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NPPs exempt from value modifier will count when CMS tallies group data

08/17/2015

You’ll need to count all of your practitioners to determine whether your practice will be subject to the 2% or 4% value-modifier adjustment in 2018, CMS clarified during an open door call on quality reporting requirements in the proposed 2016 Medicare physician fee schedule.

CMS will cover Internet-, eye-gaze-enabled speech-generating devices

08/17/2015

by: Roy Edroso

A new national coverage determination (NCD) and a new law should make it easier for you to get Medicare to pay for speech-generation devices for your patients.

You can bill TCM if patient readmitted — but watch rules on timing the claim

08/17/2015

by: Roy Edroso

Question: Our contractor denied our transitional care management (TCM) claim (99495) on the grounds that the patient was an inpatient at the time of the claim. He’d been readmitted to the hospital during the 30 days of TCM. What can we do?

Verify J codes and units of service, prepare for more MUEs after OIG report

08/10/2015

by: Laura Evans

Make sure you are billing your injectable Part B drugs appropriately in light of a recent HHS Office of Inspector General (OIG) report that recommends placing new Medicare limits on J code reimbursement.

Don’t focus on the family — CMS revisits Q-and-A to emphasize ICD-10 rules

08/10/2015

by: Julia Kyles, CPC-A

An unspecified ICD-10 diagnosis code might save a claim from a post-payment audit during the first year after the transition, but it must be valid to get through the initial submission phase, CMS emphasized in its July 31 revision to a Q-and-A document on its ICD-10 safe harbor.

5 tips to improve non-clinical staff retention without spending much money

08/10/2015

by: Roy Edroso

Can’t afford big raises to keep staff? Try low-cost changes first.

Predicting ICD-10: 5 forecasts about the Oct. 1 ICD-10 launch and how to prepare

08/10/2015

by: Richard Scott

Brace yourself for lost productivity and cash-flow issues, as some of your biggest fears related to the ICD-10 transition are expected to come true — to some degree at least. But don’t despair — you control much of your fate.

Use your resource reports to prep for PQRS 2016, beat the value-based cut

08/10/2015

by: Julia Kyles, CPC-A

Focus on the highlights section of the quality-of-care report card CMS creates for your practice to prepare for the value-based modifier (VM) calculation. Using this information now will increase the chance your practice will receive an upward payment adjustment.

Top incorrect units-of-service drugs had low denials through OIG investigation

08/10/2015

by: Roy Edroso

The five drugs that the Office of Inspector General (OIG) says were most frequently overpaid because of incorrect units of service had single-digit denial rates throughout OIG’s 2009 to 2012 investigation period and beyond, according to a Part B News analysis. And with one exception, they didn’t change much.

New CMS ICD-10 Q&A defines code family, emphasizes requirements for valid codes

08/03/2015

by: Roy Edroso, Laura Evans, CPC, and Julia Kyles, CPC-A

Practices should be prepared to give ICD-10 coding their best shot, including reporting the codes to their full specificity, based on the latest guidance from CMS.

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