Without warning, certain insurance companies have been making life difficult by denying allergy tests when some practices use CPT code 95004. The code is for percutaneous (scratch, puncture, or prick) tests with allergenic extracts, immediate type reaction. You must specify the number of tests when billing.

Part I of III

Managed care contracting can be like maneuvering through a dark room. In this three-part series running through July, TDO will direct you in how to evaluate your position, spot contracting obstacles, and skirt dangers during contract negotiations. There is light ahead.

Practices must include the GA modifier on claims anytime patients sign an advance beneficiary notice, or they’ll risk fraud and abuse trouble, according to new modifier guidelines the Centers for Medicare & Medicaid Services (CMS) released in March. For ex ample, use the GA modifier for an assigned claim when patients won’t sign the notice, but you perform the service anyway. (Use the GZ modifier, under these circumstances, but for unassigned claims.) Carriers will not consider GA modifiers in their decisions to deny or pay claims. Patients are responsible for payment w

Texas’ peer review foundation creates decision tree for docsSeveral peer review organizations have created improvement efforts this year as part of the Centers for Medicare & Medicaid Services’ (CMS) in tense initiative, called the Payment Error Prevention Program (PEPP), to reduce incorrect Medicare payments. Here we take a closer look at their programs:Documentation avalanche The Colorado Foundation for Medical Care, the state’s peer review group, has found that documentation problems can lead to incorrect diagnosis-related group assignment, according to Shelly

Let media help you avoid marketing and legal risksP.T. Barnum made bold marketing fashionable, but physician practices don’t have the luxury to dress up their marketing programs with spin. The risk is too great. “You have a lot of regulations to worry about, including the privacy law,” says Ann Perry, a health lawyer in Minneapolis.Newsletters Newsletters are okay under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy regulation. But there’s one crucial rule: You must include in formation telling the reader how they can remove thei

Part I of III: Beef up firing policies to avoid employment-practice lawsuitsBy Barbara EberlyThis three-part series will help you reduce employment practice claims and keep unemployment benefits to a minimum. Next month we examine workplace management.It seems pessimistic to plan exit strategies be fore new employees even receive office keys and computer passwords. But it’s prudent human resources. The idea of planning for employee termination is probably foreign to most of you. Yet the increase in employment practice claims makes this an area of personnel management that you mu

Coding reports give precious peer averages, but are carriers overcharging?Coding reports that compare a doctor’s billing history to peers in the same specialty are an invaluable way to audit your docs and improve reimbursement. But be careful because some carriers charge physicians different prices for these reports; worse still, they’re not easy to get if you live in a state that keeps the reports wrapped in red tape, according to several medical clinics. We can help.The Centers for Medicare & Medicaid Services (CMS) requires carriers to provide claims-profiling inform