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New ESRD conditions for coverage target ‘inappropriate steering’ to private payers

01/09/2017

Dialysis centers that provide premium assistance or channel charitable contributions from third-party groups will be required to brush up on their conditions of coverage and spell out insurance options to their patients, according to an interim final rule that becomes effective Jan. 13.

DOJ will be aggressive about false claims, other high-ticket penalties in 2017

01/09/2017

by: Roy Edroso

The new Trump administration will have problems balancing the finances of its proposed repeal of the Affordable Care Act. When that happens, they'll try and get some of that money back from Department of Justice actions on overpayments, predicts our expert.

Update rules for new prolonged service codes for smooth sailing this year

01/09/2017

by: Richard Scott

Add two new codes to your arsenal in 2017 to capture the extensive background work your providers perform for some patients and note several updated billing guidelines — including good news — that will help get your claims through.

5 ways to thwart increasingly sophisticated ransomware attacks

01/09/2017

by: Marla Durben Hirsch

Ransomware — malware that encrypts patient or other computer data and denies access to it until a ransom is paid, typically in untraceable bitcoins — does more than disrupt a provider’s ability to provide patient care and hurt one’s operations. It also can cause providers to violate federal law, warned government insiders.

Heed private payer policies when reporting preventive counseling codes

01/09/2017

by: Richard Scott

Question: Has anyone billed preventive medicine counseling codes 99401-99404 yet? If so, what was the payer response? Of course there was confusion among the physicians as to what these codes were (mixing them up with a physical), so we have not started using them yet.

Your VM score may be re-adjusted — even if you didn’t apply for review

01/09/2017

by: Roy Edroso

Question: We got an email from a client who was unexpectedly told that there was a “systematic data error” in the quality calculation for their value modifier (VM) for 2015 and that they have been moved from a 2% negative adjustment to a 0% adjustment. What happened?

Small denial rate changes mean big money in codes with modifier 25

01/09/2017

by: Roy Edroso

At first glance, it looks like not much has changed in denials for the 10 codes most often used with modifier 25 (Significantly, separately identifiable E/M service) over the past three years. As you can see in the chart, it’s mostly a matter of a point here, a point there.

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