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Medicare Advantage program frees up copays, telehealth for eligible encounters

02/11/2019

Prepare for greater levels of experimentation in plan design, copays and eligible service offerings among your Medicare Advantage payers as CMS opens up its hallmark value-based program to the nation.

What’s a ‘minimum’ assist? For modifier 81, a late entry

02/11/2019

by: Roy Edroso

Question: One of our surgeons recently performed a procedure in which she was assisted by a colleague – but only just a little. We’re debating whether this requires the use of modifier 81 (Minimum assistant surgery) rather than 80 (Assistant surgery).

Focus on 3 areas to get your annual depression screening claims through

02/11/2019

by: Richard Scott

Question: My practice has started to report more depression-screening services, but we’re still seeing a decent share of denials. My doctors want to make sure the claims are getting paid. What might I be doing wrong?

Briefs: Physician owes $1 million for fraud and PA faces jail time for kickbacks

02/11/2019

by: Marla Durben Hirsch

In this compliance-themed round-up, you'll get the details of a pain management doctor who must pay more than $1 million to resolve allegations of fraud and a physician assistant who faces jail time for accepting kickbacks.

Denial rates favor NPP surgical assistants over physicians for common procedures

02/11/2019

by: Richard Scott

When it comes to documenting a helping hand during common surgical procedures, practices tend to turn to modifier AS (Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery) rather than a range of CPT assistant-surgical modifiers — and find success in doing so.

Watch out for CMS’ claims reviews on high-price radiation oncology services

02/04/2019

by: Richard Scott

With a batch of Comparative Billing Reports (CBR) hitting providers’ inboxes in early 2019, CMS is putting practices on notice: You should be careful when reporting intensity-modulated radiation therapy (IMRT) services that may be part of a bundled package or risk further audit activity.

Exceptional performance MIPS bonus may not be worth chasing – but high scores are

02/04/2019

by: Roy Edroso

Merit-based Incentive Payment System (MIPS) bonuses for 2017 were lower than many participants expected — with the top “exceptional performance” bonus at a disappointing 1.88% of payments. But experts say your positive-score adjustment for 2019 should be better than that; and you have other reasons to go for high scores.

As Medicare revenue drops and costs rise, practices face hard choices

02/04/2019

by: Roy Edroso

If you perceive your Medicare revenue is going down rather than up, and by alarming levels, you’re not alone: a survey of practice managers commissioned by the Medical Group Management Association (MGMA) finds two-thirds of respondents reporting that these revenues are not only dropping but failing to keep up with the cost of keeping the practice open.

Watch out for CMS’ claims reviews on high-price radiation oncology services

02/04/2019

by: Richard Scott

Look to code description to determine correct units for problematic injections

02/04/2019

by: Richard Scott

Fine tune your pain-injection coding by reporting the correct level of units for an error-prone code and you’ll clean up your denials in no time. As it stands, many practices are incorrectly reporting HCPCS code J7322 (Hyaluronan or derivative, hymovis, for intra-articular injection, 1 mg) by missing on the units billed.

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