Part B News | Part B News

MACs start fingerprint background checks

09/01/2014

MACs are requring “individuals with a 5% or greater ownership interest in a provider or supplier that falls into the high-risk category and is currently enrolled in Medicare or has submitted an enrollment application,” according to MLN Matters article SE1427 (PBN 6/30/14).

Denial rates on claims with G modifiers increase from 2010 to 2012

09/01/2014

Because modifiers GA, GX, GY and GZ involve claims on which the provider is anticipating denials, it may surprise you to learn that claims with those modifiers haven’t come near 100% denial rates in recent years.

4 new HCPCS modifiers act as subset of modifier 59, could reduce denials in 2015

08/25/2014

by: Scott Kraft

The addition of four new modifiers to clarify distinct procedural services is a huge improvement that should reduce denials and abuse of modifier 59, experts tell Part B News.

Reach out to allies to improve interoperability, avoid stage 2 penalty

08/25/2014

by: Roy Edroso

If you’re not ready to share electronic health records (EHR) documentation with other practices, hospitals and ambulatory surgical centers (ASCs), you’re not alone — but you risk a 1% pay cut for failing to meet stage 2 meaningful use measures if you don’t call for help soon.

CMS proposal could cut fees for orthotics supplied in your office

08/25/2014

by: Laura Evans

If your orthopedic practice employs athletic trainers, medical assistants or certified orthotic fitters to fit custom orthotics that you dispense in your office, look out for a CMS proposal that could reduce reimbursement for those services.

Append 58 modifier for total knee done in global period of diagnostic scope

08/25/2014

by: Laura Evans

Question: Our surgeon did a diagnostic knee scope (29870) and, based on the results, determined that the patient required a total knee replacement. If he does the total knee replacement (27447) inside the 90-day global period for 29870, would he get paid half on the 27447 because of the 90-day global? Should we append modifier 78 to the total knee code?

Use new MUE list to stop bilateral modifier, unit-of-service errors

08/25/2014

by: Julia Kyles

You have a new tool to stop denials and overpayments caused by claims that exceed the number of allowed services, per patient, per day, including improper reporting of bilateral procedures.

CMS brings back related-claims denials

08/25/2014

CMS has brought back its “related claims” denial plan from last March — and this time it looks like the federal agency won’t take it back.

Medicare’s new medically unlikely edits for primary care doctors’ top-billed codes

08/25/2014

by: Laura Evans

For your reference, here are the MUEs that took effect July 1 that affect primary care practices the most. As you can see, CMS has expanded its presentation of these edits. MUEs limit the number of units of service for which a code may be billed by a provider for the same patient during one calendar day.

Neurology, family practice have highest denial rates for claims with 59 in 2012

08/25/2014

Practices should pay attention to CMS’ new modifiers for distinct procedural services (XE, XS, XP, XU) to avoid potential denials — especially neurologists and family practitioners.

Login

User Name:
Password:
Remember me Forgot password
Welcome to the new Part B News Online. If you are a returning user having trouble logging in, please click here.