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ACA repeal bill gets changes; HHS cut 18%; EPM programs delayed [UPDATED]

03/27/2017

Last-minute changes to the Obamacare replacement bill, a huge budget cut for HHS and a three-month delay of new episode payment models (EPMs) are among the top health care stories from Washington.

New data on X modifiers show they sometimes beat modifier 59 — but be careful

03/27/2017

by: Roy Edroso

Despite a lack of recent official guidance on the X modifiers that were developed to provide more specifics than modifier 59 (Distinct procedural service), in some cases Medicare providers have seen lower denial rates using the new modifiers, according to CMS data obtained by Part B News.

Confusion about new moderate sedation codes agitates carriers and providers

03/27/2017

by: Julia Kyles, CPC

Questions about how to calculate time and denials for an add-on code have left coders and Medicare administrative contractors feeling anything but sedate about the new moderate sedation codes (99151-99157). Here are some quick tips to restore calm.

Remember absolute CCI edits for prolonged care visits

03/27/2017

by: Julia Kyles

Give providers an extra dose of billing and coding compliance when it comes to prolonged services by reminding them that Correct Coding Initiative (CCI) rules bar them from reporting certain services for the same patient on the same day. For example, the codes in the chart below may not be reported with prolonged service visits 99354-99355.

Denial rates for X modifiers, 59 produce mixed returns for common codes

03/27/2017

by: Richard Scott

You may not find the X-factor you need for getting your claims through with CMS’ quartet of X modifiers if new reporting numbers from Medicare tell us anything. However, in some cases you’ll find extra motivation – read: lower denial rates – to get more X modifiers on your radar.

New CMS data on X modifier denial rates

03/27/2017

Here from CMS are the X modifier denial rates from July 1, 2015 to June 30, 2016, compared with 2015 modifier 59 denial rates.

No insurance? Tag fees to your highest non-Medicare payers’ fees

03/26/2017

by: Roy Edroso

Question: What’s the best pricing policy for uninsured patients?

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