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‘Do-over’ on this split procedure is probably a start-over, too

04/08/2019

Question: An emergency department physician treated a dislocated shoulder reduction (23655) and billed with modifier 54 (Surgical care only), as the patient’s orthopedist would be handling follow-up care with modifier 55 (Postoperative management only). The patient returned to the ED two months later having fallen and dislocated the same shoulder. Our ED physician once again reinserted the shoulder using closed manipulation. How should the second service be reported?

Eye docs most likely to report surgery-only modifier 54 for strict surgical care

04/08/2019

by: Richard Scott

Select few specialists, most notably ophthalmologists, report the bulk of procedural services with modifier 54 (Surgical care only), which denotes the work tied to the pre-operative and intraoperative pieces of the surgical puzzle.

Many providers feel unready, balk at mental health, substance screenings

04/01/2019

by: Roy Edroso

A recent study suggests your non-psychiatric providers may need some help delivering proper screening and care to patients with mental health and substance abuse issues. Fortunately, it’s not hard help to give.

Find updated coverage terms for genetic sequencing tests; beware restriction risk

04/01/2019

by: Richard Scott

Brush up your pathology policies involving genomic testing to keep pace with the latest testing options covered under Medicare, which recently revised a national coverage determination (NCD) for next generation sequencing (NGS).

From cyber to stop-loss, consider extra insurance products to defend your practice

04/01/2019

by: Roy Edroso

Apart from the usual insurance traditionally carried by practices, make sure you’ve assessed the usefulness of some less well-known policy types in keeping your practice afloat in the event of a crisis.

Show support: New E/M codes remain at risk for elevated modifier 25 denials

04/01/2019

by: Richard Scott

Alcohol, depression screening, behavior codes still a problem for providers

04/01/2019

by: Richard Scott

Denial rates for the most popular screening and counseling codes for depression and alcohol and substance abuse are not great, and in one case forbidding. Make sure you get the little things right on your claims.

MedPAC urges Medicare to right-size primary care payments and cost factors

03/25/2019

by: Richard Scott

In recent months, CMS has made a play at revamping how E/M services are documented and paid for, and the AMA is working in earnest on a rebuttal. Now the Medicare Payment Advisory Commission (MedPAC) is weighing in on the debate and urging lawmakers to be careful about the value attached to E/M codes.

Private insurer investigating you? Comply with requests, but document everything

03/25/2019

by: Roy Edroso

Private health insurers are getting aggressive about auditing providers and prosecuting what they see as fraud — and you should take any communication from them on that score very seriously.

Get cash, credit resources straight in case payers poop out

03/25/2019

by: Roy Edroso

A sudden shortfall in Blue Cross Blue Shield (BCBS)Vermont payments, and the trouble it’s causing some small practices, is a reminder that you should have a financial cushion for your practice in case of emergencies — and make sure to keep it up to date.

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