Part B Coding Coach:
Look Out--Prolonged-Services Switch Just Around the Corner
Learn how these CMS changes will affect your E/M coding and reimbursementCoding for prolon... Read more
PHYSICIAN NOTES:
Lawmakers Are Still Furiously Working to Fix the 10 Percent Pay Cut Due July 1
Plus: Fight PTA denials based on expired facility certificationPolitical posturing in Wash... Read more
READER QUESTION:
CPT Accounts for Price of 'Pill Cam' in Procedure Codes
Choose between 91110 and 91111 for appropriate paymentQuestion: What can you tell me about... Read more
GOVERNMENT REGS:
Medicare Halts Bilateral Payment for Certain Procedures as of July 1
Plus: CMS debuts several new codesIf you-ve become accustomed to collecting additional rei... Read more
PART B QUIZ:
Answer These 4 Questions to Find Out Where Your Expertise Lies
Can you withhold a patient's records if he owes you money? The answer may surprise youNow ... Read more
PART B REVENUE BOOSTER:
Nail Down Acronyms and You'll Code Charts Properly Every Time
Would you be able to count E/M bullets properly if the physician wrote -WBC WNL-?If you ca... Read more
ANSWERS TO PART B QUIZ:
Can You Report Lesion Excision and Biopsy Together? We've Got the Scoop
Add up your score to determine whether you-re a billing aceAre your coding and billing ski... Read more
Part B Coding Coach:
Guest Columnist: Alice Marie Reybitz, RN, BA, CPC, CPC-H - Apply These Surefire Tips for 90-Day Global Period Sucess
Think there really are 90 days in this period? Find out the truth As Medicare has pro... Read more
PHYSICIAN NOTES:
It's Not Too Late to Participate in PQRI
Envious of the 1.5 percent bonuses that other practices are collecting? You can join the p... Read more
READER QUESTION:
Removing Stitches? Check These Rules Before You Bill
Medicare lays down the law on this issue, ensuring that you differentiate between simple p... Read more
MODIFIER 59 COMPLIANCE:
OIG Revisits Recommendation to Institute Edits
OIG found 40 percent error rate on modifier 59 claimsWhen the OIG talks, not everyone list... Read more
INCIDENT-TO SERVICES:
CMS Rescinds Recent Incident-to Advice, With No Plan to Replace It
With the new guidelines just about to take effect, CMS scraps Transmittal 87If you spent h... Read more
IMAGING:
SPECT Coding Tops CMS' List of 'No Documentation' Errors--Now Medicare Is Watching
CMS overpaid $15.2 million last year for 78465--we-ll show you how to avoid several common... Read more
SHARED VISITS:
Shared Visits Can Net 15 Percent More on Some E/M Services
Medicare allows NPP, physician to combine forces on some hospital servicesIn the office se... Read more
Part B Coding Coach:
Take the Guesswork Out of Coding for Teaching Physicians
Here's which modifier to use for the primary-care exceptionYou can ensure that your physic... Read more
PHYSICIAN NOTES:
CMS Advisory Opinion Approves of Hospital's Software That Communicates With Physicians' EHRs
Plus: Practitioners in S. Florida made up 20 percent of Medicare fraud casesWhen it comes ... Read more
READER QUESTION:
Zoom In on 'Targets' Before Coding Moderate Sedation With Procedure
Hint: You can't always bill moderate sedation separatelyQuestion: An established patient c... Read more
MEDICARE ERRORS:
Insufficient Documentation Cost Practices $1.3 Billion in 2007
Total error rate topped $10.2 billionCan't get your physician to document thoroughly? The ... Read more
MEDICARE ERRORS:
99232 and 99211 Top the CERT List of Mistakes
With more than $100 million overpaid for 99232, physicians poorly documented subsequent ho... Read more
PAIN MANAGEMENT:
Make Sure You Follow Medicare's New Nerve Injection Modifier Rules
CMS changes could put more money in your pocketAs every coder knows, CMS updates can conta... Read more
THEARPY REGS:
CMS Report Reveals Win-Win Situation for Exceptions Process
Alternative to cap moratorium may be a viable long-term solution, experts sayIf you provid... Read more
Part B Coding Coach:
Know When You Can Report a Repeat Consultation--and When You Can't
Don't let time-limit myth restrict your optionsIf you-re a specialist and you use the thre... Read more
PHYSICIAN NOTES:
More Than 500 CPT Changes Will Take Effect in January, but AMA Hasn't Revealed Specific Codes Yet
Plus: Hospices interested in participating in the Medicare program must heed new rulesWhen... Read more
