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Physician’s past with practice owing Medicare debt could stifle new enrollment

05/06/2013

Imagine that you’re about to hire a physician who left a practice because of another doctor’s pattern of overcharging and incorrectly coding procedures. Under a proposed rule published April 29, if the former colleague was caught and owed an outstanding Medicare debt, your new physician’s enrollment could be denied.

Missing ABNs mean missed payments; 6 tips for getting them done right

05/06/2013

by: Roy Edroso

If you’re losing payments on denials because you aren’t collecting Advance Beneficiary Notices of Non-Coverage (ABNs), put in a process that makes sure you get them when you need them.

RACs in 11 states start pre-payment review of therapy claims over $3,700

05/06/2013

by: Karen Long

Make sure your therapy claims can withstand recovery auditor (RAC) scrutiny now that those contractors will review your claims for patients who have exceeded the $3,700 therapy threshold.

Look for remittance advice message about therapy G-codes, C-modifiers

05/06/2013

by: Karen Long

Medicare administrative contractors (MACs) are using warnings in the form of new remittance advice to let you know your therapy claims will not process without G-codes or C-modifiers starting July 1.

Case study: Reduce care costs by using data to educate doctors

05/06/2013

by: Karen Long

Break down by provider the cost per patient for one diagnosis to find and eliminate unnecessary variation and reduce the costs of care.

Hospital ownership, state rules just two stealth causes of NPP denials

05/06/2013

by: Scott Kraft

Services rendered by non-physician practitioners (NPPs) enable physician practices to lower the cost of providing care, but be mindful of state-specific scope of practice issues and private payer and Medicare policies to bill and get paid correctly.

Ask the expert: Don’t bill an E/M for a colonoscopy pre-screening without a complaint

05/06/2013

by: Lauren C. Williams

Question: Can an E/M visit be billed prior to or on the same day as a colonoscopy screening if it is just for a screening? If so, where does CMS state that?

Benchmark of the Week: Upper level E/M visits see huge utilization gains over 5 years, 2007-2011

05/06/2013

by: Lauren C. Williams

Even though denial rates for new and established patient E/M services remained stable since 2007 — even dipping slightly in 2011 — the rate at which providers have been billing level 4 and level 5 new and established patient E/Ms has grown tremendously, according to Part B News’ analysis of CMS claims data.

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