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Practice Management Alert

Collections Corner:
Capture Every Non-Par Dollar You Deserve With 3 Strategies
Don't let patients keep the money your doctors earned -- get proactive.As insurance c... Read more
News You Can Use:
Congress Votes to Freeze Medicare Pay Through 2011
Rejoice along with the AMA now that you have a full year fix.Although the government appea... Read more
Diagnosis Coding Primer:
Eliminate 'Uncertain Behavior' Confusion With Expert Tips on 238.2 Use
Hint: Wait for the path report to avoid payer scrutiny.If you always use diagnosis code 23... Read more
You Be the Billing Expert:
Applying Medicare Timely Filing Rules
Question: During a recent internal review, we found several claims from November 2009 that... Read more
Payer Updates:
CMS Says It May Not Deny PECOS Claims Starting in January
Plus, Minnesota BCBS tests new incentive-based payment with four hospital systems.You may&... Read more
In other news
If you contract with Blue Cross Blue Shield in Minnesota incentive-based payment may be on... Read more
Reader Questions:
Check Rules for Injection + E/M
Question: A payer denied our claim for an established patient office visitin addition to C... Read more
Reader Questions:
Submit 99211 for Blood Pressure Check
Question: An established patient came to our office for a blood pressure check because he ... Read more
Reader Questions:
Can Provider Change Tax ID?
Question: One of our physicians wants to stop billing under the group's tax ID and start b... Read more
Reader Questions:
Pick Inpatient E/M for Admission Date
Question: If our surgeon sees a patient, and later that same day, another physician admits... Read more
Reader Questions:
Insurer Rules 99354 OK for Interpretive Services
Question: A level four office visit with an established patient took 55 minutes of physici... Read more
Denials Management:
Overcome MUE Denial Challenges By Busting 4 Common Myths
If you ignore the medically unlikely edits, you're asking for a claim rejection.If you're ... Read more
News You Can Use:
CMS Slashes 2011 Conversion Factor and Wreaks Havoc on Your Pay
Plus: Learn two new HCPCS codes if your physician performs wellness visits.Get ready for a... Read more
Coding Corner:
99224, 99225, 99226: Be on the Lookout for Observation Code Changes in 2011
Get a glimpse of the codes you'll be using in January so you can prepare now.January is ju... Read more
Payer Updates:
Bundled Cancer Treatment Pay May Be On the UHC Horizon
Plus, BCBS in Michigan faces DOJ scrutiny and class-action lawsuit.If you bill for a varie... Read more
You Be the Billing Expert:
Can You Bill Under the 'House' Doctor?
Question: The doctors I work for asked me to bill a radiology procedure under the "on call... Read more
Reader Questions:
No CCI Bundle? Here's Where to Find Modifier Details
Question: Sometimes I cannot find my two-code pair in the CCI edits. How do I know which c... Read more
Reader Questions:
99239: Count All Relevant Time on Discharge Day
Question: The physician admitted a patient and then discharged the patient five days later... Read more
Reader Questions:
CMS Spells Out MD's Role in E/M
Question: I've heard that for an E/M visit, the physician is responsible for certain parts... Read more
Inpatient Billing:
Capture Split/Shared Visit Payments By Following 3 Simple Rules
Tip: Don't let Medicare's 2010 consultation changes alter your split visit billing.When yo... Read more
Prompt Pay:
Overcome Delinquent Payer Headaches By Knowing Your State's Prompt Pay Laws
Remember: Medicare requires contractors to pay your clean claims within 30 days, but priva... Read more
Coding Corner:
Update Your Dx Coding With 2011 Changes to H1N1, Fecal Incontinence, and More
488.1x cheat sheet makes fast work of snagging correct code.You've recently flipped the ca... Read more
You Be the Billing Expert:
Copays With No Billable Service
Question: Can we collect a copay from a patient on a postoperative follow-up visit which i... Read more
Reader Questions:
Avoid a 'Finders Keepers' Overpayment Mentality
Question: We've discovered that a patient overpaid us on her copay. We collected $50, whic... Read more
Reader Questions:
Apply 'Birthday Rule' to Double-Covered Patients
Question: If a married couple has a baby who becomes our patient, what insurance do we bil... Read more
Reader Questions:
Get Individual Payer Coding Rules in Writing
Question: One of our patients had a laparoscopic partial omenectomy. I chose the unlisted ... Read more
Reader Questions:
Add Modifier 24 For Treatment Discussion During Global
Question: A patient came in for the biopsy report after a 90-day global procedure. The doc... Read more
Reader Questions:
Altering Coding Just to Get Paid Is a Big No-No
Question: When coding a mastectomy for gynecomastia in a male, what CPT code should I use?... Read more
Auditing 101:
3 Steps Help You Uncover Missed Billing Opportunities With Internal Audits
Tip: The same audit process and timeline won't work for every office -- identify your prac... Read more
ICD-10:
Start Prepping Now for ICD-10 With 3 Mythbusters