READER QUESTION:
Don't Lose Sight of HPV Coverage Rules When Billing for the Lab's Side
Question: I am in a laboratory setting. For a patient whose thin-prep Pap test showed LGSI... Read more
REGULATORY NEWS:
Lawmakers Agree to 2009 Budget Plan Without Medicare Cuts
Plan would create budget surplus by 2012 without Medicare cuts--but June -08 cuts are left... Read more
PART B PAYMENT:
New CMS Pilot Program Bundles Physician's Pay With Hospital's
Certain cardiac, orthopedic services targeted first in the 4 participating statesIf you th... Read more
COMPLIANCE:
Take Initiative--5 Steps Can Help You Handle Medicare Audits
Be proactive to avoid audits--but if all else fails, remain professionalThis year, hundred... Read more
DOCUMENTATION:
Documentation Addendums Are Acceptable--Most of the Time
Ensure that the physician isn't amending the record just to get the claim paidImagine this... Read more
Part B Coding Coach:
Prepare Now So Pain Management Diagnosis Coding for 2009 Is No Pain, All Gain
You may have to leave your 784.0 comfort zone in OctoberICD-9 2009 may include more new co... Read more
PHYSICIAN NOTES:
NPI-Only Date Is Here-Get Your Claims on Track
Plus: New DME competitive bidding program awardees announced for 10 communities, effective... Read more
READER QUESTION:
New CCI Verbiage Shouldn't Constrain Your Modifier Use, CMS Says
Version 13.3's introductory notes confused physicians, but we-ve got clarification Questio... Read more
ANTI-KICKBACK STATUTE:
Labs Offering Favors at No Charge May Violate Anti-Kickback Rules
Simply labeling test tubes on behalf of a dialysis facility could be going too far, the OI... Read more
PART B CODING QUIZ:
Think You're 99211 Savvy? Take Our Quiz to Find Out
Hint: 99211 may not be just for nursesSome practices report 99211 every day, but how much ... Read more
PART B THERAPY BILLING:
Medicare Offers Updated Physical Therapy Coding and Billing Rules to Guide Your Claims Submission
Personnel qualifications, policies change in Transmittal 88If you thought CMS- therapy bil... Read more
ICD-9 CODING:
You'll Be Coding Diagnoses With Ease in October, Thanks to New Ob-Gyn ICD-9 Codes
Discover new ways to code for Pap tests, OB conditionsYou already know to look at the 795 ... Read more
Part B Coding Coach:
Capture Urine Culture Payment Wtih These Coding Best Practices
If you-re just assigning 87086 to every culture, you could be losing $3 per testUrine cult... Read more
PHYSICIAN NOTES:
CMS Puts Its Foot Down With Strong Stance on New Intracranial Stenting and Angioplasty Device
Plus: New DME competitive bidding program advice adds meat to Medicare's Claims Processing... Read more
READER QUESTION:
Zoom In on Fluoroscein Use When Detecting, Treating Corneal Abrasions
Hint: Billing for a fluoroscein stain will usually be included as part of the physician's ... Read more
PART B MYTHBUSTER:
Proceed With Caution When Device Maker Offers to Appeal for You
Consider the more conservative approach of the manufacturer guiding your appeal, experts s... Read more
REGULATORY NEWS:
Hospices Reel at Proposed 5 Percent Wage Index Cut
Industry decries potential reduction to Medicare hospice reimbursementThe Medicare hospice... Read more
PART B COVERAGE UPDATE:
Medicare Won't Cover DNA Stool Tests to Screen for Cancer--Stick to FOBT Instead
CMS notes that the currently available DNA stool test still requires FDA reviewIf your phy... Read more
ICD-9 CODING:
2 Scenarios Help You Find the Right ICD-9 Code When the Physician Doesn't Provide It
Tip: Don't choose a code based on the coverage decisionPhysicians do it every day--they ha... Read more
Part B Coding Coach:
Use Instrumentation, Depth to Decide Laceration Repair Level-Here's How
Hint: Anatomic classifications get smaller as repairs get more complex On your lacera... Read more
PHYSICIAN NOTES:
CMS Updates Incident-to Regs--NPPs Take Note
Plus: Lawmakers plan legislation to save Medicare payment cuts for early JuneIf you-ve bee... Read more
READER QUESTION:
Don't Report Inpatient Hospital Care When Physician Admits Patient to Observation
You can list subsequent days as inpatient care, howeverQuestion: Our physician admitted a ... Read more
PART B MYTHBUSTER:
You Can Once Again Collect for Prolonged Nursing Facility Services
