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

08/25/2014

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.

CMS reopens Open Payments website, gives physicians until Sept. 8 for review

08/25/2014

by: Ben Hartman

Physicians now have until Sept. 8 to register, review and dispute the financial payments linked to them on the Open Payments website.

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