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03/04/2010

This week's question is answered by Sean Weiss, CPC, vice president of DecisionHealth Professional Services.

Q. Could you please give us guidance on when we should use modifier GG and when we should use modifier GH?

03/04/2010

The Temporary Extension Act of 2010 extended the therapy cap exceptions, which expired Jan. 1, through March 31. Attach modifier KX to claims for outpatient therapy services provided to patients who've exceeded either of the two therapy caps. The 2010 caps are set at $1,860 for physical therapy and speech language pathology services combined; and $1,860 for occupational therapy services.

03/04/2010

Summary: Duplicate services and documentation errors are driving denials of high-volume services, according to provider education articles on several carrier websites. The top services implicated include a low-level E/M code, common chest X-rays, EKGs and therapeutic exercises. NOTE: The percent figures above the bars show the denial rate for each service, first in 2006 and then in 2008.

03/04/2010

You'll be able to offset some of the burdens of meeting meaningful use by charging fees to patients, CMS officials said during a public conference call on its electronic health record (EHR) incentive program. However, you won't be able to participate in both the EHR incentive program and the e-prescribing program simultaneously, officials said.

03/04/2010

HHS wants a permanent fix to the sustainable growth rate (SGR) formula as much as you do, the agency's top official told a gathering of AMA members on March 2. Congress passed a one-month pay fix later the same day (see related story), but HHS Secretary Kathleen Sebelius underscored her agency's support for a final solution.

03/04/2010

Expect reimbursements from private fee-for-service plans to continue to erode in the future as you'll "be at the mercy" of big commercial payers, experts told attendees of the AMA's National Advocacy Conference in Washington on March 3.

03/04/2010

You can bill subsequent hospital care codes (99231, $30.09 and 99232, $54.22) when the services you provide that would have previously been billed as inpatient consults don't meet criteria for use of the lower-level inpatient hospital care code 99221, CMS states in a newly published 12-page document. Your carriers have begun to update their own instructions based on the CMS guidance.

03/04/2010

You've got until Oct. 1, 2012 to get an electronic health records (EHR) system in place that meets the final meaningful use rule CMS will unveil this year. Meet this goal and you're eligible for up to $15,000 in government incentive money - the full amount possible in the first round of EHR bonus payments.

03/04/2010

Your claims have been released for processing by CMS after lawmakers delayed the 21% cut to your Medicare payments until April 1.

President Barack Obama signed the Temporary Extension Act of 2010 on March 2 - ensuring you will get paid the same amount for services rendered in March that you got in January and February. The bill also extends the therapy cap, which expired Jan. 1, to March 31.

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