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Part B Insider (Multispecialty) Coding Alert

CONSULT ELIMINATION:
New Modifier AI Allows Multiple Docs to Bill Initial Hospital Care
Modifier AI will denote the primary physician of record, now that consult coding is a thi... Read more
CONSULT ELIMINATION:
Let These 5 Facts Guide You Now That Consults No Longer Apply
Tip: ABNs won't help you collect for consults. January 1 is only a few weeks away, so you... Read more
PRIVACY:
Maintain Your Privacy With These Safeguards
Health system puts over a million records at risk. If you've been putting privacy complia... Read more
PRIVACY:
Keep Your Remote Workers' Information Private With This Sample Document
Make sure your offsite workers are aware of security and privacy concerns Your practice h... Read more
PRIVACY:
Follow 3 Tips When Handling Patient Privacy Concerns at Your Organization
Hint: Paper files can be breached just as easily as electronic files. You may be sure tha... Read more
ORTHOPEDICS:
3 Questions Point You to Correct Joint Aftercare Codes
Shift gears to different V codes after the global period. You know to report V codes for ... Read more
CLIP-AND-SAVE:
Use This Chart to Select the Right Hip Codes -- Every Time
Match the site to the documentation to choose the correct options. When it comes to joint... Read more
PART B REGS:
CMS Transitioned Over 230,000 Providers' NPIs Into PECOS
Plus: Medicare officials stress that you should start ICD-10 readiness preparations soone... Read more
RADIOLOGY:
Apply 36145's Replacement Codes Correctly With These Tips
Reporting 75790 for shunt evaluation goes the way of the dodo in a few weeks. If you've n... Read more
PART B REVENUE BOOSTER:
Ensure Tetanus Payment With 5 Guidelines
Get familiar with Medicare's rules from medical necessity to choice of products. Medicare... Read more
PART B CODING COACH:
Is Your Ob-Gyn Practice Up to Date? Take This 5- Part Challenge to Find Out
If your physician documents 'puerperal infection,' you've got 4 new options. This year, I... Read more
PHYSICIAN NOTES:
Congress Votes to Postpone the 21.2 Percent Conversion Factor Cut
Plus: Know hospice claims reporting requirements, or expect added scrutiny. With just day... Read more
In other news ...
• Don't miss the newest instructions from the feds on how to accurately comply with ... Read more
READER QUESTIONS:
Know When to Report Fluoro Separately
Plus: Rein in wireless network access, and more. Fluoro May Be Separately Billable Questi... Read more
READER QUESTIONS:
Know What You Can Report With Rhinoplasty
Plus: Nail down how to report ketorolac tromethamine injection, and more. Use Primary Rhi... Read more
READER QUESTIONS:
Heed the 'Re-' Term in 96521's Descriptor -- It Refers to 'Refill'
Know the CCI edits when attempting to report chemotherapy administration along with porta... Read more
CORRECT CODING INITIATIVE:
CCI Now Allows a Modifier to Separate Hundreds of Edits
But other new bundles that 16.0 has in store might put a dent in your reimbursement. You ... Read more
CORRECT CODING INITIATIVE:
CCI Now Allows a Modifier to Separate Hundreds of Edits
But other new bundles that 16.0 has in store might put a dent in your reimbursement. You ... Read more
MODIFIERS:
New Medicare Modifiers Throw Practices for a Loop
Key: Know how to report professional component. CMS introduced three new modifiers effect... Read more
MODIFIERS:
New Medicare Modifiers Throw Practices for a Loop
Key: Know how to report professional component. CMS introduced three new modifiers effect... Read more
COMPLIANCE:
OIG Recovered $21 Billion in 2009, With Plans to Stay 'Aggressive' Going Forward
OIG keeps ophthalmology services, chiropractic, and ultrasound on its radar screen, along... Read more
COMPLIANCE:
OIG Recovered $21 Billion in 2009, With Plans to Stay 'Aggressive' Going Forward
OIG keeps ophthalmology services, chiropractic, and ultrasound on its radar screen, along... Read more
CCI:
Learn CCI Basics -- Or Watch Denials Flood In
Not overriding when you can means missing billable services. If you don't understand what... Read more
CCI:
Learn CCI Basics -- Or Watch Denials Flood In
Not overriding when you can means missing billable services. If you don't understand what... Read more
PART B CODING COACH:
Eliminate Ventilator-Associated Pneumonia Uncertainty With Clear Diagnosis Parameters
Tip: Other conditions 'mimic' ventilator-associated pneumonia and can lead to misdiagnosi... Read more
PART B CODING COACH:
Eliminate Ventilator-Associated Pneumonia Uncertainty With Clear Diagnosis Parameters
Tip: Other conditions 'mimic' ventilator-associated pneumonia and can lead to misdiagnosi... Read more
PHYSICIAN NOTES:
CMS Will Cover HIV Screening As Preventive Care Service Effective Immediately
Plus: FDA asks providers to be aware of potential dangers of negative pressure wound ther... Read more
PHYSICIAN NOTES:
CMS Will Cover HIV Screening As Preventive Care Service Effective Immediately
Plus: FDA asks providers to be aware of potential dangers of negative pressure wound ther... Read more
In other news ...
• If you're using negative pressure wound therapy (NPWT) devices (i.e., wound vacs),... Read more
In other news ...
• If you're using negative pressure wound therapy (NPWT) devices (i.e., wound vacs),... Read more
READER QUESTION:
Nail Down Sleep Study Type to Determine Coverage
Medicare has strict requirements about tests performed in the patient's home. Question: O... Read more
READER QUESTION:
Nail Down Sleep Study Type to Determine Coverage
Medicare has strict requirements about tests performed in the patient's home. Question: O... Read more
PART B PAYMENT:
CMS Revises 2010 Conversion Factor With New Communique
Meanwhile, the Senate is poised to vote on the proposed permanent fix to the Medicare pay... Read more
ENROLLMENT:
All Ordering/Referring Providers Must Be in PECOS by April 5
Your MAC will begin denying claims in April. CMS wants to make sure that the PECOS system... Read more
COMPLIANCE:
Avoid Holiday Gift-Giving Trouble With 7 Steps
You can't ignore the rest of the year. The holidays can present one of the biggest compli... Read more
COMPLIANCE:
Don't Forget Patient, Non-Physician Gifts in Your Compliance Efforts
Use the anti-kickback statute to guide you when you're giving presents to non-physician s... Read more
PART B CODING COACH:
Enter the E-Prescribing Era by Following 3 Simple Steps
Find out what percentage bonus you'll receive from Medicare. Can your physician afford no... Read more
PHYSICIAN NOTES:
Make These Corrections to CPT 2010
Plus: CMS announces new therapy cap amount of $1,860 for 2010, and reveals results of 200... Read more
In other news ...
• CMS has once again revised the therapy caps, making $1,860 the limit for therapy s... Read more
In other news ...
• CMS doled out over $92 million in PQRI payments in 2008, more than double what prov... Read more
READER QUESTION:
Distinguish 'May Include' From 'Required'
Also: Know the requirements of a 'limited' study. Question: Does the doctor need to docum... Read more
PART B PAYMENT:
CMS Will Offer Modifier to Denote Admitting Physician on Claims
With the changes to consult coding, it will be more important than ever to report hospita... Read more
CPT 2010:
Look for New Cat III Cardio Codes
These new high-tech codes take effect Jan. 1. Warm up to the cardiology changes coming yo... Read more
CPT 2010:
3 New Codes, 2 Deletions Bring Big Changes to Your Urodynamics Coding
The new codes could also change your reimbursement While CPT 2010 brings a record low ... Read more
CPT 2010:
Get Your Lab Up to Speed for 2010 With This New Code Rundown
Stop using general codes for analyte specific tests. You have 15 new codes scattered t... Read more
PART B CODING COACH:
Need to Differentiate E/M Codes From Eye Codes? Consider These 5 Items
5 questions let you ditch eye codes with confidence. Frustrated counting E/M codes' HPI, ... Read more
PHYSICIAN NOTES:
RACs May Accept Payment Plans If They Find Medicare Has Overpaid You
Plus: Medicare will no longer accept paper claims or adjustments for Medicare Secondary P... Read more
In other news ...