You'll need to implement the new 5010 claim form first to be ready for ICD-10.While the fa... Read more
Evaluation and Management:
Use These Questions to Capture HPI for Full Reimbursement
Get your physician to collect the information you need, with this handy list. In the l... Read more
ICD-10:
Catch a Glimpse at ICD-10 Codes for Cough, Cardiac Arrest, and More
Get used to using letters in your diagnosis coding.In the previous article, you've learned... Read more
You Be the Billing Expert:
Prompt Pay and Worker's Comp
Question: Do the prompt pay laws apply to worker's comp claims? These take so long to rece... Read more
Payer Updates:
NY Insurance Department Fines Payers For Prompt Pay Violations
The New York State Insurance Department fined 20 payers for not paying providers within th... Read more
Reader Questions:
Check Supervision Requirements Before Billing 'Incident To'
Question: Can I bill for an NP's services without a physician in the building? The doctor ... Read more
Reader Questions:
Attach JW for Drug Wastage " Sometimes
Question: How should I bill for wasted drug? My doctor often splits a single vial between ... Read more
Reader Questions:
Beware Tacking on Additional Patient Charges
Question: Can you charge a processing fee or a "statement" fee to pastdue patients when we... Read more
Reader Questions:
Bilateral Done On 1 Side Means 52
Question: A patient underwent a hysteroscopy. The code 58565 represents a bilateral proced... Read more
Reader Questions:
Attach GV or GW to Ensure Hospice Pay
Question: We have a patient our physician performed an incision and drainage procedure on.... Read more
Consolidated Billing:
Set Up a Solid Contract With Nursing Facilities to Ensure You Get Paid Every Time
Consider having a healthcare attorney assist with the process.To receive payment for the s... Read more
Evaluation and Management:
Scope Out Potential Level 4 and 5 E/Ms By Knowing Crucial HPI Facts
Watch out for CPT/Medicare differences when counting HPI elements.If you're not accurately... Read more
Clip and Save:
Proactively Avoid Consolidated Billing Troubles With a Set Contract
Setting up a plan with each facility before rendering services will make your job easier a... Read more
You Be the Billing Expert:
Set Up a Benefits Eligibility Verification Plan
Question: I've heard that verifying a patient's benefits before our doctors even see the p... Read more
Reader Questions:
Resolve Secondary Payer Issues With Conversations
Question: Our doctor performed surgery on a patient 11 months ago. We just learned that th... Read more
Reader Questions:
Pay Attention to Individual State WC Rules
Question: We had a patient who was injured on the job (workers' compensation) in Virginia ... Read more
Reader Questions:
The Hard Truth about Phone Call Pay
Question: Another physician told my doctor that he's receiving payment from his contractor... Read more
Reader Questions:
Catch Up on Incomplete Claims
Question: Our practice has a few claims that have missing or incorrect information. I'm no... Read more
Reader Questions:
Straighten Out Your Modifiers For ER Admit
Question: Our doctor saw a patient in the emergency room and decided to admit him and perf... Read more
Consolidated Billing:
3 Simple Steps Put You on the Path to Capturing Payment for Your NF Services
Determining whether a patient is in a Part A or Part B stay is your key to proper reimburs... Read more
News You Can Use:
Welcome a 2.2 Percent Medicare Pay Boost For the Rest of This Year -- Finally
But the news isn't all good -- first, you faced a week of lower payments, and second,... Read more
Money Matters:
Don't Scrap PQRI If Some of Your Doctors Don't Participate
Plus: Look for 2009 incentive payments this fall, CMS says.If all of your physicians are g... Read more
You Be the Billing Expert:
Get the Scoop on Billing Before Credentialing
Question: Our practice has a new physician coming on board to replace a retiring doctor. W... Read more
Payer Updates:
BCBS in Delaware Scraps Pre-Authorization Requirements for Nuclear Stress Tests
Plus, attorney general in Connecticut investigating data breach by WellPoint.The News Jour... Read more
In other news:
In other news:
WellPoint, based in Indiana, has come under scrutiny by Connecticut Attorney General Richa... Read more
Reader Questions:
Collect Surgical Deductibles Up Front
Question: We often have patients who don't pay their deductible after surgery. Is there a ... Read more
Reader Questions:
Get to Know Capitation Contracts
Question: I'm confused about what capitation actually is and how we bill under capitation ... Read more
Reader Questions:
Clarify Temp Services Using Modifier Q6
Question: Our regular physician is taking some time off, and a temporary physician takes h... Read more
Reader Questions:
Know When 'Current' Becomes 'History'
Question: Could you please provide some direction about when I should use "history of" cod... Read more
Timely Filing:
Keep Your Payments Coming In By Focusing on Timely Filing
With the Medicare deadline cut from three years to one, using a chart can help.As the impa... Read more
Quick Quiz:
Do You Remember the 'Red Flags Rule' Requirements?