After years of having to eat the cost of these services, you're in the clear to billMyth: ... Read more
PART B REVENUE BOOSTER:
Don't Write Off Those Pre- or Postop Observation Care Dollars
Hint: Keep an eye on modifier choiceIf you-ve been eating the cost of preoperative observa... Read more
ELECTRONIC HEALTH RECORDS:
Act Fast to Apply to Medicare's Groundbreaking EHR Demonstration Project
The deadline looms for this P4P programCMS is so hopeful that more health practices will a... Read more
COMPETITIVE BIDDING:
Round One Competitive Bidding Notices Rock DME Industry
Outraged trade groups plan legal actionSuppliers nationwide are catching a glimpse of thei... Read more
Part B Coding Coach:
Know When to Combine Burns for Diagnosis Coding
Fourth, fifth digits are vital to these ICD-9 codesTo accurately code diagnoses for patien... Read more
PHYSICIAN NOTES:
CMS Clarifies Hospice Signature Requirements
Also: Get advice from Medicare to discover differences between payment review programsYou ... Read more
READER QUESTION:
'With' Is Key for Diabetic Manifestations in Specific Conditions
Keep ICD-9 subterms in mind when reporting these conditionsQuestion: How should I code dia... Read more
COMPLIANCE:
Corporate Integrity Agreements No Longer Apply to Self-Disclosers
Move could save millions for those who cooperateProviders who self-disclose their offenses... Read more
CORRECT CODING INITIATIVE:
CCI Error May Mean You Should Resubmit 57287-57288 Claims
You-ll see the correction in the final CCI version 14.2, but you-ll be able to resubmit pr... Read more
PART B SELF-TEST:
Take 5 to Answer These Reader-Submitted Questions
Determine how well you would answer these common questionsDust off your thinking cap again... Read more
PART B SELF-TEST ANSWERS:
Check Your Skills Against the Answers to Our Quiz
Determine whether you can ace this testOur quiz was a mixed bag of questions that cov... Read more
ICD-9 CODING:
Oncology, Diabetes Top Proposed ICD-9 Codes
New diagnosis codes could be effective Oct. 1, if approvedIf you-ve got high hopes that yo... Read more
Part B Coding Coach:
Know Which Nerve Conduction Study Code Is Right for You
Take the fear out of modifier 59 using the scenarios our experts revealChoosing the approp... Read more
PHYSICIAN NOTES:
CMS Adds to List of 'Never Events'
The new diagnoses go beyond forgotten surgical clampsGet ready for nine new -never events,... Read more
READER QUESTION:
Keep Track of Refills for E/M Service
Tip: You can't bill an E/M just for handing a refill to a patientQuestion: May we bill an ... Read more
CODE UTILIZATION:
Compare Your Top 10 Billed Codes to Medicare's
CMS released its latest claims processing data, and the results may surprise youIf you-ve ... Read more
COMPLIANCE:
Medicare's Enrollment, Revalidation Process Just Got Trickier
Don't let these new Medicare provider requirements catch you by surpriseThat time of year ... Read more
PART B REVENUE BOOSTER:
Take 5 to Nail Down ASC Coding Rules
As CMS issues its quarterly ASC payment rates, the time to brush up is hereTrue or false: ... Read more
PART B BILLING:
Boost Efficiency and Speed Reimbursement With RTCA
Several payers are offering real-time claims adjudication--are you taking advantage yet?Yo... Read more
Part B Coding Coach:
Hone Your Critical Care Coding Skills Now, Avoid Denials Later
Watch for life-threatening conditions before reporting 99291-99292Your physician documents... Read more
PHYSICIAN NOTES:
Senate Could Vote on 18-Month Pay Increase by Next Month
But physician pay boosts could result in cuts to other providersMost physicians don't want... Read more
READER QUESTION:
Track Botulinum Wastage for Accurate Coding
Question: We often perform botulinum toxin injections to treat spasm disorders. Can I bill... Read more
HOSPICE:
19 Percent of Respite Care Claims Didn't Meet the 5-Day Rule
The OIG's review of these services could prove costly for some providersIf you provide res... Read more
PART B QUIZ:
Test Your Medicare Claims Mettle With This Quick Quiz
Are you an expert? If so, you shouldn't break a sweat over this quizYou may be out of scho... Read more
PART B MYTHBUSTER:
Know What Wound Repair Includes--And What It Doesn't
Dismantle this common myth to get on the road to correct codingMyth: Wound repair codes in... Read more
PART B QUIZ ANSWERS:
Quick Quiz Results--Did You Rate An A+?