• You can no longer submit Medicare Secondary Payer (MSP) claims or adjustments on p... Read more
READER QUESTION:
Counseling/Coordination Domination? Consider Time-Based Billing
Question: An established pregnant  atient with a plan of care in place for her gastr... Read more
PART B PAYMENT:
Fee Schedule Cuts Medicare Pay By 21.2%, Scraps Consults
Bonus: CMS increases pay for office visit codes. Get ready for another year of nail-bitin... Read more
HCPCS 2010:
CMS Debuts New Synvisc Code
Plus: CMS makes key changes to ABN modifiers. Hot on the heels of the new CPT codes, CMS ... Read more
PART B PAYMENT:
2010 Final Rule Simplifies E-Prescribing Process
Extra: CMS will debut a new e-prescribing numerator code. CMS's 2010 Physician Fee Schedu... Read more
PART B PAYMENT:
2010 Fee Schedule Slices Pay for Cardiology, Nuclear Medicine, Audiology, and Other Specialties
But some specialties will benefit from pay boosts. As if a 21.2 percent payment cut wasn'... Read more
PART B CODING COACH:
Perfect Your Radiology Coding Skills By Using 5 CCI Lessons
Wonder if there's a method to the 76001 madness? Here's where you can look for answers. T... Read more
PHYSICIAN NOTES:
FTC Offers Last-Minute Reprieve on Red Flags Rule Until June 1, 2010
Plus: CMS clarifies how you should bill procedures that are subject to genderspecific edi... Read more
In other news ...
• If you've been frustrated over gender-specific edits for your Medicare claims, CMS... Read more
READER QUESTION:
You May Need to Bill Multiple Codes for Trigger Point Injections in the Emergency Department
Remember to document the drug that the physician injected. Question: A patient reports to... Read more
PRIVACY:
Red Flags Rule Flies Nov. 1, After Several Delays
Determine whether your practice is a 'creditor,' and make up your plan accordingly. After... Read more
ICD-9 CODING:
Code Late Effects With Ease
Know these two important exceptions. When coding for late effects, sequencing is everythi... Read more
COMPLIANCE:
Spot Potential Fraud on Your Provider's Claims? Check Documentation, Then Contact Provider
Examine claims for odd activity, experts say. With compliance in the spotlight, many code... Read more
CLIP AND SAVE:
Ace Late Effects Sequencing With This Handy Chart
Combination codes for stroke late effects won't always cover all the details. Proper sequ... Read more
PART B CODING COACH:
Stop Forfeiting Up to $779 for Appendectomy Procedures
2 requirements open the door to adding on 44950 to 44970. Do you assume payers will bundl... Read more
PHYSICIAN NOTES:
CMS Formally Debuts New Geriatric Psychiatry Specialty Code
Plus: CMS changed the Medicare contractor interest rate effective Oct. 22, according to a... Read more
In other news ...
• CMS is lining up its interest rate with what private consumers pay. Effective Oct.... Read more
READER QUESTION:
These Tips Help You Select the Right Migraine Code
In some cases, the unspecified code may be your best option. Question: A 46-year-old new ... Read more
CPT 2010:
New Codes for Cardiac CT, Imaging Debut Jan. 1
Plus: Say goodbye to two perfusion codes. If you've ever wondered whether Medicare actual... Read more
BILLING:
Give Your MAC Permission to Communicate With Billing Co.
Prepare ahead of time by designating the billing company on your enrollment form. HIPAA l... Read more
CPT 2010:
CPT 2010 Retains Consult Codes, Adds Specificity to Tumor Excision Codes
Plus: Look for new nerve conduction study, facet joint injection codes. Although CMS has ... Read more
PQRI:
CMS Offers Alternative Way to Access Your PQRI Feedback Reports
No need to register in the IACS system to read individual physicians' report -- simply co... Read more
PART B CODING COACH:
Ventilator Management vs. E/M Codes: This Guide Helps You Make the Call
Boost reimbursement by 70 percent on subsequent care days with 9400x in lieu of low-level... Read more
PHYSICIAN NOTES:
Senate Lacks Votes to Change Medicare Payment Structure, But Members Vow to Keep Trying
Plus: CMS heads closer to defining 'meaningful use,' but official definition won't be iss... Read more
In other news ...
• What's "meaningful use?" That definition could be part of your holiday gift this y... Read more
READER QUESTION:
Don't Code Fibroid Tumor Diagnosis Until You Pinpoint Location
Plus: Know the alternative terms that physicians use to describe the various types of tum... Read more
Compliance:
Wrong Address on File? MACs Can Repeal Your Billing Rights
Make sure your carrier's system has accurate information for your practice. Effective Nov... Read more
Therapy Billing:
Take a Quick Refresher on Therapy Supervision Rules
Keep incident to billing and assistant supervision issues separate. If you've been concen... Read more
Part B Mythbuster:
Avoid Billing Locum Tenens for New Docs Who Aren't Yet Credentialed
Medicare doesn't consider locum tenens an appropriate billing scenario for an uncredentia... Read more
Clip And Save:
13 Tips for Recouping Payment for Substitute Physicians
Hint: Don't mix up modifiers Q5 and Q6. Although you can't bill locum tenens... Read more
Part B Coding Coach:
Confused About Trach Tube Changes? 5 Tips Perfect Your Claims
Hint: Whether the fistula tract is established may decide whether code 31502 is war... Read more
Physician Notes:
Not All OIG Audits Result in Bad News or Accusations of Wrongdoing
This New York cardiologist spent time under the OIG's microscope, only to learn he was bi... Read more
Reader Question:
Note Two Ways to Code Patient Complaint Resulting From Previous Injury
Prior conditions can contribute to patient's current complaint -- keep track of them by u... Read more
NEW CPT CODES:
AMA Reveals Which Cat. II and III Codes Won't Appear in CPT 2010
Add these codes to new CPT Codes book when it arrives. Our CPT books are fountains of kn... Read more
VACCINES:
Differentiate Between CPT's New H1N1 Admin Code Vs. CMS's
Code 488.1 does not guarantee a confirmed dx. Swine flu has made an early arrival in seve... Read more
COMPLIANCE:
OIG Intends to Hone in on Modifier GY Claims, POS Errors, and More in 2010
The OIG's 2010 Work Plan indicates which areas the agency will be reviewing next year, an... Read more
PART B REGS:
Licensed Physicians Can Enroll in PECOS Even If They Don't Intend to See Medicare Patients
Plus: CMS plans to debut two new physician specialty designations for hospice providers a... Read more
PART B CODING COACH:
Mark Manipulation to Potentially Recoup $100 or More Per Encounter
No maybes here -- answer this question wrong and you will code your fracture claims ... Read more
PHYSICIAN NOTES:
OIG Finds That CMS's Comprehensive Error Rate Testing (CERT) Results Were Inaccurate
Plus: OIG nabs California hospital director for alleged violations of the Stark and Civil... Read more
In other news ...
• Despite heightened focus on how to stay compliant with the Stark law, some medical... Read more
READER QUESTION:
Note Length of Wound Before You Report a Laceration Closure Code
Plus: Make sure you report the appropriate wound code to represent the patient's diagnosi... Read more
REIMBURSEMENT:
Watch Out for Claim-Denying Computer Glitches
Don't wait for your MAC to alert you to an error -- be on the lookout for them. If y... Read more
ELECTRONIC RECORDS:
CMS Begins to Distribute Millions Earmarked for EHRs
Get your electronic health record in place so you can benefit from government bonuses. ... Read more
REIMBURSEMENT:
7 Tips Help You Avoid Computer Claim Casualties
Pay attention to EOBs and keep talking to your MAC. You could be losing money to a comput... Read more
COLLECTIONS:
Step Up Your Collection Efforts With Credit Cards
But protect patients' credit information to comply with privacy, identity theft rules. Wi... Read more
PART B CODING COACH:
Medicare Might Pay for Mycotic Nail Debridement
Know frequency limitations for CPT 11720 and CPT 11721 . If Medicare routinely denies c... Read more
PHYSICIAN NOTES:
Keep Medication Units in Check With MAC-Approved Drug Calculator Tool
Plus: One carrier suffers claims glitch regarding Medicare Secondary Payer (MSP) claims. ... Read more
In other news ...
