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CCI edits set parameters around new cognitive therapy code, prolonged services
03/12/2018
by: Richard Scott
You’ll find updated billing restrictions on a new cognitive function therapy code that CMS approved for 2018 reporting amid the latest Correct Coding Initiative (CCI) edits, which go into effect April 1.
3 tips to steady modifier 59 claims as CMS issues clarification on its use
03/12/2018
by: Richard Scott
Tread carefully when opting for modifier 59 (Distinct procedural service) when reporting multiple procedures on the same day and implement CMS’ guidance on anatomic sites, separate encounters and more to get your claims paid correctly.
Update: Anthem rescinds decision to cut modifier 25-related payments
03/12/2018
by: Richard Scott
Citing pushback from numerous physician groups, Anthem Inc. announced it would not move forward with its planned pay cuts impacting same-day services involving modifier 25 (Significant, separately identifiable E/M service), which had been set to reduce E/M rates by 25% on March 1.
From the Part B News blog
03/12/2018
by: DecisionHealth staff
Take note of the news that happens between Part B News issues by checking out the free Part B News blog at https://pbn.decisionhealth.com/Blogs/default.aspx. Here’s a sampling from this week.
Psychologists, therapists report bulk of cognitive therapy claims amid code swap
03/12/2018
by: Richard Scott
Clinical psychologists outpaced other specialists when reporting cognitive-training code 97532, now deleted, yet all reporters, including occupational therapists and primary care providers, should take note of CMS’ guidance to use HCPCS code G0515 (Development of cognitive skills to improve attention, memory, problem solving [includes compensatory training], direct [one-on-one] patient contact, each 15 minutes) in its place in 2018.
Knee X-ray codes go down easy – except for some modifier combos
03/05/2018
by: Roy Edroso
The five CPT knee X-ray codes have relatively low denial rates – except for a bit of mayhem with the two least-used codes.
Hiring NPPs can add value, satisfaction, revenue to your practice; assess your fit
03/05/2018
by: Richard Scott

When considering the benefits of bringing on additional non-physician practitioners (NPPs) to deliver patient care, medical practices may wind up enumerating a checklist of business objectives — how to increase revenue, enhance patient satisfaction, create more flexible care delivery and sensibly plan for the future of health care.

EHR switch requires communication, definite contract terms — and patience
03/05/2018
by: Roy Edroso

If you’re thinking of switching electronic health records (EHRs) but are afraid of the potential hassle, don’t be intimidated: know your rights, ask the right questions and get answers in writing — especially when it comes to your new contract.

Vendor’s improper disposal of equipment can expose PHI, create PR nightmare
03/05/2018
by: Marla Durben Hirsch

Tread carefully when you rely on a third-party vendor to dispose of equipment that may contain patient protected health information (PHI). You may still suffer breach-related headaches even if the vendor assured you that it deleted the information.

Without face-to-face visit, you’re stuck holding the bag on prolonged care
03/05/2018
by: Richard Scott

Part B News recently fielded two questions about prolonged services when a face-to-face visit has not occurred:

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