Part B Insider (Multispecialty) Coding Alert

Reader Question:

Keep Updated with Part B Changes to Avoid Portable X-ray Denials

Published on Mon Aug 08, 2016

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Make the effort to educate your practice or group before claims are denied.

Question: The portable X-ray company that I manage is relatively young, and we’ve encountered some coding obstacles. In a past Part B Insider issue, you addressed the billing issues that face portable X-ray groups and the providers who use them. Are there any additional resources for portable X-ray providers to ensure we are in compliance and following the proper protocols, procedures, and codes?

—Ohio Subscriber

Answer: Yes. As we referenced in the Part B Insider article (Vol. 17, no. 23), a review of past OIG reports, advisory opinions, and guidelines can help you to combat audits and keep your group in compliance.

CMS also offers excellent advice to providers with an entire chapter devoted to radiology and mobile imaging in the Medicare Claims Processing Manual. MLN Matters articles have touched on subjects and concerns related to coding for portable X-rays, too. Lastly, the MAC in your jurisdiction may have special rules related to your field in coordination with the state where you provide service, so it is always necessary to check with them before you proceed.

Re-check documentation. In many instances of improper coding, the documentation ends up being the key to overcoming the audit. Though the rules by state are confusing, it is usually misinterpreted notes that are then incorrectly coded for the claim.

The National Association for Portable X-Ray Providers (NAPXP) is also a great resource for providers, especially those just entering this growing field. The organization holds an annual conference devoted entirely to those who code, bill, and document for portable diagnostics. The group also provides updates and outreach to members all year long “to take a proactive approach to understanding the complex and ever-changing landscape of Medicare billing,” Scott Grinley, NAPXP president, says.

“Some of the challenges to our industry’s growing popularity and ever-changing regulations are that it gives rise to the number of audits that business owners are susceptible to. Despite this, only about a third of portable X-ray providers are currently members of the NAPXP and take advantage of the CEU billing credits available at our mid-year billing conference,” Grinley explains. “All too often, business owners are calling for NAPXP membership only after they have been identified by Medicare as having billing and documentation woes.”

Resources: For more information about NAPXP, visit http://napxp.org. For a quick link to the Medicare Claims Processing Manual, visit https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c13.pdf.