• If your Medicare Secondary Payer claims appear to be in limbo, you're not alone. N... Read more
READER QUESTION:
Know When You Can Report Visits After Global
You may have to explain why additional postop visits are required. Question: Codes 10060 ... Read more
PART B APPEALS:
CMS Can't Recoup Overpayments From You During Appeal Phase
You can collect interest from CMS on overpayments if you triumph during third appeal leve... Read more
PQRI:
Register in CMS's IACS Program If You Want PQRI Report Access
But you must be in PECOS before IACS will accept your registration, CMS officials warn. C... Read more
PART B MYTHBUSTER:
Coding 'Comfort' Visits as Fracture Care Can Land You in Hot Water
Plus: Don't forget to bill supply codes to Medicare. A patient reports to your practice w... Read more
COMPLIANCE:
Senior Medicare Patrol Recovered $4.5 Million by Watching for Fraud and Abuse
Seniors volunteer for this program, which aims to help the OIG detect issues that might c... Read more
PART B CODING COACH:
CPT 2010 Preview: Getting Paid Per Drug Class for Test Kits? That's About to End
You'll get less pay for low complexity drug screen. This winter a pair of G codes may rep... Read more
Clip and Save Chart:
Welcome 15 New Specific Codes for Up-And-Coming Tests
Handy table lists new clinical laboratory test codes. CMS recently posted the new lab tes... Read more
PHYSICIAN NOTES:
Finally: All Four RACs List Areas of Review on Their Web Sites
Plus: Power wheelchair suppliers balk at OIG report. If you've been waiting for your reco... Read more
In other news ...
• Industry insiders take exception to the Office of the Inspector General's August r... Read more
READER QUESTION:
Get Your Intra-Office Consults in Line
Document the consults as if an outside physician performed them. Question: I have an ob-g... Read more
CORRECT CODING INITIATIVE:
You Can Resubmit Dozens of Previously-Bundled 22526 Claims
CCI 15.3 retroactively deletes hundreds of edit pairs, but institutes over 18,000 new bun... Read more
CMS COVERAGE DECISIONS:
MACs Can Make Exceptions to LCDs, CMS Says
RACs can only make exceptions to approve claims. Local coverage decisions are known by co... Read more
PHYSICIAN ORDERS/REFERRALS:
Next Year, Medicare Will Deny Claims if Referring/ Ordering Doc Isn't in PECOS Or Claims System
Plus: If your physician isn't 'of the specialty to order or refer,' your MAC will deny yo... Read more
PART B REVENUE BOOSTER:
4 Income Opportunities You Don't Want to Overlook
Make sure you aren't bleeding revenue in these areas -- it only takes a few minutes ... Read more
PART B CODING COACH:
Play the Lesion Excision Waiting Game Unless Carrier Directs You Otherwise
Pathology report can unlock $57 more for 11620 if it justifies using the malignancy code.... Read more
PHYSICIAN NOTES:
Durable Medical Equipment Competitive Bidding Deadline Is Less Than a Month Away
Plus: CMS determines that negative pressure wound therapy systems don't warrant their own... Read more
In other news ...
The research on negative pressure wound therapy (NPWT) has just been completed by CMS and... Read more
READER QUESTION:
Always Include a Code From the 948.xx Range When Treating Burns
Follow the 'Rule of Nines' to identify and code the patient's burns appropriately, based ... Read more
MEDICARE FORMS:
CMS Wants You to Start Prepping Soon for 5010 Transition
New, standardized reports will show you why your claim was rejected and how to fix it. Yo... Read more
DIAGNOSIS CODING:
Break These Diabetes Coding Bad Habits
Learn the 4th digits for 250.xx to increase success. Coding for diabetes has grown tricki... Read more
HOSPICE:
OIG Finds Startling 82 Percent Error Rate in Hospice Billing, Accounting for $1.8 Billion
Plus: Get ready for new requirements in your hospice certification statements. The OIG th... Read more
E-PRESCRIBING:
3 Tips Help You Transition Easily to E-Prescribing
Don't let your incentive payments fall through the cracks. If your practice is one of the... Read more
PART B CODING COACH:
Don't Let 'Discontinued' Spell Disaster for Your Claims
Learn the best ways to know when modifier 53 applies -- or doesn't. Your physician w... Read more
PHYSICIAN NOTES:
Medicare Paid Nearly Four Times the Average Amount to Acquire Standard Power Wheelchairs
Plus: Michigan clinic manager pleads guilty to defrauding Medicare to the tune of $6.5 mi... Read more
In other news ...
• The Department of Justice has laid down the law on another infusion clinic employe... Read more
READER QUESTION:
Is Inpatient Code OK for Observation Patient?
Know the right way to bill observation care for your patients. Question: I've been told t... Read more
HCPCS CODES:
CMS Releases New H1N1 Vaccine Administration Code
Plus: New Bevacizumab code is effective Oct. 1. If you're planning to administer the vacc... Read more
PRIVACY:
Sending PHI Via Email? Find out How to Make Sure It Stays Safe
Look at alternatives to encryption when you deem them necessary. An email that contains a... Read more
STRATEGY:
Beware of Buying Equipment Before Ensuring Medicare Reimbursement
Don't let manufacturers snow you into investing in new gadgets. You've heard other office... Read more
ICD-9 CODING QUIZ:
Upgrade Your Diagnosis Coding Skills Before the New ICD-9 Codes Hit
4 questions reveal whether you're ready for the new dx codes. October 1 is just around th... Read more
PART B CODING COACH:
Don't Let Age-Related Macular Degeneration Reimbursement Fade Away
Focus on 3 key areas to keep your claims on track. Nearly 2 million Americans have age-re... Read more
PHYSICIAN NOTES:
GAO Considers Nonsurgical Procedures for Multiple Procedures Payment Chopping Block
Plus: Michigan physical therapist faces up to 10 years in prison after pleading guilty to... Read more
In other news ...
• A Detroit-area physical therapist (PT) has learned the hard way that fraudulently ... Read more
READER QUESTION:
Can You Bill All Services as Incident-to Under One Physician's ID Number?
Incident-to rules apply to the relationship between a physician and a mid-level provider.... Read more
PART B REGS:
Get Ready for H1N1 Vaccine Coding Rules
Plus: CMS officials reiterate how you can update your provider enrollment documentation. ... Read more
PATIENT PRIVACY:
Know the Rules When You Experience a Security Breach
In some cases, you must alert the media. If you violate a patient's privacy, the days whe... Read more
ELECTRONIC HEALTH RECORDS:
Need Help Instituting EHRs? HHS Plans to Open 70 Regional Centers That Can Assist You
Plus: HHS officials discuss the term 'meaningful use.' Need a jump start to institute you... Read more
IMMUNIZATIONS:
Correctly Predict Tetanus Injection Coverage
Medicare won't always reimburse tetanus vaccines, but there are exceptions. Think getting... Read more
PART B CODING COACH:
5 Steps Break You of Bad Subsequent Care Coding Habits
Virtually everything your physician does can contribute to the documentation. If you repo... Read more
PHYSICIAN NOTES:
CMS Asks You to Resubmit Comments Regarding 2010 Fee Schedule Due to Technical Glitch
Plus: CMS classifies 18 additional lab tests as 'CLIA-waived' effective October 1, accord... Read more
In other news ...
