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Billing an outpatient who’s an inpatient? Bill where they’re admitted, not treated

07/08/2019

Question: We have a patient who received outpatient care at our hospital clinic. This patient is also currently an inpatient in a rehab orthopedic hospital. We’re getting a Recovery Auditor (RAC) investigation on our charges for the patient stating we cannot bill an outpatient physician visit while the patient is an inpatient. (Our hospital bills an outpatient code on the rehab hospital’s inpatient bill.) The hospitals are both owned by the same system. What can we do?

NPs and PAs get more work and, with the right codes, lower denial rates

07/08/2019

by: Roy Edroso

MedPAC may be right that the use of nurse practitioners (NPs) and physician assistants (PAs) under incident-to billing is masking the size of their contribution to care. It’s clear that even when billing under their own specialty codes, these top mid-levels are billing more than before, according to 2017 Medicare claims data, the most recent available. Overall denial rates are not great, but when you put them to work on the right service they do very well.

Breach alert: If ransomware hits, consider the pros and cons of paying the ransom

07/01/2019

by: Roy Edroso

Though it’s been in the news for years, ransomware and related cyber exploits have not been contained. Your best bet is to keep or step up your diligence but also decide whether you’re willing to pay the cybercrooks to get your data back — and, if so, to prepare for it.

Bipartisan bill takes aim at unruly prior authorizations, seeks real-time approvals

07/01/2019

by: Richard Scott

Practices that dread the time lags and course-of-care disruptions that result from prior authorizations gained good news as momentum builds behind legislation aimed at streamlining these types of approvals.

As audits spike, stick to medical necessity, bundling rules for 99291-99292 claims

07/01/2019

by: Richard Scott

Watch out for federal auditors clamping down on critical care coding and double down on medical necessity to secure you’re in the clear for these oft-used services.

To avoid denials, ensure CCM initiating visit code G0506 goes beyond norm

07/01/2019

by: Richard Scott

Question: I’m seeing a lot of denials on my initiating visit claims for chronic care management (CCM) services. Is that because I’m reporting the CCM code with a routine E/M code? Do I need to wait for a specific date to bill? Please help!

Prior authorizations causing many patients to abandon the plan of care, survey shows

07/01/2019

by: Richard Scott

The regulatory burden linked to prior authorizations is getting worse, and it’s not only causing administrative headaches. It’s also leading to patients veering from the recommended course of treatment.

Want to banish burdens? Air your grievances, propose ideas to CMS now

06/24/2019

by: Richard Scott

If you want to diminish the red tape you must cut through when participating in federal health care programs, you have until Aug. 12 to let CMS know what it can do to ease your administrative hurdles, such as onerous documentation.

Heed employee charges of patient harassment — but be careful about banning the patient

06/24/2019

by: Roy Edroso

Physician practices have a duty to protect their employees from sexual harassment by patients with clear reporting procedures and follow-through. But you may want to consider your options before telling the accused patient not to come back for treatment.

Claiming modifier 22? Make sure it’s extra work, then make your case

06/24/2019

by: Roy Edroso

Question: Our surgeon performed an acetabular fracture (27254) and it took him a great deal longer than usual owing to the patient’s obesity. He wants to use modifier 22 (Increased procedural services) to be paid for the extra time. What do we have to give CMS to get that paid?

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