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Pinpoint signs, symptoms when coding for rare diseases under ICD-10-CM

12/16/2019

Make sure your keystroke combinations for rare disease coding do not collect dust as an out-of-the-ordinary ailment could come across your path at any time. Keep in mind, finding the best ICD-10-CM code for a patient who has a rare disease can be a challenge.

Experts see little impact of planned CPT code 99201 deletion set for 2021

12/16/2019

by: James Dresbach

Beginning in 2021, you will have one less CPT code to tangle your billing cycles. The AMA plans to officially delete 99201 from the E/M code set that year, whittling down available office visit codes for new patients to four.

If secondary provider is out of network, so is their charge — but check state law first

12/16/2019

by: Roy Edroso

Question: One of our doctors assisted at surgery and found out later that, unlike the primary surgeon, he’s not credentialed with the payer under whose plan the patient is insured. Given that he’s not the billing provider, how will he be paid?

Multiple specialties zapped by 99201 denials as claims, revenue plummet

12/16/2019

by: James Dresbach

Nurse practitioners, orthopedic surgeons, general surgeons and family practice providers have all faced significant hurdles with their 99201 claims, with denial rates ranging from 10% to 22% in 2018, the latest year of available Medicare claims data. But no specialty matched chiropractic’s dismal return — a 100% denial rate on nearly 93,000 services, with a loss of $5 million.

Beat the high cost of provider directory maintenance with smarter reporting

12/09/2019

by: Roy Edroso

A recent survey shows provider directory maintenance can be expensive and, in the absence of an affordable technical fix, if you want to reduce those costs you’ll just have to tighten up your record updating.

Beat the high cost of provider directory maintenance with smarter reporting

12/09/2019

by: Roy Edroso

A recent survey shows provider directory maintenance can be expensive and, in the absence of an affordable technical fix, if you want to reduce those costs you’ll have to tighten up your record updating.

CMS hopes a revised advisory opinion process will attract more requestors

12/09/2019

by: Julia Kyles

Discover three main takeaways — including new timelines for CMS, new fees and potential protection for arrangements that closely mimic arrangements in an existing advisory opinion — from the final changes to the Stark physician self-referral advisory opinion process in the final 2020 Medicare physician fee schedule.

Alert: Government continues to crack down on routine waiver of copayments

12/09/2019

by: Marla Durben Hirsch

Take a good look at how you waive copayments. Routinely waiving these amounts is a compliance risk, and it’s in the government’s crosshairs.

Check for clues that your practice is improperly waiving copayments

12/09/2019

by: Marla Durben Hirsch

Here’s a list based on the OIG's special fraud alert on waiving copayments that outlines activity that could be unlawful. Share the list with staff and use it to check your policies and procedures to make sure that your practice does not engage in waiver behavior that puts it at legal risk.

If multiple biopsies exceed MUEs, expect a denial — unless you can split them by side

12/09/2019

by: Roy Edroso

Question: My doctor recently did 10 biopsies on a single patient and we’re billing 11102 (Tangential biopsy of skin; single lesion) and 11103 (Tangential biopsy of skin; each separate/additional lesion). I see by CMS’ medically unlikely edits (MUEs) update that the former has a practitioner services MUE value of 1, and the latter has a value of 6, so we’re clearly going to exceed that. I fear we’ll get caught in an edit. Is there anything we can do ahead of time to avoid a denial?

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