• You'll have 18 lab codes that you'll be able to report as "CLIAwaived," thanks to ... Read more
READER QUESTION:
Multiple Injuries? No Problem!
Mind your modifiers to ensure payment for several procedures and diagnoses. Question: A 3... Read more
COMPLIANCE:
Treat Self-Audits as Learning Opportunities -- Not Punishments
Presentation is everything when talking to staffers. How many ticking time bombs are wait... Read more
E/M CODING:
Hail to the Chief -- Complaint
Chief complaint need not be at the very top of the note, but the physician must state it ... Read more
PART B MYTHBUSTER:
Look at All Other Options Before Using Modifier 59
Remember that modifier 59 can't solve all your unbundling woes. Myth: Modifier 59 is an e... Read more
This Tool Can Do the Modifier Work for You
Follow this flow chart to determine when modifier 59 best fits the bill.  ... Read more
PART B CODING COACH:
Get Ready Now for October's Urinary Diversion, Renal Disease Diagnosis Changes
Bonus:You'll have additional personal history V codes for next year. In just a few months... Read more
PHYSICIAN NOTES:
CMS Reiterates Modifier 50 Advice for Providers Billing Facet Joint Injections
Plus: OIG comes down on inappropriate Medicare payments for pressure reducing support sur... Read more
In other news ...
• You'll see more medical review for pressure reducing support surfaces if the OIG g... Read more
READER QUESTION:
Consider Two Different Ways to Possibly Code Complaint From Past Injury
Tip: Determine whether prior conditions contribute to the patient's current complaint bef... Read more
INCIDENT TO:
OIG Finds Alarming Error Rates Among Incident To Claims
OIG wants practices to append a special modifier to denote incident to services, but CMS ... Read more
RAC AUDITS:
RAC Contractors List 7 Audit Issues on Their Radar Screens
Tip: Even if you voluntarily refund improper payments to your MAC, the RAC might still au... Read more
CRITICAL CARE CODING:
Become a Master of Time With These 2 Critical Care FAQs
Beware: CPT, CMS differ on 'family discussion' parameters. When the physician treats a pa... Read more
INCIDENT TO:
Service Doesn't Meet Incident To Rules? Bill Under Non-Physician Practitioner's NPI
Don't take unnecessary risks for 15 percent more pay Do you know how the incident to rule... Read more
PART B CODING COACH:
4 Tips Position Your 'Multiple Scope' Codes Perfectly
Here's what you should do when there's no base procedure. If your physician performs seve... Read more
PHYSICIAN NOTES:
Medicare's Strike Force Comes Down Hard on Dozens of Shady Providers
Plus: HHS no longer provides oversight of HIPAA -- you'll instead look to the Office... Read more
In other news ...
• You've got a new sheriff in town for HIPAA enforcement. The Department of Health a... Read more
READER QUESTION:
OK if Hospital/Physician E/Ms Don't Match
Plus: Many cath removals are included in E/M service. Question: If the physician performs... Read more
PART B MYTHBUSTER:
Check Secondary Coverage Before Billing Preventive Service
Obtain Medicare denial so the claim can cross over. Myth: You can't bill for a preventive... Read more
ASC QUIZ:
Think Your ASC Coding Skills Are Top-Notch? Take This Quiz
Hint: Your physician may still be able to collect for non-ASC-approved procedures, but th... Read more
INPATIENT E/M CODING:
Do Admit Codes and Admission Have to Show Same DOS?
Overlook this rule and risk leaving E/M dollars on the table. When the physician admits a... Read more
ASC QUIZ ANSWERS:
Check Your ASC Coding Skills With These Answers
Hint: CMS no longer requires modifier SG for ASC services. How did you fare in our ASC co... Read more
PART B CODING COACH:
Use 99211 Requirements for Prothrombin Time Payment
E/M specifics give hints on what's needed for this low-level test. You'll need a blend of... Read more
PHYSICIAN NOTES:
Medicare Will Pay for Some Telehealth Services -- Get the Lowdown on How to Report Them
Plus: Federal Trade Commission extends the Red Flags Rule until November 1, giving you 3 ... Read more
In other news ...
• August 1 has come and gone -- and some practices haven't yet prepared for the... Read more
READER QUESTION:
Get Details of the Patient's Asthma Cause Before You Assign Diagnosis Code
Hint: Know the definitions of intrinsic and extrinsic before you select your ICD-9 code. ... Read more
COPAYMENTS:
Don't Write Off Low-Income Copays Until You Get the Facts
Use all of your state's resources for assistance. If your practice sees a lot of lowincom... Read more
NEUROLOGY:
Count Separate Nerves If Coding Neuromuscular Junction Tests
Counting nerves correctly leads to fewer repays. Even though your physician may --and oft... Read more
REIMBURSEMENT:
5 Coding Opportunities You May Have Overlooked
You could be turning away your rightful reimbursement for scores of services. Medicare co... Read more
MODIFIERS:
Don't Get Burned by Bilateral Modifier Guidelines
Number '2' in column Z? Strike out modifiers 50, RT, LT as options. Not sure if you can a... Read more
PART B CODING COACH:
Bilateral Cochlear Implants Create Programming Code Dilemma
Professional associations go to bat for audiology coders. If your physician performs coch... Read more
PHYSICIAN NOTES:
Hospital Readmissions Continue to Remain a Priority for CMS
Plus: N.J. Attorney General charges one practice with billing surgeries when in actuality... Read more
In other news ...
• Modifier misuse allegations might be partly responsible for one physician's legal ... Read more
READER QUESTION:
Before Using Repair Code, Check for These Essential Items
Hint: Steri strips won't allow you to qualify for the 12001 series -- look to the E/... Read more
PHYSICIAN FEE SCHEDULE:
CMS Proposes $26 IPPE Raise in 2010, Despite Cuts in Other Areas
Plus: Consult pay change will save CMS $1 billion. Your 'Welcome to Medicare' exam servic... Read more
COMPLIANCE:
20 Percent of Ultrasound Claims 'Raise Concerns,' OIG Says
Plus: The OIG identified 20 counties it classifies as "high use" for ultrasounds. The OIG... Read more
SELF-AUDITS:
6 Steps Help You Perform a Successful Self-Audit
Use all the resources at your fingertips, including any applicable worksheets that your M... Read more
PART B MYTHBUSTER:
Take MACs' Refund Requests Seriously
Follow these steps to ensure you don't enter a cycle of unwanted recoupments. Myth: If yo... Read more
READER QUESTION:
Avoid AQ Modifier If Your ZIP Code Is Included in Medicare's Annual Automated File
Your MAC will make your health professional shortage area bonus automatically if you'... Read more
PART B CODING COACH:
4 FAQs Get Your Pulmonary Rehab Coding on the Straight and Narrow
This Q&A gets you up to speed on correct coding and documentation for pulmonary rehab... Read more
PHYSICIAN NOTES:
OIG Reminds Practices to Watch Carefully When Selecting Place of Service Codes
Plus: ADRs don't require you to resend your initial documentation, one MAC says. If you f... Read more
In other news ...
• Don't waste time and resources sending in extra documentation if you're appealing ... Read more
PHYSICIAN FEE SCHEDULE:
CMS Proposes Scrapping Consult Code Payment
Plus: 21.5 percent cut looms for your services. Heavy pay cuts for your physician's servi... Read more
PHYSICIAN FEE SCHEDULE:
Fee Schedule Proposes Raising Pay for IPPE Visits
Plus: Look for changes to e-prescribing eligibility. CMS's proposed 21.5 percent pay cut ... Read more
MODIFIERS:
Quick Tips Help You Differentiate Between Modifiers 58, 78, and 79
Hint: For complication with return to OR, look to modifier 78. Can you easily distinguish... Read more
CLIP-AND-SAVE:
Chart Helps Simplify Your Postoperative Services Claims
Ask the following questions to make your modifier decision easier. If you have trouble de... Read more
PART B CODING COACH:
3 Steps Prep Your Pre-Op SPECT Claims for Success
Here's why listing V codes first is OK in certain cases -- but watch your documentat... Read more
PHYSICIAN NOTES:
American Medical Association Offers E-Prescribing Resources to Get You Started
Plus: Medicare payers will still process claims missing ordering docs' NPI numbers, but w... Read more
In other news ...