Test your identity theft prevention skills with these questions.Even though the Red Flags ... Read more
Coding Corner:
E/M Services Call for Modifier 25, But Only When Necessary
You'll be putting your practice in the crosshairs if you overuse this modifier.Knowing whe... Read more
Three Conditions Warrant Modifier 25
There are three basic conditions under which an E/M service might qualify for a 25 modifie... Read more
You Be the Billing Expert:
Can You Not Submit a Claim to a Payer?
Question: We have a patient who wants us to give her the allowable amounts for a procedure... Read more
Reader Questions:
Capture Long E/M With +99354
Question: My physician spent 105 minutes with a new patient in the office. Is 99205 the on... Read more
Reader Questions:
Rule Out Billing Without Face-to-Face Encounter
Question: From his office a physician reviews lab test results and, by telephone, orders a... Read more
Reader Questions:
Don't Overlook Shared Visit Billing for Inpatients
Question: I know I cannot bill services incident-to in the hospital setting. Is there any ... Read more
Reimbursement:
Get Your Extra 15 Percent with Incident-to Billing
Proper use of physician's NPI could get you paid in full. With the current economic clima... Read more
News You Can Use:
Watch for Denials If You Take Shortcuts on Form 5010
Say goodbye to form 4010A1 for ICD codes as well, starting in 2012. Dig into your claim f... Read more
Billing 101:
Speed Up New Patient Data Capture With 5 Tips
A smart registration process can prevent claim-submission headaches. If you're trying to ... Read more
Payer Updates:
Mass. Insurers Sue to Block Rate Hike Decision
Plus, AMA offers help to physicians claiming damages from UnitedHealth settlement. A grou... Read more
You Be the Billing Expert:
Can Provider Change Tax ID?
Question: One of our physicians wants to stop billing under the group's tax ID and start ... Read more
Reader Questions:
Notify Payer About Patient Dismissal, Sometimes
Question: We recently dismissed a patient by sending her a certified letter and informing... Read more
Reader Questions:
Collect Medicare Copay Upfront
Question: We have many patients on Medicare in our practice. When a Medicare patient pres... Read more
Reader Questions:
Accepting a PFFS Plan is Your Choice
Question: Our practice is considering accepting patients with PFFS plans. We're heard tha... Read more
Reader Questions:
E/M Nurse Visits Can Get 99211
Question: What are the rules regarding exactly when I can bill 99211 for a nurse visit? W... Read more
Part Two:
Don't Let Patients' Financial Hardship Become Yours
A clear financial hardship policy might prevent some write-offs. You have a head start on... Read more
You Be the Billing Expert:
Can You Ask for Extension on Retro Billing?
Question: I work for a billing service for a hospitalist program where the physicians bil... Read more
Recognize a Write-Off in 6 Steps
Save this option for when other collection methods have failed. You've offered discounts,... Read more
Use an EHR System to Your Billing Advantage
Upfront costs could give way to savings in many areas. If you've been considering the swi... Read more
Has a Broken Payment Agreement Come to Dismissal?
