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Attach the right modifier to get paid for services during global surgery period

01/19/2015

For a patient requiring extra attention during the surgical period, you’ll want to append the correct modifier for additional, elevated or unusual services to make sure you receive the payment you deserve — and avoid denials that occur up to 35% of the time.

OIG advisory opinion: Charity can pay some copays for low-income patients

01/19/2015

by: Roy Edroso

A new Office of Inspector General (OIG) advisory opinion offers more evidence that, as long as they observe certain guidelines, charitable organizations can pay part of the cost of indigent patients’ treatment without triggering the anti-kickback statute and leading to civil monetary penalties.

VA issues rule enabling veterans to seek treatment from non-VA providers

01/19/2015

by: Marla Durben Hirsch

The Department of Veterans Affairs (VA) has amended its medical regulations to provide veterans with more flexibility in obtaining care by allowing them to seek treatment from non-VA providers in certain circumstances, such as to avoid overlong wait times at the local VA hospital.

Updated fee schedule creates winners, losers in new reimbursement amounts

01/19/2015

by: Richard Scott

Revisions to the 2015 Medicare physician fee schedule, a brew of new cost calculations that CMS released Dec. 30, means you’ll be receiving more — or less — money for thousands of procedures and services you perform this year.

4 ways Medicare’s turbo-charged PQRS list can make measure selection easier

01/12/2015

by: Julia Kyles

Take advantage of a new tool that will help you juggle the quality measures your providers must report this year or face a 2% pay cut.

Experts: 9 months to go — time for ICD-10 restart with testing, cash reserve

01/12/2015

by: Roy Edroso

Now that the ICD-10 deadline is less than nine months away, experts warn against foot-dragging and advise you to focus on the big things — finding testing opportunities and shoring up your cash reserves for Oct. 1.

CMS restarts RAC program, makes changes to rules for auditing claims

01/12/2015

by: Josh Poltilove

Practices can expect increased review of claims now that CMS announced the official restart of their recovery auditor (RAC) reviews.

Follow these 5 tips on modifier 25 to correctly bill separate E/M services

01/12/2015

by: Richard Scott

When a patient in for a procedure requires additional services, you’ll want to make sure same-day E/M services are distinct and documented comprehensively to avoid a modifier 25 denial, which accounts for millions in denied claims annually.

More CME payments to providers may be reportable under CMS clarification

01/12/2015

by: Roy Edroso

A clarification from CMS on Open Payments and continuing medical education (CME) leaves your physicians vulnerable to more nettlesome associations with drug and device companies online.

Top denial rates of modifier 25 include low-level E/M, preventive services

01/12/2015

by: Richard Scott

Modifier 25 (Significantly, separately identifiable E/M service) is linked to hundreds of millions of dollars in denied claims annually, according to an analysis of 2013 Medicare data, the latest available.

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