• Get ready to see a new remark message this fall if your claims don\'t contain the ... Read more
READER QUESTION:
Prevent Co-Surgery Denials With Modifier Help
Remember: Co-surgeons can't share documentation. Question: Our physicians often work with... Read more
CORRECT CODING INITIATIVE:
CCI 15.2 Scraps Applied Neurostimulator Edit
Look for new edits that affect eye exam codes, anesthesia, and vent management. The Corre... Read more
CARRIER SPOTLIGHT:
Don't Expect Electronic PECOS Signatures in the Near Future
CMS still wants certification statements. Medicare carriers are just as eager as you are ... Read more
COLLECTIONS:
3 Steps Increase Your Collections Success Rate
Improve collections rates and lower write-off amounts with expert advice. With Medicare p... Read more
COLLECTIONS:
Get Results for Your Collections Efforts -- Know What to Say to Patients Who Owe
Ask your staff members to use this handy script when they call patients -- that way,... Read more
PART B CODING COACH:
3 Expert Answers Can Relieve Your Consultation Coding Fears
Caution: Avoid adding a consultation charge to every surgical procedure that your physici... Read more
PHYSICIAN NOTES:
CMS Scraps Timeliness Advice From Recent CMS-855 Transmittal
Plus: Medicare fraud strike force nails 53 individuals who billed more than $50 million i... Read more
READER QUESTION:
Factor in Range of Service When Coding Visit With Obese Patient
If you use modifier 22, make sure your documentation is crystal clear. Question: Recently... Read more
MEDICARE FORMS :
3 Mistakes Could Derail Your Medicare Enrollment
New transmittal indicates that CMS will return your application immediately if you apply ... Read more
GYN SURGERY :
3 Steps Help You Collect for Vaginal Cuff Repairs
Know when to use unlisted code for this service. If you're stuck trying to figure out wha... Read more
PQRI :
Don't Shy Away From PQRI Just Because You Weren't in Business on Jan. 1, CMS Says
Plus: You can take part in e-prescribing even if your pharmacy can't receive the e-prescr... Read more
Correction:
Correction:
Our article "Prevent Uni-Bi Reporting Errors With This Expert Insight" in the Insider, Vol... Read more
DME :
Competitive Bidding Steamrolls Ahead Suppliers are in for the fight of
Medical equipment suppliers must have accreditation, surety bonds to bid. Suppliers are i... Read more
PART B CODING COACH :
Maximize E/M Payment for Hepatitis Patients With Accurate MDM
Follow these 4 tips and learn how to make the most out of initial visit claims through di... Read more
PHYSICIAN NOTES :
CCI Version 15.2 Creates Over 3,500 New Code Pairs; Changes Modifier Status on Several Codes
Plus: CMS is taking comments on its new potential definitions of EHR 'meaningful use.' CP... Read more
In other news ...
• When CMS announced that providers could get bonuses for demonstrating "meaningful ... Read more
READER QUESTION :
Document Pelvic Exam and Pap Elements Properly to Improve Pay -- And Keep Patients Happy
If you don't document appropriately, the patient could end up being responsible for appli... Read more
MEDICARE FORMS :
Get a Leg Up on CMS's New HIPAA 5010 Form
Yes, physicians are affected by the new form -- but so are billers and claims cleari... Read more
MEDICARE FORMS :
HIPAA 5010 Form Paves the Way for ICD-10 Claims
Plus: Know what to ask your vendors. Want the scoop on how the new HIPAA 5010 form will a... Read more
DIAGNOSIS CODING :
Snag Summer Tick-Related Case Diagnoses With Insect Fast Facts
Injury code hinges on venomous/non-venomous savvy -- and more. Think a tick is ve... Read more
LESION CODING QUIZ ANSWERS :
Check Out How You Fared in Our Lesion Coding Quiz
Determine whether you've got top-notch lesion coding skills -- or whether you need a... Read more
PART B CODING COACH :
Plan Ahead for New Parallel Upper and Lower Extremity Embolism Coding
Is 'unspecified' your go-to code? You'll need to check your choices. Lower extremity embo... Read more
PHYSICIAN NOTES :
Take Note of New Diagnosis Code That Applies to H1N1 Virus " Also Known As 'Swine Flu'
Plus: One carrier overlooked therapy cap amounts earlier this year. Practices that are st... Read more
In other news ...
• You may not have to worry about therapy caps for patients who received outpatient ... Read more
READER QUESTION :
Open Fracture May Not Require Use of Open Fracture Care Codes
Keep an eye on the full operative report -- not just the diagnosis codes -- to ... Read more
MEDICARE FEE SCHEDULE:
CMS Adds 5 New Codes Effective July 1, Changes Bilateral Status
Check out these changes to the 2009 Medicare Physician Fee Schedules mid-year ... Read more
PART B MYTHBUSTER:
Auditors Review the Op Note -- Not Just Its Title
Plus: Bust this myth about same-day E/M services. Myth: The title o... Read more
LESION CODING:
Confused by Recent Lesion Coding Directives From NGS? Here's the Scoop
Stick with what you know about lesion excision coding, experts say. ... Read more
LESION CODING QUIZ:
Take This Lesion Coding Quiz to Ensure That Your Skills Jibe With Payer Rules
Determine whether youve got top-notch lesion coding skills -- or whether you n... Read more
PART B CODING COACH:
Double Your $$ When You Spot E/M + Burn
Know the key component of 16000 and put burn coding questions on ice. ... Read more
PHYSICIAN NOTES:
Make a Mistake on Paper Claim Form? Start Over Rather Than 'Whiting Out' the Error, One Carrier Says
Plus: OIG reveals 108 pages of recommendations that havent been implemented. ... Read more
In other news ...• The OIG never forgets a recommendation -- particularly when
To remind practices of the outstanding recommendations that the OIG suggested ... Read more
READER QUESTION:
Count Minutes on 'Counseling Exception' Claims
Non-physician practitioner claims may merit time-based E/M coding -- chec... Read more
COMPLIANCE :
New Law Tightens Scope of False Claims Act
What looked like a law that cracks down on mortgage and financial fraud could ... Read more
MODIFIERS :
Put Patient -- Not Money -- First With Split Surgical Care
Plus: Pay attention to whether your payer is recognizing your modifiers. ... Read more
PART B MYTHBUSTER :
Responsibility Is on Your Practice to Provide Sign Language Interpreter -- Free of Charge
In some cases -- but not always -- prolonged service codes may apply... Read more
DME ERRORS :
CERT Error Rate Creates Difficulties for DME Suppliers -- Again
2008 error rate for DME is 70 percent, contractor maintains. Durabl... Read more
PART B CODING COACH :
Oncology Coding in Focus: Dig Into 2 Dosimetry Examples and Unlock Payment
Note the one question you must put to your payer. The descriptor fo... Read more
PHYSICIAN NOTES :
CMS' Senior Medicare Patrol Project Appears to Be
Plus: Even carriers appear to be confused about how to report discharge codes ... Read more
In other news ...
