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Check for clues that your practice is improperly waiving copayments

12/09/2019

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?

Growth in use, and decline in denials, may have doomed old biopsy codes

12/09/2019

by: Roy Edroso

The two skin biopsy codes that were replaced by six more specific codes this year experienced huge growth in the past 10 years, which may explain why the switch was made.

With Primary Care First ready to lift, check readiness, risk tolerance to see if it fits

12/02/2019

by: Roy Edroso

Now that the application process for Primary Care First is open, primary care providers should think seriously about whether this is the time to jump into a value-based model — and whether theirs is the kind of practice that would benefit.

OIG report on CCM errors a warning to tighten up billing before CMS does

12/02/2019

by: Roy Edroso

Though the dollar figures aren’t big, OIG’s report on faulty chronic care management (CCM) billing should be concerning for any practice billing those codes, especially since some of the problems have no simple answers.

Find ‘simplified,’ ‘standardized’ approaches under 2020 documentation changes

12/02/2019

by: James Dresbach

You can expect more initials, signatures and hands involved in medical record documentations as CMS prepares to make the physician fee schedule final rule effective Jan. 1, 2020.

Medicare OKs esketamine therapy for major depression, but prepare for hurdles

12/02/2019

by: Julia Kyles

An interim final rule with comment period in the final 2020 Medicare physician fee schedule creates a new service for patients with depression who have not responded to oral anti-depressants. However, the treatments will include some unusual rules for practices and patients.

X-ray codes highlight list of top fee gainers in 2020; dozens drop double digits

12/02/2019

by: James Dresbach

Radiology procedures are leading the way in a list of the largest gainers, by percentage, of updated service fees come Jan. 1, according to an analysis of the final Medicare 2020 physician fee schedule.

CMS eases scope of practice regulations for PAs as part of NPP advancement

11/18/2019

by: Roy Edroso

The final 2020 Medicare physician fee schedule features multiple advances in the regulations governing non-physician practitioners (NPPs), suggesting CMS’ growing awareness of and support for these providers’ roles in delivering health care.

Find full descriptors for new care management services

11/18/2019

by: Julia Kyles

CMS introduced an add-on code for chronic care management (CCM) and two principal care management (PCM) codes that it will pay for starting Jan. 1, 2020. Here are the full descriptors for the codes.

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