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CMS warns on sleep studies: Watch coding, certifications and diagnoses

02/03/2020

Heads up: CMS, tipped off by OIG, is warning providers who do sleep studies to make sure they have appropriate documentation and don’t botch the billing of technicians.

Sleep study codes hold steady – but CPAP startup code is a denial trap

02/03/2020

by: Roy Edroso

While sleep studies and continuous positive airway pressure (CPAP) devices are getting more popular, Medicare billing for them so far has held pretty steady. But as the tough denial rates for a major CPAP code show, you still have to be careful about billing them.

Heed payer-specific guidelines to avoid denials when using modifier 25

01/27/2020

by: Sarah Gould

Steer clear of common obstacles that can derail your use of modifier 25 (Significant, separately identifiable E/M service) and leave you with yawning gaps in revenue. When applying this modifier, coders must consider CPT reporting rules and adhere to potentially restrictive billing rules followed by their payers.

2020 strategic planning strategy, part 2: Avoid threats to your business, pursue strengths

01/27/2020

by: Roy Edroso

In Part One of the 2020 strategic planning feature, published Jan. 13, we discussed how to identify leading indicators to optimize your business plan and operational success. In Part Two, below, you’ll find out how to anticipate threats and read success tips from a start-up solo practitioner.

Heed payer-specific guidelines to avoid denials when using modifier 25

01/27/2020

by: Sarah Gould

Steer clear of common obstacles that can derail your use of modifier 25 (Significant, separately identifiable E/M service) and leave you with yawning gaps in revenue.

Take stock of federal value-based model performance to weigh risks, opportunities

01/27/2020

by: Jim Dresbach

You should be monitoring the performance of alternative payment models (APM) that CMS and its Innovation Center have launched in recent years under non-traditional payment structures.

Hyberbaric oxygen therapy claims, under CMS’ gaze, seesaw between 2015 and 2018

01/27/2020

by: Jim Dresbach

Medicare claims data for non-emergent hyperbaric oxygen (HBO) therapy and the introduction of a prior authorization model to support the procedure disclosed numbers that show the CMS program is working as intended — to curtail overuse.

New MBIs mostly in patients’ hands — but watch for duplicates

01/27/2020

by: Roy Edroso

Both CMS and OIG say the drive to connect every Medicare beneficiary with their new Medicare beneficiary identifier (MBI), which has been required for claims since Jan. 1, has been successful.

Modifier 25 Decision Tree

01/22/2020

Modifier 25 indicates a "significant, separately identifiable E/M service." Incorporate the tips below and click the "Download file" link above to access a modifier 25 decision tree.

If you’re expanding, don’t overshoot fair market value — or you may face the feds

01/20/2020

by: Roy Edroso

The fallout of a recent whistleblower case involving physician practice acquisitions serves as a warning that, if you’re making a big deal to grow your practice, you must have either a safe harbor or a really good explanation.

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