" If youre looking for help on which discharge code you should use for hospice... Read more
READER QUESTION :
Count HPI, Or Risk Choosing Wrong E/M Level
Check how many of the essential eight questions your physician answered in his... Read more
ICD-10 :
CMS Offers Guidance on ICD-9 to ICD-10 Crosswalks
Plus: Carriers will continue to accept ICD-9 codes for a period of time for da... Read more
PQRI :
Patients With Medicare as Secondary Count Toward PQRI
Plus: Providers collecting under physician fee schedule can collect e-prescrib... Read more
HOSPICE :
Physician Headaches to Increase for Hospices
CMS wants more documentation from certifying doctors. Get ready for... Read more
APPEALS :
Add Up How Many Low-Dollar Denials You Write Off and Determine Whether to Pursue Payment
The answers may surprise you -- and addressing the appeals may add to you... Read more
PART B CODING COACH :
Stop Mixing Up Hysterectomy Codes by Highlighting Weight, Removal
Know the clues to determine whether your ob-gyn removed the ovaries. ... Read more
PHYSICIAN NOTES :
CMS Creates Health Care Fraud Prevention and Enforcement Action Team (HEAT) to Tackle Fraud
Plus: Medical practices spend $85,276 per physician annually to deal with heal... Read more
In other news ...
" Time is money in a medical practice, and a new study shows just how much mon... Read more
READER QUESTION :
Can Graduate Nurses Serve as Medicare Providers?
The answer depends on PECOS application dates. Question: I have a q... Read more
You'll Benefit From 141 New ICD-9 Codes Effective Oct. 1
Some of the new codes may help you with ICD-10. If youve got high h... Read more
DIAGNOSIS CODING :
Get a Sneak Peek at the New ICD-9 Codes You'll Use in October
Looking for new sepsis or poisoning codes? The new crop of diagnoses could be ... Read more
MEDICARE FUNDING :
Medicare Program Risks Going Broke, According to New Report
Part A is poised to run out of money -- and although safe for now, Part B could be ... Read more
MODIFIERS :
This Quick Quiz Shows IfYou Suffer From Modifier Misuse
Determine whether you need to hone your modifier coding skills. Mod... Read more
Part B Coding Coach :
Use New Hemorrhoid Destruction Code Correctly Or Miss Out on $190
Dont forget the 90-day global period on 46930. If your physician de... Read more
PHYSICIAN NOTES :
Know Diabetic Patient's BMI to Determine Eligibility for Bariatric Weight Loss Surgery
Plus: In a new decision memorandum, CMS announces that it will not cover virtu... Read more
In other news ...
" Practices that were holding out hope that CMS would change course on its vir... Read more
READER QUESTION :
Note Separate Locations to Determine How to Report Hardware Removal
Hint: Know whether the fracture care codes are the same and whether the implan... Read more
MEDICARE FORMS:
CMS Expects Practices to Use New HIPAA 5010 Form by 2012
Hint: You wont be able to submit ICD-10 codes without this new form, so start ... Read more
RED FLAGS RULE:
CMS Extends Deadline for Complying With Red Flags Rule
You now have until August 1 to prepare -- but youll need all of that time... Read more
ICD-10:
Get a Head Start on the Transition to ICD-10 Codes So You'll Be Fully Prepared When the Time Comes
Plus: Know what to expect for your staff training in the coming year. ... Read more
RAC AUDITS:
Take These 6 Steps to Prepare for the RAC Audit Onslaught
Hint: Take requests for your records seriously and ensure that your documentat... Read more
Part B Coding Coach:
Just Because You Have A New Epley Code Doesn't Mean You'll Always Get Paid for It
Medicare slaps bundled status on 95992, denies reimbursement for new code ... Read more
PHYSICIAN NOTES:
OIG Opened 1,750 New Health Care Fraud Investigations During 2008
Plus: OIG investigation finds that eye surgeons collected $97.6 million for E/... Read more
In other news ...
" As most practices know, E/M services are included in the global packages of ... Read more
READER QUESTION:
Keep Medicare's Additional Test Rules Right at Your Fingertips
Know CMSs allowable circumstances when a non-hospital radiologist can perform ... Read more
MEDICARE ERRORS:
E/M Codes Top the List of CERT Mistakes, CMS Says
With over $600 million paid improperly, physicians didnt document their subseq... Read more
MEDICARE ERRORS:
Occupational Therapists, Neurosurgeons Need to Tighten Coding
Anesthesiologists, interventional radiologists, and ASCs come out looking good... Read more
E/M CODING REFRESHER:
These 3 Q&As Will Eliminate E/M Coding Confusion
Make sure your practice doesnt become an E/M coding error statistic. ... Read more
GLOBAL SURGERY:
Watch Those Modifier 79 Claims, One MAC Advises
Remember: Medicare only pays for surgical complications during the global if t... Read more
Part B Coding Coach:
Don't Let Catheter Coding Mistakes Drain Your Reimbursement
Tip: Check to see whether an E/M code is appropriate for cath removals. ... Read more
PHYSICIAN NOTES:
Aberrant Claim Patterns for Inhalation Drugs in South Florida Set Off OIG's Radar
Plus: E-prescribing might be making your head spin, but CMS finally offers a s... Read more
In other news ...
" As most practices know, successful e-prescribers qualify for a two percent i... Read more
READER QUESTION:
Know the Ropes to Correctly Report Smoking Cessation Counseling
Medicare imposes frequency limit on 99406-99407. Question: Do I sti... Read more
COMPLIANCE:
Texas Hospital Pays Nearly $10 Million for Inflated Outlier Charges
The consultant told me to do it isnt a valid defense. If youve incr... Read more
E/M CODING QUIZ:
Check Your E/M Coding Skills With This Quick Quiz
Do you avoid reporting visits with a patients family? This advice will help yo... Read more
E/M CODING QUIZ ANSWERS:
How Did You Fare in Testing Your E/M Coding And Billing Skills?
If you answered all three questions correctly, youre a Part B ace. ... Read more
PART B MYTHBUSTER:
'Compound' Fractures Refer to Broken Skin, Experts Say
Know these keywords to select the right ICD-9 code every time. Myth... Read more
Part B Coding Coach:
Dodge Double-Billing Interpretation Claim Mishaps With This Advice
Discover this big benefit of reporting interps. When your physician... Read more
PHYSICIAN NOTES:
CMS Establishes Care Transitions Project to Cut Down on Hospital Readmissions
Plus: One Medicare carrier finds a quick fix for erroneously rejected physicia... Read more
In other news ...
" Good news for hospices that submit claims with physician services: A claims ... Read more
READER QUESTION:
Check Documentation to Confirm Whether Modifier 25 Is Warranted
Nerve block includes minor evaluation and management service, so only bill an ... Read more
HCPCS:
Look for Three New HCPCS Codes Effective July 1
Plus: CMS also introduces five new HCPCS modifiers. CMS has good ne... Read more
BILLING:
Collect at the Time of Service With Ease Using These Quick Tips
Prevent payment leaks with this expert advice. Your practice may ch... Read more
PART B REGS:
Signed Certification Statements Are Essential to Your Medicare Enrollment, CMS Says
Plus: CMS clarifies IPPE reimbursement policy. If youre using the P... Read more
RECOVERY AUDIT CONTRACTORS:
Defend Against Recovery Audit Contractor Reviews With Solid Documentation
Tip: Know when your states RAC audit rollout is scheduled so you can be prepar... Read more
Part B Coding Coach:
Prevent Uni-Bi Reporting Errors With This Expert Insight
Know when to use RT/LT and when to rely on modifier 50. Dont let tr... Read more
PHYSICIAN NOTES:
CMS Hasn't Made New PECOS Ruling Legal Yet,Analysts Say
Plus: CMS creates crosswalk that leads you from ICD-9-CM to ICD-10-CM diagnosi... Read more
In other news ...
" The transition to ICD-10-CM might be a little less painful,thanks to new too... Read more
READER QUESTION:
Use This Modifier 51 Advice When Billing Medicare Carriers
Most carriers computer systems automatically apply the modifier 51 discount wh... Read more
MEDICARE ADVANTAGE :
CMS Overhauls Medicare Advantage Program
Oversight of MA could tighten significantly. CMS is buckling down o... Read more
BILLING :
Avoid Separation Anxiety When It Comes to Submitting Claims
Measure charges and take action, experts say. So youve got a handle... Read more
PART B MYTHBUSTER :
Know the Rules for Coding Patient Discharges Followed by Readmissions
Tip: Find out the reason for readmission before you code. Myth: Onc... Read more
HOSPICE :
Higher Hospice Payment Rates Arrived on April 3 -- Are You Prepared?