Or do you need to go back to claims management 101?Were you stumped on the copay waiving q... Read more
Part B Coding Coach:
Put Consultation Request to This 2-Prong Test
These details make -transfer of care- black and whiteYou-ve been on the fence for two year... Read more
PHYSICIAN NOTES:
Dr. Smith Goes to Washington...And So Do Hundreds of Others
Rally on the Hill encourages lawmakers to save MedicareThe AMA-s National Advocacy Confere... Read more
READER QUESTION:
Dig Deeper For Pain Diagnosis
Don't stop until you find exactly what you need--it's easier than you thinkQuestion: ... Read more
MEDICARE FUNDING:
Medicare Program Risks Going Broke, Report Says
With Part A funding about to bottom out, Part B could be at risk as wellThe recent widely-... Read more
COMPLIANCE:
CMS Cracks Down on Device-Makers' Relationships With Docs
Avoid relationships that suggest incentives from manufacturersIf your physician is on the ... Read more
PART B SUCCESS STORY:
Different Specialists May Warrant Two Same-Day Consults
One practice reports success after deliberations with a Medicare payerIf you-ve ever ... Read more
PART B REVENUE BOOSTER:
CMS Allows Expanded Payment forj At-Home Prothombin Time Tests
Now patients using warfarin for chronic atrial fibrillation or venous thromboembolism are ... Read more
Part B Coding Coach:
Get More Money With 2 PQRI Coding Details
Are you in? Medicare's second reporting period began in JanuaryThanks to PQRI's renewal, y... Read more
Append Modifiers When Measure Isn't Met
Surprise: 'No action' still counts toward PQRI totalTo successfully participate in the Phy... Read more
PHYSICIAN NOTES:
Medicare Wants Your Input
CMS- survey shows which carriers get high marks--and which don-tCMS is eager to get feedba... Read more
READER QUESTION:
Document Time Spent on Counseling
Question: One of our insurers downcodes my E/M visits because the diagnoses don't support ... Read more
PART B PAYMENT:
House, Senate Want to Make Sure You Don't Face Pay Cuts
As the vote nears the floor, physicians are cautiously optimisticIf you-ve been wishing on... Read more
CONCIERGE CARE:
Concierge Physician Gets Burned for Medical Record Maintenance
Massachusetts levies fine on physician who didn't keep records, wasn't up-front about cert... Read more
PART B REVENUE BOOSTER:
Nail Down Your Modifier Choice When Deciding Between 58 and 78
Once you realize the differences, selection can be a breezeIf CPT can't guide you to the r... Read more
PART B SELF-TEST:
Test Your Selection Savvy--Modifier 58 Or 78?
Determine whether you can select the appropriate modifierHere's your chance to apply the i... Read more
Part B Coding Coach:
Simplify Stress Test Claims by Reviewing Indications and Documentation Hazards
Tip: Make sure your physician documents direct supervisionYou may think you-ve got stress ... Read more
PHYSICIAN NOTES:
CMS Opens the Door to CPAP Payment
If you were worried about narrow diagnosis issues surrounding continuous positive airway p... Read more
READER QUESTION:
4 Little Numbers Could Be Sabotaging Your Claims
Question: We are getting denials from Medicare saying they can't see box 32 in our claim f... Read more
CCI EDITS:
Bid Farewell to Troubling DEXA Edits
But new CCI additions may disappoint some practicesFor once, you-ve got some good news fro... Read more
NPI UPDATE:
Expect Denials if You Don't Have Referring Doc's NPI
The May 23 deadline is looming, but many aren't readyWhen March 1 passed, many practices t... Read more
PART B REVENUE BOOSTER:
New ABN May Cut Need for NEMB
CMS' updated, revised ABN was effective March 3If you ever made alphabet soup out of the A... Read more
PART B REVENUE BOOSTER:
5 Examples Show You When the New ABN Suits Your Needs
Get to know these common reasons for ABN useThe new advance beneficiary notice (ABN) form ... Read more
Part B Coding Coach:
Surefire Strategies Take Luck Out of the Botulinum Toxin Equation
Don't roll the dice with your 64612-64614 reimbursementsYou face a lot of bumps on the roa... Read more
PHYSICIAN NOTES:
UHC Providers--Accredit Your Imaging Facility or Face Denials
Want to collect for imaging procedures? Apply for accreditationIf you bill United Healthca... Read more
READER QUESTION:
Are Nail Trims Billable?
