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HHS opens vaccine payment fund for providers stuck with exempt plans

05/17/2021

Having provided reimbursement programs for other COVID-related costs unpaid by patients, HHS has now set up a new initiative to make sure providers get reimbursed for vaccine administration that’s not covered by some patients’ insurance plans.

CPT errata amends E/M coding with series of technical corrections

05/17/2021

by: Laura Evans, CPC and Julia Kyles, CPC

Pay close attention to revisions and corrections to the E/M office visit guidelines that kicked in Jan. 1. The AMA has made a number of updates, and you will need to refer to the “Errata and Technical Corrections — CPT 2021” document issued on the AMA website March 9 for the freshest E/M guidance.

Hospital claims shift reveals a dip in inpatient codes, and a bigger one in denials

05/17/2021

by: Roy Edroso

In a recent five-year span, the use of inpatient codes declined at a faster rate than they had in previous years, and denial rates dropped even more quickly.

Missing payments? No easy fix for unpaid out-of-network COVID claims

05/10/2021

by: Roy Edroso

A $6 million case concerning thousands of unpaid claims for COVID-19 testing and related services suggests that if you’re refused payment for services administered to out-of-network beneficiaries, you may be up a creek, despite laws that appear to protect your interests.

Master modifier 59: Scenarios, tips that go beyond the basics

05/10/2021

by: Susan E. Garrison

Ensure that your documentation can support modifier 59, used to describe a distinct procedural service, in order to steer clear of billing snafus. Remember that you should append modifier 59 to codes to identify procedures or services that are not usually payable when reported together.

Stay sharp: Feds’ health care enforcement is shifting — and expanding

05/10/2021

by: Marla Durben Hirsch

It’s time to reassess and update your practice’s compliance program. The government’s health care enforcement priorities are expected to shift with the new administration.

Here’s what the DOJ wants in an effective compliance program

05/10/2021

by: Marla Durben Hirsch

The HHS Office of Inspector General (OIG) has long established that a strong compliance program for physicians consists of seven elements:

New diagnosis? Try a corrected claim, but expect pushback from your MAC

05/10/2021

by: Roy Edroso

Question: We’ve had a claim denied on the basis of medical necessity because the provider’s original diagnosis was not covered. Now the provider, after further analysis, has determined that the actual issue is different from what she had originally thought and she wants to change her diagnosis and treatment. Can we resubmit the previous claim with the new diagnosis?

Modifier 59 claims return nearly $1.5 billion in Medicare payments

05/10/2021

by: Richard Scott

Mastering the use of modifiers can be lucrative business for physician practices, as the latest modifier 59 (Distinct procedural service) utilization numbers reveal. In 2019, providers pulled in nearly $1.5 billion from Medicare on thousands of codes paired with the modifier.

Medicare age drop, adding millions, on hold, but its favor grows among lawmakers

05/03/2021

by: Roy Edroso

A number of prominent Democrats, including President Joe Biden, have advocated for a drop in the Medicare eligibility age, a move that would add millions to the program. But since Biden left this proposal out of his April 28 Congressional address, there seems little chance that it will happen this year.

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