Take these steps to end a practicepatient relationship without drama. If you have a patie... Read more
News You Can Use:
CMS Finds Problems with Medicare Claims Crossover
Part B providers might have to resubmit some claims to supplemental payers. The Centers f... Read more
Payer Updates:
Horizon BCBS Revises Modifier 25 Cut
Same-day E/M services will be paid full rate. Providers who contract with Horizon Blue Cr... Read more
Reader Questions:
Condition Doesn't Change Patient Status
Question: Our office saw a patient six months ago for a certain condition, and sent the p... Read more
Reader Questions:
Don't Put Suspended Claims on the Back Burner
Question: My office has a few claims that have missing or incorrect information. I'm new ... Read more
Reader Questions:
Use 36415 for Coding Lab Draws
Question: Our vascular office performs blooddraws and analysis for a local hospital. Can ... Read more
Reader Questions:
Code Primary Diagnosis for Valve Replacement
Question: My cardiologist performed a heart valve transplant on a patient who suffered fr... Read more
Reader Questions:
Use 99283 for E/Ms That Stay in the ER
Question: One of my surgeons consulted on a Medicaid patient in the emergency room (ER) f... Read more
Update Your PECOS File Now to Ensure Payment Later
Hint: You'll need the system's electronic funds transfers in order to get paid. If your p... Read more
You Be the Billing Expert:
Look Into Options for Handling Late or No Show Patients
Question: We have a few patients who routinely miss appointments or show up late.We'd lik... Read more
News You Can Use:
Horizon BCBS Modifier Cut May Threaten Your Income
Upcoming policy change will slash your payments by half. Big changes are on the horizon i... Read more
Weigh Your Options Before Accepting Modifier Cuts
Dropping Horizon BCBS isn't the only way to avoid steep cuts. If your New Jersey practice... Read more
Coding Corner:
Follow 3 Steps on the Path to Paid Cerumen Removal
Medicare won't pay 69210 alone, so here's how to unlock payment. Impacted cerumen removal... Read more
Payer Updates:
California Lawmaker Sues Anthem BCBS for Claims Violations
Plus, report finds wasteful healthcare spending costs $1.2 trillion. Anthem Blue Cross an... Read more
Watch These Affected Modifiers
25 (Significant separately identifiable evaluation and management service by the same phy... Read more
Reader Question:
Face Time Is Essential to Established Patient
Question: Our practice performed a test on a patient who was referred to us by another do... Read more
Reader Question:
Choose E/M Type Based on Admission
Question: A 57-year-old patient reported to our hospital's emergency department (ED) earl... Read more
Reader Question:
Start with 36430 for Transfusions
Question: My provider wants to start doing blood transfusions in the office. This is new ... Read more
Reader Question:
Ease the Pain of Confirming Patient Information
Question: We update important patient information,such as insurance, address, emergency c... Read more
Don't Let Patients' Financial Hardship Become Yours
Discounts and write-offs are options, if you follow these guidelines. That a patient may ... Read more
You Be the Billing Expert:
Unfortunately Death Doesn't Eliminate Bills
Question: We have several self-pay patients who are elderly and frequently patients pass ... Read more
Quick Quiz:
Think You Understand the New Consult Rules? Find Out Fast
Test your 2010 consultation coding understanding with these questions. Consultation codin... Read more
Ensure You Can Bill the Patient Using 2 ABN Modifiers
A revised GA and new GX hope to clarify some of Medicare's non-coverage policies. At leas... Read more
Quick Quiz Answers:
Think You Understand the New Consult Rules? Find Out Fast
Check your 2010 consultation coding savvy. Find out if you're set to properly code your p... Read more
Payer Updates:
Highmark, 2 Hospitals Talk Flat-Rate Reimbursement
Answer: Highmark and two Pennsylvania-based hospitals are in talks to change the reimburs... Read more
Reader Question:
Consider 2 Codes for Drug Withdrawal
Question: My physician was the primary care physician for a baby who was born to a mother... Read more
Reader Question:
Get Patient's Signature on Records Transfers
Question: A patient broke our drug contract, so we were forced to discharge her. She paid... Read more
Reader Question:
Graduate Nurses Limited by 30-Day Rule
Question: The sequence in our state of applying for the advanced practice registered nurs... Read more
Reader Question:
Look at Service Date Before Appending Modifier 59
Question: A patient presented for a colectomy for colon cancer. The physician also discov... Read more
Navigate the Medicare Opt-Out Process in 3 Easy Steps
No Medicare does not equal no contracts. If you decided that 2010 is the year your practi... Read more
You Be the Billing Expert:
Does Some SNF Billing Violate Stark Laws?
Question: My physician is the medical director for a skilled nursing facility and receive... Read more
Clip and Save:
Use This Checklist to Avoid Missing Opt-Out Contract Essentials
Hunting for the CMS contract must-haves? This list puts them right at your fingertips. Be... Read more
CPT 2010 Update:
Overcome 99221-99223 Denials With New Modifier
With consult non-payment, you will need to relearn some old rules. While most coders know... Read more
Watch for Private Payer Consult Differences
You may have multiple ways of reporting your doctor's services. CPT did not eliminate the... Read more
Payer Updates:
Anthem BCBS Tests E-Visits in Maine
Plus, CMS alters 2010 conversion factor with emergency action. Physicians in Maine are te... Read more
READER QUESTIONS:
Check to See If CMS Signed Your Doc Into PECOS
Question: I keep hearing about PECOS, but I'm so confused about the whole thing. Do I nee... Read more
READER QUESTIONS:
Count H&P in Global for Surgery
Question: I understand that I cannot bill for an H&P if there is a global because it ... Read more
READER QUESTIONS:
Check Your Contracts for Collections Advice
Question: We wanted to collect a $100 deposit for a self-pay patient prior to surgery, bu... Read more
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