Part B News | Part B News

4 ways your Medicare enrollment may hit a snag, and how to stay clear

10/25/2021

Common mistakes can result in costly delays to your provider enrollment. Improve your chances of getting your enrollment right the first time by sharpening your focus on basic but often-missed Medicare requirements.

Think twice before you refer patients for urine drug tests

10/25/2021

by: Julia Kyles, CPC

Practices that use an outside lab to perform urine drug tests should make sure they follow the guidelines for the codes. The long-standing concern about improper utilization extends beyond practices and laboratories that bill for the tests; it also encompasses providers who create referrals for the tests.

Warning: OCR reports widespread breach notification failures

10/25/2021

by: Marla Durben Hirsch

Prepare for more scrutiny of your practice’s patient breach notification process, as a recent HHS Office for Civil Rights’ (OCR) HIPAA audit report reveals deficiencies in covered entities’ breach notification letters.

Take a 6-step test of your practice’s breach notification process

10/25/2021

by: Marla Durben Hirsch

No one likes to think that their practice will experience a HIPAA breach, but every practice must be ready to deploy a breach notification to patients before the 60-day deadline. A practice that doesn’t have a plan to inform patients affected by a breach of unsecured patient protected health information (PHI) will be exposed to patient anger, investigations and costly fines.

Spotted a claim error? Before appealing, consider resubmitting or reopening

10/25/2021

by: Roy Edroso

Question: I‘ve heard that, rather than waiting for a denial on a claim so I can request a formal appeal, I can ask to have my claim changed after I’ve submitted it to the Medicare administrative contractor (MAC). I’ve heard this variously called a “reopening” and a “resubmission.” My question is, how do I do it?

How to report debridement procedure with rash treatment

10/25/2021

by: Sarah Gould

Question: A wound care patient with a 25-sq-cm chronic foot ulcer presents with a new cellulitic rash, which is treated using topical medication. During the visit, the physician also surgically removes dead tissue from the ulcer. How would these services be reported in CPT?

First-level appeals drop, but success rate rises for Part B providers, DME

10/25/2021

by: Roy Edroso

If you’ve been doing better on Medicare appeals lately, you’re part of a trend. Between 2013 and 2020, the overall rate of success for providers and suppliers on redeterminations, the first level of formal Medicare appeals on claims denials, rose from 46.5% to 55% at Part B Medicare administrative contractors (MACs). And Part B durable medical equipment (DME) claimants did even better.

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