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New enrollment deactivation guidance provides uniformity, ‘rebuttal rights’ to providers

10/14/2019

An extensive manual change concerning enrollment deactivations suggests that CMS is trying to make it easier for providers to avoid the hassle of accidental removal — but you still have to know and follow the rules.

Bypass chronic care management barriers that suppress revenue, care plans

10/14/2019

by: Jim Dresbach

Many practices are now performing chronic care management (CCM) services — the non-face-to-face consultations provided to patients who have two or more chronic conditions — yet providers continue to encounter significant barriers in completely connecting eligible patients to such care.

Executive order seeks Medicare FFS payment redress, MA plan proliferation

10/14/2019

by: Roy Edroso and Richard Scott

Proponents of Medicare Advantage plans will find likeminded support from the White House, which seeks to counter single-payer health program proposals with a renewed focus on “market-based approaches in the current system,” according to an Oct. 3 executive order released by President Trump.

As Medicare inspects claims, enhance your coding standards for subsequent hospital visits

10/14/2019

by: Richard Scott

Tread carefully with your coding for subsequent hospital visits — 99231, 99232 and 99233 — because one of Medicare’s watchdogs is putting providers on alert that the services are linked to a raft of improper payments.

With secondary insurance, what COB says goes — or you may get stuck with the bill

10/14/2019

by: Roy Edroso

Question: A patient wants to use her secondary insurance as her primary insurance because it offers her a better price point. Are there any circumstances under which this is allowed?

Chronic care management spike: CPT code 99489 goes up, up and away

10/14/2019

by: Jim Dresbach

The utilization of complex chronic care management (CCM) code 99489 increased more than 285% between 2017 and 2018, as practices appeared to embrace longer-lasting care management episodes.

Decision time: Navigate revisions to levels of MDM amid coming E/M changes

10/07/2019

by: Nancy Enos, FACMPE, CPC-I, CPMA, CEMC, CPC emeritus

Leaders in the medical practice setting should take note: You’ll be facing a significant series of decisions amid the transformative journey to a new E/M coding and documentation paradigm that’s soon coming your way.

Proposed Stark update: Open advisory opinions, shortened timeframes

10/07/2019

by: Julia Kyles

Based on clues in the proposed 2020 Medicare physician fee schedule, practices that are worried about violating the labyrinthine physician self-referral rule may soon have a quicker path to guidance.

Add a dose of diagnosis rigor to vitamin D tests to ward off audits, denials

10/07/2019

by: Richard Scott

Adhere to your payers’ coverage terms to ensure your vitamin D testing meets eligibility requirements or you may fall victim to mass denials or get wrapped up in an audit.

If payers downcode lots of your E/Ms, check your work – and fight if you’re right

10/07/2019

by: Roy Edroso

Question: One of my payers is sending back a few dozen of our claims with the E/M codes downcoded from Level 4s to Level 3s. Is this common? Should we appeal?

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