Be careful if you plan to rely on mapping tools to select the correct ICD-10-CM codes as part of your transition to the new code set. Not only do these tools, such as General Equivalency Mappings (GEMs), not offer the full range of ICD-10-CM codes available that could crosswalk from the ICD-9-CM code, but also the only choices you’re offered may be incorrect choices based on the physician’s documentation.

Good news: New guidance from CMS on chronic care management (CCM) says you can start the CCM billing clock on a patient the same month he was in the hospital or skilled nursing facility, as long as he wasn’t an inpatient for the entire month.

Tighten up your billing protocol to ensure you’re coding for the correct place of service (POS) when your provider steps into a facility to perform a procedure — and avoid increased scrutiny from your Medicare administrative contractor (MAC).

If your practice is enrolled as a supplier of durable medical equipment (DME), watch out for letters from your Medicare administrative contractor (MAC) requiring your providers to receive fingerprint-based background checks.

A new House bill seeks an 18-month safe harbor period after the Oct. 1 ICD-10 transition deadline during which claims won’t be denied “due solely to the use of an unspecified or inaccurate subcode.” 

You’ll see up to a $14,000 difference in your reimbursement rate for some surgical procedures depending on whether you performed the service in a non-facility setting such as your office as opposed to a hospital, ambulatory surgical center (ASC) or other facility setting.