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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? 
 
Outpatient E/M use — especially 99214 — continued to rise in 2018
10/07/2019
by: Roy Edroso

Medicare has published its 2018 patient claims data, which shows a pretty smooth rise in spending for total claims — and a bit of a spike for established patient office E/M code 99214.

A tale of two sides: Practices report more right- than left-side modifiers
09/30/2019
by: Richard Scott

     When delivering common injection and procedure services, providers tend to veer to the right side of the body more often than the left. That’s what an inspection of claims with RT (Right side) and LT (Left side) modifiers reveals.
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