Keep in mind: Big cuts still lie ahead for the hospice industry in the coming ... Read more
Part B Coding Coach :
Keep Chronic Pain Denials at Bay With Surefire Diagnosis Tips
Be careful not to put words in your physicians mouth, or risk audit woes. ... Read more
PHYSICIAN NOTES :
CMS Changes Course: Physicians Need Not Personally Complete PECOS Application
Plus: Check out CCI 15.1s retroactive deletions to keep reimbursement flowing.... Read more
READER QUESTION :
Use Time and Modifiers Carefully When Reporting EMG Services
Tip: Counting minutes may not aid reimbursement. Question: Our phys... Read more
RED FLAGS RULE:
No Red Flags Program? You Could Be Losing Thousands
Tip: Institute your Red Flags program ASAP. You may think the gover... Read more
RED FLAGS RULE:
Act Quickly If Your Practice Identifies a Red Flag
Identity theft is nearly a $50 billion industry. Youve implemented ... Read more
COMPLIANCE:
OIG Advisory Opinion Process Can Be Long,Arduous -- And Costly
The Advisory Opinion will give you peace of mind, so proceed with requesting o... Read more
PART B REVENUE BOOSTER:
Brush Up on Your ICD-9 Know-How With 3 Tips
Confused about fifth digits or V codes? Look no further. Insurers b... Read more
Part B Coding Coach:
5 Answers Capture Suture Removal and Related Work
Tip: Your E/M usually requires 2 components -- which means more than prob... Read more
PHYSICIAN NOTES:
OIG Imposes One of the Largest Ever Civil Monetary Penalties Against Nevada Radiology Practice
Plus: CMS establishes MLN Matters article to answer your PQRI questions. ... Read more
READER QUESTION:
Mind This Year's CPT Deletions for Accurate Botox Coding
Tip: Report chemodenervation guidance once per day, not per injection or injec... Read more
CORRECT CODING INITIATIVE:
CCI Institutes Over 300,000 New Code Pair Edits
This round, CCI also creates a few welcome deletions. If you thought CCI versions after J... Read more
COMPLIANCE:
Find Out When the OIG Advisory Process Applies to Your Practice
Tip: Make request before implementing policies. You've most likely read about one or two ... Read more
PQRI:
Cardiology Association Urges Physician Involvement for Successful PQRI Implementation
Plus: If your claim has a zero dollar charge, don't expect your PQRI bonus to increase. I... Read more
CRITICAL CARE:
Follow This FAQ to Maximize 99291 Coding
Physician 'preventing further deterioration' keys valid critical care claims. What do cri... Read more
Part B Coding Coach:
Keep Your Scope Coding All in the Family to Avoid Errors
Are you missing out on hundreds? Now's the time to find out. Coding scope procedures, s... Read more
PHYSICIAN NOTES:
Take Note: CMS Issues Corrections to 2009 Physician Fee Schedule Final Rule
Plus: One RAC reveals information about how it will evaluate claims during its review pr... Read more
In other news ...
Wondering how the new Recovery Audit Contractors plan to review -- and po... Read more
READER QUESTION:
Know How to Report Hospital Discharge After Consultation
Tip: Differentiate attending doc from referring. Question: A family practice physician ad... Read more
OBSERVATION CODING:
Observation Stays Are on the Rise -- 4 Tips Help Code Them
Hint: Roll office visit, observation stay into one code. Physicians are admitting more pa... Read more
COMPLIANCE:
Disclose Physician Ownership of Referring Hospitals Up-Front
Both physician-owner and hospital are responsible. If your physician owns a stake in a ho... Read more
PART B MYTHBUSTER:
Just Because CCI Doesn't 'Bundle' Procedures Doesn't Mean You Can Always Bill Them Together
Even if CCI doesn't publish edits bundling two procedures together, your practice should ... Read more
UNBUNDLING:
Get to Know These Code Pairs That You Shouldn't Report Together Under Certain Circumstances
Follow the advice on these examples and it will lead the way to reporting your code combi... Read more
Part B Coding Coach:
3 Scenarios Help You Perfect Your Orthopedic ICD-9 Coding Skills
Tip: Let the surgeon determine whether the condition is acute vs. chronic. If you choos... Read more
PHYSICIAN NOTES:
CMS Offers Overview of the RAC Program With New Transmittal
Plus: NPPES system will prompt password changes this week, thanks to CMS system overhaul.... Read more
In other news ...• You'll have to change your NPPES password after system updates taking place March 7.
The National Plan and Provider Enumeration System which houses the National Provider Iden... Read more
In other news ...• Starting July 7, you should begin seeing your NPI on all paperwork from the National Supplier Clearinghouse.
A Feb. 27 transmittal (CR 6314, Transmittal No. 451) from CMS instructs the NSC to "inser... Read more
READER QUESTION:
Know the Differences Between 'Mutually Exclusive' And 'Bundled' Procedures
The differences could affect your reimbursement. Question: Can you explain what the diffe... Read more
PART B MYTHBUSTER:
3 Deadly Myths That Could Rob Your Practice of Reimbursement
Check your own methods against these coding and billing pitfalls. If you subscribe to any ... Read more
PQRI:
Make Sure These Errors Don't Cause Your PQRI Bonus to Tank
CMS shows which issues sidelined these practices. Most practices would agree that a 57.2 p... Read more
RACS:
CMS Rolls Recovery Audit Contractors Back Into Business
Plus: Medicare officials clarify who can bill incident-to services and under what ci... Read more
PART B REVENUE BOOSTER:
Make Co-Surgery Denials a Thing of the Past
4 tips break down what documentation both physicians should have. When two physicians perf... Read more
Part B Coding Coach:
Consult or Referral? You Be the Judge
Know the 5 Rs to keep the auditors at bay and collect that extra $50 The feds have consul... Read more
Physician Notes:
CMS Designates Additional Lab Procedures As 'CLIA-Waived'
Plus: CMS agrees to cover sleep testing when a physician is initially diagnosing a p... Read more
READER QUESTION:
Pelvic Floor Therapy May Require You to Report More Than One Code
You'll also have to get your modifiers ready to ensure that your Medicare carrier reimburs... Read more
FACET JOINT COMPLIANCE:
Physicians Overbilled Facet Joint Injections by $96 Million, OIG Says
CMS warns MACs to be on the lookout for improperly billed injections. Making a $50 erro... Read more
PRIVACY:
Be Prepared -- Stimulus Plan Strengthens HIPAA Rules
Many HIPAA regulations are now applicable to your practice's business associates. If you'... Read more
FACET JOINT COMPLIANCE:
Avoid OIG Scrutiny With Facet Joint Injection Savvy
Our tips help you report modifier 50 the right way. Think billing bilateral facet joint i... Read more
IDENTITY THEFT:
Prepare for Red Flag Rule by Squelching Opportunities for Identity Theft at Your Practice
Implementation guideline is right around the corner. Does it apply to you -- and are... Read more
IDENTITY THEFT:
Get The Right Facts in Your Red Flag Program And You'll Be All Set for the May 1 Deadline
These sample items can help you get on the right track -- and can help you shape you... Read more
Part B Coding Coach:
5 Steps Ensure Your Observation Care Success
Code service only when making admittance decision to prevent denials. Although CPT offers... Read more
PHYSICIAN NOTES:
CMS Spending on Physician and Clinical Services to Grow 6 Percent in 2009
Plus: Payers may not honor new outpatient therapy cap amount until April,CMS says. If CMS... Read more
In other news ...• The outpatient therapy cap is $1,840 for 2009, but the claims system won't reflect that until April.
