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Beat the high cost of provider directory maintenance with smarter reporting

12/09/2019

A recent survey shows provider directory maintenance can be expensive and, in the absence of an affordable technical fix, if you want to reduce those costs you’ll have to tighten up your record updating.

CMS hopes a revised advisory opinion process will attract more requestors

12/09/2019

by: Julia Kyles

Discover three main takeaways — including new timelines for CMS, new fees and potential protection for arrangements that closely mimic arrangements in an existing advisory opinion — from the final changes to the Stark physician self-referral advisory opinion process in the final 2020 Medicare physician fee schedule.

Alert: Government continues to crack down on routine waiver of copayments

12/09/2019

by: Marla Durben Hirsch

Take a good look at how you waive copayments. Routinely waiving these amounts is a compliance risk, and it’s in the government’s crosshairs.

Check for clues that your practice is improperly waiving copayments

12/09/2019

by: Marla Durben Hirsch

Here’s a list based on the OIG's special fraud alert on waiving copayments that outlines activity that could be unlawful. Share the list with staff and use it to check your policies and procedures to make sure that your practice does not engage in waiver behavior that puts it at legal risk.

If multiple biopsies exceed MUEs, expect a denial — unless you can split them by side

12/09/2019

by: Roy Edroso

Question: My doctor recently did 10 biopsies on a single patient and we’re billing 11102 (Tangential biopsy of skin; single lesion) and 11103 (Tangential biopsy of skin; each separate/additional lesion). I see by CMS’ medically unlikely edits (MUEs) update that the former has a practitioner services MUE value of 1, and the latter has a value of 6, so we’re clearly going to exceed that. I fear we’ll get caught in an edit. Is there anything we can do ahead of time to avoid a denial?

Growth in use, and decline in denials, may have doomed old biopsy codes

12/09/2019

by: Roy Edroso

The two skin biopsy codes that were replaced by six more specific codes this year experienced huge growth in the past 10 years, which may explain why the switch was made.

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