Question: I saw in your last issue that a podiatrist was sent to prison for billing routin... Read more
RECOVERY AUDIT CONTRACTORS:
RACs Collect $371.5 Million, But Many Oppose the Program
Described as -bounty hunters,- RACs are still frowned upon by many If a recovery audit con... Read more
PART B PAYMENT:
MedPAC Advises Congress to Raise Physician Payment in 2009
But where there are hikes, there are also dropsThe Medicare Payment Advisory Commission (M... Read more
PART B PAYMENT:
What You Need to Know About the MedPAC Report
Get to know the committee's thoughts with this simple chartMedPAC's recent Report to the C... Read more
PART B REVENUE BOOSTER:
3 FAQs Help You Get a Handle on Your E/M Claims
E/M claims are the #1 billed codes to Medicare, but some practices are billing them incorr... Read more
Part B Coding Coach:
Auditing Tool-- 3 Can't-Miss Radiology Coding Lessons
Will Medicare be asking you to return part of the $59 million overpaid to radiologists?CMS... Read more
PHYSICIAN NOTES:
AMA Reacts to Medicare Payment Cut Projections
Your Medicare payment woes may not end in July, according to one new Medicare report.In a ... Read more
READER QUESTION:
CMS Says No-Show Fee Is OK - Sometimes
Question: Did Medicare change its billing policy for missed appointments? What does the po... Read more
NEWS:
Lawmakers Officially Introduce Bill to Curb Medicare Spending
Trigger bill could be the first in a string of proposalsThe proposals to -fix- Medicare's ... Read more
PART B REVENUE BOOSTER:
Who Can Bill as Assistant Surgeon? Check With Your Carrier
Warning: Assistant surgeon rules differ between carriers, and change in teaching hospitals... Read more
PART B REVENUE BOOSTER:
This Simple Tool Can Help Ease Your Assistant Surgery Claims
Follow this flow chart for clues on which modifier to use... Read more
EVALUATION AND MANAGEMENT:
CMS Reminds Practices That Observation Codes Differ Greatly
MLN Matters provides guidance on observation and hospital care codingThink fast: Do you kn... Read more
Part B Coding Coach:
Don't Let Your PEG Coding Go Down the Tubes--5 Tips You Need Now
Hint: G-tube procedures now include fluoroscopic guidance, when usedRecent AMA revisions h... Read more
PHYSICIAN NOTES:
Medicare Remains Among OIG's Biggest Challenges
Earlier this week, the HHS Office of Inspector General (OIG) released a summary of its Top... Read more
READER QUESTION:
Primary Surgeon Should Keep Global in Mind
Question: If a neurosurgeon calls our orthopedic surgeon to the operating room to assist, ... Read more
2009 BUDGET:
Proposed Budget Cuts ASC, Outpatient Hospital and Hospice Pay
Plus, Bush's proposal makes beneficiaries pay moreWhen President Bush proposed $178 billio... Read more
BILLING:
New Software May Be the Answer to Your Medicare Secondary Payer Woes
Consider downloading additional software from your carrier or clearinghouse if necessaryIf... Read more
COMPLIANCE:
Kickbacks Still Stir Up the OIG's Interest
The Office of Inspector General's latest report shows that Stark laws haven't curbed some ... Read more
COMPLIANCE:
Peruse This Breakdown of the OIG's Report
No entities were spared by the OIG in 2006If you want to know who got caught in the OIG's ... Read more
Part B Coding Coach:
4 Questions You Should Ask Before Choosing Debridement Codes
FAQ addresses coding conventions for wound carePatients who present to your practice for d... Read more
PHYSICIAN NOTES:
Some Practices Still Aren't Ready for NPI
Despite CMS- frequent remind-ers, many Medicare-participating physician groups have not ye... Read more
READER QUESTION:
Don't Count on Patient for WTM Data
Don't Count on Patient for WTM DataQuestion: Recently, we-ve been faced with several -Welc... Read more
PART B REVENUE BOOSTER:
Success Story: Fight Your Carrier if You've Used Modifier 59 Properly
