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New military history bullet prompts doctors to screen for related conditions

02/23/2015

Now that the AMA E/M service guidelines list a bullet point for “military history” under the patient’s social history, practices have the opportunity to develop this aspect of past family social history to zero in on potential treatment areas, one physician recommends.

Use codes that show medical necessity when billing wound-related tetanus shots

02/23/2015

by: Roy Edroso

My physician has a Medicare patient who had a wound that required incision and drainage, but the doctor also billed for administering tetanus vaccine and the vaccine... Medicare denied it, claiming patient responsibility. Does Medicare not cover tetanus vaccine?

6 tips to improve responses to documentation requests, get claims paid quickly

02/23/2015

by: Roy Edroso

Institute simple, fail-safe procedures — such as single-sided, numbered pages in the documentation — to satisfy additional documentation requests (ADR) and keep your claims from being rejected.

Simple billing mistakes can cost big money with vaccine, administration codes

02/23/2015

by: Roy Edroso

Pay attention to vaccine and vaccine administration codes with the highest denial rates to avoid losing out.

Use modifier 59 until Medicare fleshes out its X modifier policy

02/16/2015

by: Laura Evans

Many practices are excited to begin using the new X modifiers in place of modifier 59 (Distinct procedural service), but you may want to hold off a little longer, at least for your Medicare patients.

Pre-screen patients, isolate if needed when infection threat rises

02/16/2015

by: Roy Edroso

Take simple precautions to make sure your patients don’t get sicker when a patient presenting special infection risks comes in for treatment.

Fight your way through murky rules to get paid for physician-led home services

02/16/2015

by: Richard Scott

Don’t let confusion surrounding Medicare’s abbreviated rules for providing home services — and the hefty price tag of approximately $40.5 million in denied claims — stop you from delivering needed services to high-risk patients.

Homebound criteria

02/16/2015

Though regulations for what constitutes a patient who needs a physician home visit can be vague, providers can look to these rules for home health homebound status for guidance.

7 small steps — including wellness visits, registries — with big P4P rewards

02/16/2015

by: Roy Edroso

http://pbn.decisionhealth.com/Articles/Detail.aspx?id=519314Use easy lay-ups such as annual wellness visits (AWVs) and clinical documentation improvement as a springboard to meet for pay-for-performance models that HHS says are coming soon.

Look to patient status, medical necessity to avoid denials of home service codes

02/16/2015

by: Richard Scott

Home service codes 99341-99350 see an average denial rate of approximately 11%, with denied dollar amounts north of $40 million annually, according to an analysis of 2013 Medicare data, the latest available.

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