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Delete 2 regulations for every new 1, orders Trump; HHS nominee Price pushed through

02/06/2017

An executive order that President Donald Trump signed Jan. 30, which instructs departments and agencies to remove two regulations for every one issued, may have a significant impact on the medical practice industry. “For every new regulation issued, at least two prior regulations [must] be identified for elimination,” states the executive order.

Beyond QPP: Check your readiness for insurer-based physician incentive programs

02/06/2017

by: Roy Edroso

While nearly all Part B providers have to engage the Quality Payment Program (QPP) in some way to avoid pay cuts, voluntary incentive programs can increase your providers’ payments – without financial risk.

Be firm, follow due process when you suspect fraud in the office

02/06/2017

by: Richard Scott

Don’t get swept up in fraudulent activity that may be occurring in your office — whether it’s intentional or not — or you may wind up punching the jailhouse clock with some other medical practice personnel caught in the feds’ snares in 2016.

How to bill cognitive assessment G0505 and CCM services simultaneously

02/06/2017

by: Roy Edroso

Question: In the 2017 Medicare physician fee schedule, CMS specifically mentions that the newly billable G0505 (Cognition and functional assessment by the physician or other qualified health care professional in office or other outpatient) could be billed with chronic care management, transitional care management and other services. Under what circumstances would you legitimately bill CCM (99490) with G0505?

Can screening tests turn diagnostic? Not unless you were actually diagnosing

02/06/2017

by: Roy Edroso

Question: An EKG was ordered as a pre-op screening before cataract surgery, but it revealed a right bundle branch block. What diagnosis code would you choose to submit with the claim for the EKG?

Brief: Office for Civil Rights (OCR) comes out swinging in 2017

02/06/2017

by: Marla Durben Hirsch

OCR has been active in HIPAA compliance so far this year. It entered into its first settlement for missing the 60-day breach notification deadline Jan. 9. Presence Health agreed to pay $475,000 for the company’s failure to notify OCR in a timely fashion.

Brief: CMS updates Open Payments database

02/06/2017

by: Marla Durben Hirsch

CMS on Jan. 17 revised the Open Payments data set to reflect changes to the data. The updates include changes made to records, disputed records and deleted records.

Brief: New rule updates protections for patients in clinical trials

02/06/2017

by: Marla Durben Hirsch

HHS and 15 other departments published a final rule Jan. 19 that revises the protections afforded to individuals participating in medical research, often called the “Common Rule.”

Brief: St. Vincent settles flu shot employee discrimination lawsuit for $300,000

02/06/2017

by: Marla Durben Hirsch

Pennsylvania-based St. Vincent Health Center has agreed to settle a lawsuit brought against it by the Equal Employment Opportunity Commission (EEOC) for $300,000, including back pay and compensatory damages.

Primary diagnosis codes accepted more easily than secondary codes

02/06/2017

by: Roy Edroso

The ICD-10 codes reported most frequently to a major clearinghouse are pretty much what you’d expect — but their denial rates are much worse when they’re claimed as secondary diagnoses than when they’re claimed as the primary.

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