This practice fought its carrier--and wonYou don't have to eat the cost of modifier 59 den... Read more
MEDICAL ERROR REPORTING:
HHS Puts Medical Error Guidance in Writing
HIPAA confidentiality violations will cost $20,000 a piece under proposed ruleIf the U.S. ... Read more
COMPLIANCE:
Watch Those Big-Ticket Claims or the OIG Will Watch for You
Ever wondered why MUEs matter? Several recent audits show you If big-ticket claims are you... Read more
PART B MYTHBUSTER:
Keep Physician Specialty in Mind When Determining New vs. Established Patient Status
But 3-year rule applies in most other situationsMyth: Medicare's -three-year rule,- which ... Read more
Part B Coding Coach:
2 Scenarios Pinpoint the Perfect Preventive Med Counseling Code
Here's how to make diagnosis codes support your claimYou could be missing out if you don't... Read more
Position Preventive Medicine Counseling Codes Correctly
Learn why a patient's illness negates using these codesIf the patient sees the physician j... Read more
PHYSICIAN NOTES:
CMS Offers Physician Self-Referral Guidance
If you have more Stark questions than answers, CMS has a resource for you. Thanks to a new... Read more
READER QUESTION:
Straight From the Listserve--Know the Ropes of Medicare Opt-Outs
Question: In anticipation of the July 1 Medicare rate cut, our physicians are considering ... Read more
REIMBURSEMENT:
President's Proposed Budget Would Slash Future Medicare Funds
But House Dems pledge to fight the bill when it hits the Congress floorIf President Bush h... Read more
REIMBURSEMENT:
5 Steps Reveal Your Cash Flow Secrets
Chart your A/R and other billing variables to ensure you don't leave money in Medicare's h... Read more
PART B MYTHBUSTER:
Shatter These 4 'Push' Myths to Create Pristine Claims
Steer clear of this common concurrent coding misdeedIf you thought you couldn't report an ... Read more
PHYSICAL THERAPY:
Dig Deeper When Seeking True Therapy Modality
If PT's notes don't match CPT, differentiate between acronyms and separate proceduresWith ... Read more
Part B Coding Coach:
Advanced ICD-9 Lesson--3 Steps Keep Your Diabetic Neuropathy Coding on the Up-and-Up
Solve the 337.1-vs.-357.2 puzzle with this easy-to-reference guideYou-re going to have to ... Read more
PHYSICIAN NOTES:
CMS Proposes Artificial Heart Device Coverage
On Feb. 1, CMS proposed coverage -with evidence development- of artificial heart devices f... Read more
READER QUESTION:
Straight From the Listserve--Nail Down Supervision Levels
Question: Our carrier asked us to verify that our tech performed a patient's elbow MRI und... Read more
HCPCS CODING:
CMS Changes Its Mind, Reinstating Albuterol HCPCS Codes This April
Quarterly update announces additions, revisions, correctionsIn a move sure to surprise som... Read more
IMAGING:
Chiropractor-Requested X-Rays Are No Longer Valid in CMS' Eyes
Medicare's -chiropractor exception- expired earlier this monthCMS has made an age-old chir... Read more
MODIFIERS:
Update Your Modifier Practices -- or You Could Be Writing Off Thousands
One internal audit reminded a practice to apply the new descriptors to claimsIf you haven'... Read more
COLONOSCOPIES:
Once a Screening, Always a Screening, CMS Says
Your colonoscopy procedure code may change, but the dx won-t CMS has clarified that i... Read more
SUCCESS STORY:
National Policy Review Pays Off for One Practice
Don't write off your denials if you know you-re right--this practice fought and wonIn the ... Read more
Part B Coding Coach:
Follow These 5 Routes to Modifier 22 Claim Success
You decide which services warrant the effort associated with modifier 22Catch 22: If you-r... Read more
PHYSICIAN NOTES:
President Bush to Call for Medicare Cuts, Times Says
When President Bush submits his 2009 budget on Monday, he-ll propose -large cuts- in the M... Read more
READER QUESTION:
Which Codes Are Missing From CPT 2008?
