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Check trends, claims data to avoid undercoding E/M office visits

02/20/2017

You may be falsely reporting your E/M claims if you don’t code to the highest level of service that your encounters demand. Practices left significant dollars on the table in 2016 because of undercoding, or reporting at a lower level of service than warranted.

Retired spouse’s insurance should be secondary to Medicare — but check

02/20/2017

by: Roy Edroso

Question: I have a patient who is on Medicare but was until recently also covered under his wife’s group health plan at work, which made Medicare his secondary payer. He tells me his wife recently retired. She has kept up the insurance for both of them, but our understanding (and the patient’s) is that in this case, the group plan should now be the secondary and Medicare the primary. Medicare doesn’t acknowledge it, though. What to do?

Check your specialty’s denials with modifier 59 — by number as well as rate

02/20/2017

by: Roy Edroso

Your chance of a denied claim goes up when you bill codes with modifier 59 (Distinct procedural service). In 2015, the most recent year available for Medicare claims data, claims with modifier 59 had a 19% denial rate versus a 16% denial rate without it. But that average fluctuates depending on specialty — and each of those specialties has its own highly denied codes when billed with 59.

2-for-1 impact on physician payments; SCOTUS nominee on health care

02/13/2017

by: Roy Edroso

Take a look at the latest developments in health care impacting regulatory guidance, fiscal policy and business practice.

As cannabis laws loosen, follow state requirements for patient discussions

02/13/2017

by: Richard Scott

Don’t be reluctant to have a talk with your patients about the buds and the weeds — that is, about medical marijuana — if you work in a state that has legalized it. If you do, stick to your state’s policy, which may require that you sign up for a registry, among other actions.

Injunction lifts transgender discrimination ban — but possible consequences remain

02/13/2017

by: Roy Edroso

An injunction against enforcement of certain anti-discrimination regulations seems to leave insurers and employers free to refuse certain procedures to transgender patients — but it does not necessarily protect them from legal action if they do.

Inspect mammography coding policies amid reporting upheaval

02/13/2017

by: Richard Scott

You may find yourself in a tricky situation when reporting mammography tests this year, as new CPT codes debuted but at least one major payer – CMS – is not equipped to process claims for them. But you can avoid mammography-coding mayhem this year with a close look at your payers’ policies.

Hypertension, immunization encounters linked to the highest total denials

02/13/2017

by: Richard Scott

Firm up your ICD-10 coding when your patient encounters are related to essential hypertension, immunization encounters, general adult and pediatric visits and other diagnoses tied to mass denials.

Delete 2 regulations for every new 1, orders Trump; HHS nominee Price pushed through

02/06/2017

by: Richard Scott

An executive order that President Donald Trump signed Jan. 30, which instructs departments and agencies to remove two regulations for every one issued, may have a significant impact on the medical practice industry. “For every new regulation issued, at least two prior regulations [must] be identified for elimination,” states the executive order.

Beyond QPP: Check your readiness for insurer-based physician incentive programs

02/06/2017

by: Roy Edroso

While nearly all Part B providers have to engage the Quality Payment Program (QPP) in some way to avoid pay cuts, voluntary incentive programs can increase your providers’ payments – without financial risk.

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