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Price confirmed, Verma up next; proposed rule seeks to stabilize ACA markets

02/20/2017

After several contentious hearings on Capitol Hill and a rule change in the Senate Finance Committee to allow his nomination to move forward, Price became the 23rd secretary of HHS when Congress confirmed him Feb. 10.

Quality, attestation, risk adjustment create compliance traps for doctors

02/20/2017

by: Marla Durben Hirsch

It’s not just improper billing that can lead to legal hot water. Providers need to make sure that their quality reporting is correct. If not, they face more than a pay cut for failing follow to a quality program’s requirements; the government can also accuse you of violating the False Claims Act.

Use X modifiers to decrease denials, even if CMS has offered scant instructions

02/20/2017

by: Roy Edroso

If you’re taking Medicare’s silence on X modifiers as a sign that you don’t need to think about them, reconsider; they’re already lowering denial rates.

Check trends, claims data to avoid undercoding E/M office visits

02/20/2017

by: Richard Scott

You may be falsely reporting your E/M claims if you don’t code to the highest level of service that your encounters demand. Practices left significant dollars on the table in 2016 because of undercoding, or reporting at a lower level of service than warranted.

Retired spouse’s insurance should be secondary to Medicare — but check

02/20/2017

by: Roy Edroso

Question: I have a patient who is on Medicare but was until recently also covered under his wife’s group health plan at work, which made Medicare his secondary payer. He tells me his wife recently retired. She has kept up the insurance for both of them, but our understanding (and the patient’s) is that in this case, the group plan should now be the secondary and Medicare the primary. Medicare doesn’t acknowledge it, though. What to do?

Check your specialty’s denials with modifier 59 — by number as well as rate

02/20/2017

by: Roy Edroso

Your chance of a denied claim goes up when you bill codes with modifier 59 (Distinct procedural service). In 2015, the most recent year available for Medicare claims data, claims with modifier 59 had a 19% denial rate versus a 16% denial rate without it. But that average fluctuates depending on specialty — and each of those specialties has its own highly denied codes when billed with 59.

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