Question: I read that the CPT 2008 manual doesn't contain three new vaccine codes. Could y... Read more
REVENUE BOOSTER:
Forget G Code for Cerumen Removal and Forget Payment
One practice challenged Medicare and won for its G0268 claimsIf you-ve got one New Year's ... Read more
DOCUMENTATION:
Chart Auditors May See -- But Not Agree With -- "Seen and Agreed" Stamp
Make sure the physician signs the note, rather than stamping a standard lineRubber stamps ... Read more
HIPAA:
Have Your HIPAA Practices Gone Out of Sight, Out of Mind?
The government has convicted HIPAA violators--make sure you-re not at riskHIPAA compliance... Read more
MYTHBUSTER:
Reporting Q4087 for IVIG? Not Anymore
New MLN Matters article reminds coders to ditch 2007's mid-year replacement codesMyth: You... Read more
Part B Coding Coach:
Combat Hip Coding Confusion With a Few Simple Expert Tips
Understand eponyms, acronyms and unlisted-procedure coding rules to make your claims spark... Read more
PHYSICIAN NOTES:
MedPAC Recommends Deep Freeze for SNF, Home Health Rates
The Medicare Payment Advisory Commission (MedPAC) made two new recommendations last week t... Read more
READER QUESTION:
Straight From the Listserve--Treatment and Tests Don't Rule Out Consults
Question: Can I still report a consultation if the consulting physician initiates treatmen... Read more
AMBULATORY SURGERY CENTERS:
CMS Confirms ASCs Can Collect From Medicare for Brachytherapy
Just before 2007 ended, CMS offered ambulatory surgery centers a New Year's surprise--endi... Read more
IMAGING:
CMS Delays Imaging Anti-Markup Provision Until 2009
Delay does not apply to some pathology services, howeverOne of Medicare's most confusing n... Read more
COMPLIANCE:
Therapists--Forget Your John Hancock and You Could Be Out Thousands
Recent OIG audit shows that one therapist's mistakes will cost him over $280,000You-ve met... Read more
CPT 2008:
Master the New Cardiology Codes and Say Goodbye to Payment Woes
New cardiac MRI, ablation codes streamline cardio practices By now, you-re quite aware of ... Read more
Part B Coding Coach:
Know What Pain Management Specialists Do to Win the Coding Battle
Brush up on these procedures and codes before OIG comes callingAs pain management continue... Read more
PHYSICIAN NOTES:
Hospices--Shore Up Your Claims Data
Starting in July, CMS requires claims to be a lot more detailedAccording to MLN Matters ar... Read more
READER QUESTION:
Straight From the Listserv--You Don't Need a Modifier for Incident-to Claims
Question: We recently hired a nurse practitioner and aren't sure which modifier we should ... Read more
REIMBURSEMENT:
Legislators Give Docs a Happy Holiday With 0.5 Percent Pay Raise
But the rule only extends until June 30, so you'll still need another fix mid-yearIf you w... Read more
CCI 14.0:
Stop Reporting 36000 With Injections, Surgeries
Plus, pulmonologists should be ready for scores of edits to affect themThe latest version ... Read more
CCI 14.0:
CCI Strikes Allergy, Urology, Neurology and Other Specialties
New medication therapy management codes suffer scores of bundlesIf you were delighted abou... Read more
PART B MYTHBUSTER:
Give Your Emergency Dept. E/M Coding a Makeover
Tip: The ED is an outpatient setting, not inpatientMyth: Only a certified emergency depart... Read more
PART B CODING COACH:
Cure Your Colonoscopy Denials by Following CMS' Advice
Guidance concerning what diagnosis codes you should report may surprise youIf you-re confu... Read more
PHYSICIAN NOTES:
OIG Semiannual Report Reflects $43 Billion in Recoveries
Audits covered everything from hospice to suppliesThe OIG has released its Semiannual Repo... Read more
PART B CODING COACH:
Cure Your Colonoscopy Denials by Following CMS' Advice
Guidance concerning what diagnosis codes you should report may surprise you If you-re... Read more
READER QUESTION:
Know How to Code Blood Draws vs. Lab Tests
Question: We saw a patient for a blood draw and sent it to an outside lab for testing. The... Read more
Available Years:  2008  2007  2006  2005  2004  2003