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ALJ appeals backlog is growing, but several big changes may help providers

05/14/2018

Despite HHS’ efforts to reduce the backlog of appeals at the Administrative Law Judge (ALJ) level, the average processing time for appeals has continued to grow. But now, providers caught up in — or contemplating entering — the massive backlog of appeals have several reasons to jump for joy.

CMS opens up telehealth billing sites, including home, for some dialysis patients

05/14/2018

by: Richard Scott

Certain providers who treat patients with end-stage renal disease (ESRD) will soon be clear of telehealth billing restrictions and eligible to provide video-based encounters to patients at their homes, as well as other sites of service.

Millions gained from ESRD management codes as billing restrictions loosen

05/14/2018

by: Richard Scott

SNF patient in your office? Bill MAC for E/M, SNF for technical services

05/14/2018

by: Roy Edroso

Question: If Medicare beneficiary enrolled in a skilled nursing facility (SNF) under Part A goes to see a practice physician in her office and the doctor performs E/M and an X-ray, orders a lab test and prescribes a drug, how would each of these services be billed by that physician’s office?

From the Part B News blog

05/14/2018

Take note of the news that happens between Part B News issues by checking out the free Part B News blog. Here’s a sampling from this week.

Despite uncertainty, practices accelerate into the wide-open world of value-based care

05/07/2018

by: Richard Scott

The journey was not easy, nor is it complete, but the rewards are beginning to pile up for AMITA Health’s accountable care organization (ACO), a network in suburban Chicago that offers a striking example of the risk-and-reward environment underpinning health care’s seemingly unstoppable shift to value-based care.

CMS warns on wet AMD, cataract surgery billing; watch Lucentis shots, modifiers

05/07/2018

by: Roy Edroso

A note dropped in a recent MLN Connects suggests CMS is keeping an eye on wet age-related macular degeneration (wet AMD) or cataracts issues the Office of Inspector General (OIG) brought to its attention in 2014 and 2015.

New tax law limits deductibility of paid overpayments, settlements

05/07/2018

by: Marla Durben Hirsch

Paying a settlement or overpayment is never pleasant. But the new tax law has made it more onerous by greatly reducing the ability of providers to deduct the payment on their tax returns. To make matters worse, the Internal Revenue Service (IRS) hasn’t released much information on the new rules.

No sugarcoating it: Improve diabetes screening compliance to get claims right

05/07/2018

by: Richard Scott

Don’t veer from the frequency guidelines for hemoglobin A1c testing unless you can prove medical necessity and append the correct modifier if you’re performing the test in your office — otherwise you may be one of the many to see a denial on code 83036 (Hemoglobin; glycosylated [A1C]).

Despite warning, cataract claims steady since 2014 — but not with modifier 55

05/07/2018

by: Roy Edroso

Watch out for cataract surgery and other ophthalmological claims with modifier 55 (Postoperative management only). The modifier draws special contractor scrutiny for the post-op provider.

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