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Final 2014 fee schedule released: CMS finalizes smaller rate cut, allows telehealth for TCM

11/27/2013

CMS softened the blow to the physician rate cut – dropping it from 24.4% in the proposed rule to 20.1% in the final Medicare physician fee schedule released Nov. 27 – but that still means steep cuts if Congress doesn’t approve a doc fix.

ICD-10 “testing week” not enough to prep providers for deadline, experts say

11/25/2013

by: Roy Edroso

CMS now offers a “testing week” in March after previously declining to give providers end-to-end ICD-10 testing with contractors. But experts say CMS will have to do better — and some think provider pressure will eventually get them to do so.

Success of Obama insurance “fix” may depend on insurer response

11/25/2013

by: Roy Edroso

On Nov. 14, President Obama announced a fix to a perceived problem with the Affordable Care Act (ACA) that caused some health insurance customers whose plans were not “grandfathered” under the law to be changed by their insurers, in contradiction to the “If you like your plan, you can keep it” promise on which Obama campaigned.

Doctor-manufacturer deals under scrutiny after drug settlement

11/25/2013

by: Marla Durben Hirsch

Providers will see heightened scrutiny of their relationships with pharmaceutical and medical device manufacturers in light of one of the largest health care fraud settlements in history. Johnson & Johnson (J&J) agreed to pay $2.2 billion in civil and criminal penalties and the government is cracking down.

Be wary of bundling, documentation when billing debridement codes

11/25/2013

by: Scott Kraft

Chronically high denial rates for debridement services are likely the result of incorrectly measuring how much tissue was debrided when those services are bundled and billed the same day. Denial rates for debridement codes average 10.5%, but when you exclude the two highest-volume codes, the denials spiked to 17.1%.

Write and implement a whistleblower policy that protects employees, practice

11/25/2013

by: Roy Edroso

Protect your practice with a clear whistleblower policy that shows you’ve done due diligence to prevent wrongdoing, and make sure your staff understands and internalizes that policy.

Benchmark: Initial and subsequent nursing facility E/M code use on the rise since 2010

11/25/2013

by: Scott Kraft

Billing for initial and subsequent patient visits rendered in skilled nursing facilities (SNFs) and nursing facilities (NFs) has seen a significant lift in recent years. However, denial rates for initial visits (99304–99306) dipped, while denials for established codes (99307–99310) are tracking up, according to a Part B News analysis of Medicare billing data from 2010–2012.

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