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More TCM answers: Patient contact, F2F can be same visit; don’t bill CPO with TCM

04/29/2013

Part B News has more answers to readers’ questions about the transitional care management (TCM) codes, 99495 and 99496, providers could start billing this year. This week’s batch explains whether one visit can satisfy the patient contact and face-to-face meeting requirements; how to handle a claim rejection based on discharge paperwork; whether you can bill care plan oversight (CPO) with TCM; and whether emergency room visits qualify.

CMS to add fifth RAC for home health, DME, but physicians could see more audits

04/29/2013

by: Karen Long

Physician practices could see more scrutiny from the four recovery auditors (RAC) now that CMS plans to shift some of their workload to another contractor.

CMS tells Part B News that it expects to add a fifth RAC with a national focus on home health and durable medical equipment (DME) claims, leaving the rest of the RACs to split up the states and concentrate on other provider types.

7 ways to jumpstart your ICD-10 prep now that CMS confirms deadline

04/29/2013

by: Roy Edroso

CMS has given the whole industry a big heads-up on ICD-10, and many practices are behind schedule on preparedness. Don’t panic, our experts say — but do grab the best available resources, and get to work fast.

3 tips to prepare to become an ACO plus 5 steps to complete CMS’ application

04/29/2013

by: Karen Long

Practices can start the process May 1 to become accountable care organizations (ACOs) in 2014, but even before that, your practice should take three steps to ensure the ACO’s success.

PT services see high denial rates for electrical stimulation, other techniques

04/29/2013

by: Lauren C. Williams

The following graphs depict claims denial trends for therapy services listed on CMS’ “always therapy” code list that were billed in 2010 and 2011. These codes are eligible for the therapy cap rule, which requires use of the KX modifier (Requirements specified in the medical policy have been met) when therapy services for a single patient exceed $1,900 (PBN 1/14/13).

Note: Claims billed with the KX modifier were not included in the analysis because the modifier became active Jan. 1, 2011, and was not listed in CMS’ claims database. (Visit www.cms.gov/Medicare/Billing/TherapyServices/AnnualTherapyUpdate.html to download the full “always therapy” list. Look for more about the therapy cap in an upcoming issue of Part B News.)

Take note of 9 tests granted CLIA waivers starting July 1

04/29/2013

by: Scott Kraft

Take note of the nine new lab tests below that will be considered CLIA-waived by CMS, according to CMS transmittal 2671 to the Medicare Claims Processing Manual. Note that the codes listed below won’t appear new — in many instances, other tests billed with these codes are already CLIA-waived, but the specific brand of test is being added.

Navigator proposal set to help patients; be prepared to spot changes in plans

04/29/2013

by: Scott Kraft

A proposed rule defining how patients will receive assistance from qualified health care “navigators” to select the right health insurance exchange plan under the Affordable Care Act (ACA) aims to close the door on insurance broker and health plan participation, as well as any state law efforts to thwart ACA implementation.

Sequestration update: Cuts go through March

04/29/2013

The 2% sequestration cuts to your Medicare payments could continue through March 31, 2014, if Congress takes no action, according to new sequestration Q&As posted on Medicare administrative contractor (MAC) websites such as Palmetto’s.

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