It will reject therapy claims that exceed the 2008 cap amount of $1,810 until then, CMS s... Read more
READER QUESTION:
You Will Need a Diagnosis Code for a Feigned
Hint: Select the diagnosis code based on the physician's documentation, even if you end u... Read more
PART B UPDATE:
Stimulus Plan Could Put $44,000 in Your Doctor's Pocket
Plus: Tighten up your HIPAA policies -- new bill gives the government more resources... Read more
MODIFIERS:
Focus on Modifier 79 Compliance -- Before Your Carrier Does
Our tips help you report modifier 79 the right way. CMS wants to make it crystal clear: I... Read more
COMPLIANCE:
Tackle Your Compliance Questions With 2 FAQs
Would you know how to write an annual report to the OIG? We've got expert tips. Medical p... Read more
Part B Coding Coach:
Prevent Transcranial Doppler Denials With AMA Approved Guidelines
Missing CPT requirements for 93893 can cost you. In 1993, the Office of Inspector General... Read more
PHYSICIAN NOTES; Differentiate Traditional Medicare Carriers From the New MACs
Know where to go to find out how long payers in your state are allowed to wait before see... Read more
READER QUESTION:
Get This Prior-to-Surgery Modifier Advice to Avoid Any Coding Snafus
Remember: You can't report modifier 57 if the decision for surgery was made long ago. Q... Read more
PART B APPEALS:
CMS Changes Dollar Amount Threshold for U.S. Court Appeals
$1,220 must be in dispute to qualify for district court hearing. Forty dollars may not so... Read more
ENROLLMENT:
Quell Confusion About CMS' 30-Day Retrospective Billing Rule
If your head continues to spin over the new 30-day rule, we've got clarification straight... Read more
PART B REVENUE BOOSTER:
Co-Surgery or Assistant Surgery? The Difference Could Cost You 46 Percent of Your Pay
Keep an eye out for separate op notes, experts say. Can't tell a surgical assist from a c... Read more
COMPLIANCE:
6 Ways to Head Off Compliance Problems --and Lawsuits
How carefully do you listen to your employees' complaints? A hospice chain's $25 million ... Read more
Part B Coding Coach:
Affect Your Practice's Bottom Line With Nosebleed Repair Smarts
Coders often under-report their epistaxis claims. If you can't differentiate a complex an... Read more
PHYSICIAN NOTES:
If Your Modifier JW Claims Resulted in Instant Rejections, Don't Lose Heart
Plus: CMS offers quick primer on billing/coding services performed in ambulatory surgical... Read more
READER QUESTION:
Differentiate Glaucoma Patient Coding Rules Based on Whether SNF Is Involved
If the patient comes to your practice from a skilled nursing facility, consolidated billi... Read more
Part B Documentation:
3 Quick Tips Help You Implement New ABN Form
Combo form streamlines your work. If you aren't using CMS's new advance beneficiary notic... Read more
Part B Revenue Booster:
Recognize Incident-to Services Or Pay the 15-Percent Penalty
Hint: Doctor's schedule will be the key. Under incident-to rules, qualified nonphys... Read more
Part B Revenue Booster:
Clip and Save: Let This Tool Do the Incident-To Decision Making for You
Follow the flow chart to determine when incident-to services are billable. Suppose your n... Read more
Hospice:
Hospices May Need Additional Details From Physicians Based on New Recommendations
MedPAC also targets 5 hot spots for focus areas, which could burden some hospices if put ... Read more
Use These 3 Easy Tips for Headache-Related Nerve Blocks
Correct 64400 and 64405 coding helps ensure payment. If your practice is looking to add b... Read more
Physician Notes:
CMS Expands Coverage for Prothrombin Time to Include Additional Diagnoses
Plus: CMS offers a new resource for billing and coding preventive services to Part ... Read more
Reader Question:
Get to Know the Ins And Outs of Medicare's E-Prescribing Bonus
Three G codes could help you tell your payer why you deserve a bonus for your e-prescribi... Read more
Part B Funding:
Dems' Stimulus Bill Earmarks Over $26 Billion for Healthcare
$550 billion bill doesn't ignore medical practices. President Barack Obama was just sworn... Read more
Part B Payment:
Calculate Fees Differently in '09
We'll show you how your payer will establish fees. CMS has tried to make it easier for yo... Read more
Part B Mythbuster:
Modifier 57 Alone Should Preclude the Need for 25
Medicare carriers don't require you to append both modifiers. Myth: Payers "don't l... Read more
Part B Revenue Booster:
2 Tips Easily Solve Your Code Compliance Errors
Reduce denials for your practice by reading the fine print. There are always a few tricky... Read more
Part B Coding Coach:
Bust 3 Myths About How Global Rules Affect Your Postop Coding
CMS and CPT disagree about one key term. If you automatically assume you can't separately... Read more
Physician Notes:
Avoid Stamped Physician Signatures on Durable Medical Equipment Forms
Plus: If a CERT auditor requests just one record, treat the request the same as if ... Read more
Reader Question:
Master This Tricky Recertification Timing Issue for Part B Therapy
Know the limits to the 90-day rule -- and whether the therapy must occur on pre-spec... Read more
PART B CREDENTIALING:
CMS Clarifies New 30-Day Retrospective Billing Rule
Count 30 days back from application date, CMS CMS has cut its retrospective billing rule ... Read more
PART B ENROLLMENT:
CMS: Billing Co. Can't Fill Out PECOS Form on Doc's Behalf
Practitioners must personally fill out online form. Most practices that participate with ... Read more
PQRI CMS Offers Guidance on PQRI for 2009 -- And Confirms Increased Incentive Payment
Plus: CMS offers two reporting periods for PQRI participation. Want to collect your... Read more
PART B MYTHBUSTER:
Avoid Basing Code Selection on SuperbillChoice -- Or Risk Denials
No matter which specialty you code, bill based on documentation -- not the codes cir... Read more
Part B Coding Coach; Steer Your Incident-To Coding Using These 4 Questions
100 percent pay is possible if NPP follows physician's plan of care. If you do not ... Read more
Physician Notes:
Get Ready: CMS Will Implement ICD-10 on Oct. 1, 2013, HHS Says
Plus: Keep anti-kickback statute top of mind when setting up a practice. If you wer... Read more
In other news ...• One Maryland rehab practice paid dearly for allegations of violating the anti-kickback statute.
Advanced Centers for Ortho-paedic Surgery and Sports Medicine Inc. and Maryland Sportscar... Read more
READER QUESTION:
How Should You Report 2 Polyp Removals Performed at Separate Sessions
Hint: The answer depends upon whether the physician used the same type of technique... Read more
Correct Coding Initiative:
CCI 15.0 Takes Aim at Several New CPT Codes
New IV infusion code 96365 sees scores of bundles. With over half a million changes... Read more
CCI:
Now No Modifier Can Separate 90865/90807 Bundle, CCI Says
Several modifier changes will alter the way you code psychotherapy, conscious sedation, a... Read more
CCI:
CCI Aims Sights at Turbinate Procedure Codes
Plus: You'll find new bundles in gastro, neuro, and orthopedics. Version 15.0 of th... Read more
Part B Billing:
Stop Chasing After 'Welcome to Medicare' Exam Deductibles
Plus: Medicare no longer requires you to perform a screening EKG with the WTM... Read more
Part B Coding Coach:
Spot E/M Evidence to Gain $130 When Ventilation Management Occurs
These tips help you identify higher paying critical care versus emergency department E/M ... Read more
Physician Notes:
CMS Assigns 'CLIA-Waived' Status to 5 Additional Lab Tests
Plus: CMS proposes expanding coverage of diagnostic testing using PET scans for cancer pa... Read more
In other news ...• CMS soon may rework its HCPCS coding for negative pressure wound therapy (NPWT) devices.
CMS and the Agency for Healthcare Research and Quality are reviewing the items. CMS is ca... Read more
Reader Question:
Are You Undercoding Condition Checks?
Know where MDM puts you on the E/M range. Question: We see a lot of patients ... Read more
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