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Registries, QCDRs face higher burdens in MIPS rule — and so do providers

09/23/2019

New burdens aimed at qualified registries and qualified clinical data registries (QCDRs) would, if finalized, mean higher costs for them and maybe for you.

Master common repeat modifiers to prevent duplicate claim denials

09/23/2019

by: Richard Scott

Question: I’ve recently received a spate of denials with duplicate claims messages. Why -- and what can I do to avoid this?

Provider charged with child porn? Get him out, and follow the cops’ lead

09/23/2019

by: Roy Edroso

Question: I’ve just heard about a doctor at Cedars-Sinai who was removed from his post after he was formally charged with possession of child pornography. I’m interested to know: If we were, God forbid, to have such a situation at our practice, would we be able to remove the doctor, even if he hadn’t gone to trial and been found guilty? Also, what do we tell the patients?

Not worth it: Codes wrongly bundled with blood draws pay too well to trifle with

09/23/2019

by: Roy Edroso

Auditors emphasize the amount of improper payments attributed to common venipuncture code 36415 with bundled codes in 2018. But it’s also worth noting that the codes with which 36415 may have been improperly claimed generally pay more — and it’s really not worth potentially gumming up your claims on those codes for a small extra payment on a blood draw.

Take AUC testing year to see how well your reporting works — and how well docs take it

09/16/2019

by: Roy Edroso

The appropriate use criteria (AUC) “educational” year is soon to arrive, and it would behoove providers involved with advanced imaging to get in the swim before the results are made to count — which may require you to seek prior authorization for the affected tests.

Time is of the essence: Decipher how to use time-based E/M documentation standards

09/16/2019

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

In an ongoing effort to revise the documentation guidelines for E/M codes, CMS has proposed a new policy that includes elimination of history and physical exam as elements for code selection, allowing providers to choose whether their documentation is based on medical decision-making (MDM) or time (PBN 8/12/19).

Get ready to report even minor affiliations or risk your enrollment under new rule

09/16/2019

by: Roy Edroso

A sweeping new Medicare enrollment final rule with comment period will eventually require all providers and suppliers to report even modest relationships with other entities whose debts, exclusions, revocations and suspensions may affect you: The rule would allow providers and suppliers to be kicked out if HHS thinks even this secondhand relationship “poses an undue risk of fraud, waste or abuse.”

How to report E/M office codes when the physician is new but the patient is not

09/16/2019

by: Jim Dresbach

Question: We have a new physician that has recently joined our surgical group. Some patients from her previous practice have elected to follow her to our practice. Are these patients considered new or established? The patients are new to our practice and tax ID number; however, they are not new to the physician who is providing care to them.

Quarterly CCI update bundles numerous orthopedic procedures with allograft services

09/16/2019

by: Richard Scott with additional reporting by Roy Edroso

Alert your billing staff to several dozen code bundles that will restrict a range of same-day services, including some allograft procedures, when the latest Correct Coding Initiative (CCI) edits take effect Oct. 1.

Call for speakers: 2020 National Provider Enrollment Forum

09/10/2019

by: DecisionHealth staff

DecisionHealth, the publisher of Part B News, is currently seeking speakers to present at the 2020 National Provider Enrollment Forum, to be held April 19-22 in New Orleans.

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