Part B News | Part B News

Don’t bill for treating even extended family of the doctor — or her associates

04/22/2019

Question: In the “Charges Imposed by Immediate Relatives of the Patient or Members of the Patient’s Household” section of the Medicare Policy Manual, CMS lists several categories of persons whose treatment cannot be billed to Medicare when the related provider treats them. But if a doctor who is not related to me supervises my treatment, but the NPP who actually performs the treatment incident-to is related to me, can the doctor charge for that? Also, if I’m the spouse of one of the doctors in a practice, are all the doctors in that practice prohibited from charging for my treatment?

Extended blood-pressure monitoring proves a challenge, though some succeed

04/22/2019

by: Richard Scott

Cardiologists, internal medicine providers and nephrologists are the most likely specialty groups to report a series of ambulatory blood-pressure monitoring codes that, ultimately, don’t get much attention.

Plan for practice survival if a partner gets caught in the opioid crackdown

04/15/2019

by: Roy Edroso

With more doctors being picked up by law enforcement for the consequences of their opioid prescriptions, it’s a good idea to make sure your practice is protected from resulting legal problems.

Stick to ADA legal requirements when treating patients with disabilities

04/15/2019

by: Richard Scott

If your practice is not up to speed on providing equitable treatment to patients with disabilities, you may be running afoul of the law and leaving yourself legally exposed — not to mention providing a disservice to your patient care.

Find opportunity with home-visit codes under Medicare’s loosened policy

04/15/2019

by: Richard Scott

Going forward, you’ll find laxer coding and documentation requirements when reporting home-visit services (99341-99350) after Medicare eliminated the long-standing rules surrounding medical necessity and made it easier for providers to get paid in place-of-service 12 (Home).

Don’t jump the gun with modifier 53 – wait for the anesthetic

04/15/2019

by: Roy Edroso

Question: Our doctors sometimes have to cancel a procedure because of patient prep non-compliance, patient emergency, a fever, etc. Is it okay to just stick modifier 53 (Discontinued services) on the claim?

Modifier 53 looking good denial-wise, but 52’s a minefield

04/15/2019

by: Roy Edroso

Looking at Part B denial rates for modifiers 52 (Reduced services) or 53 (Discontinued procedure), it appears easier to get contractors to buy your reasons for stopping a procedure than your reasons for curtailing it, according to claims data from 2017, the most recent available.

Tech tools, financial help and ‘high touch’ can turn med-avoiding patients around

04/08/2019

by: Roy Edroso

Results of a new survey suggest patient medication adherence can be a problem for even day-to-day long-term therapies. While there are some novel tech solutions for the problem, provider involvement remains a powerful tool to keep your patients taking their pills.

Part B services in the hospital demand attention, offer counseling opportunity

04/08/2019

by: Richard Scott

When it comes to services rendered within a hospital setting, you should be prepared to explain to your patients the financial nuances of the billing process and how that may impact their out-of-pocket costs. In some cases, your patients may be looking to their trusted physicians for guidance.

Meet strict definitions when reporting modifier 50 for bilateral services

04/08/2019

by: Richard Scott

Sharpen your modifier reporting when you conduct bilateral procedures to know when you should turn to — or avoid using — modifier 50 (Bilateral procedure) to avoid claims issues that will impact your payments.

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