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Payments reach billions for medically necessary modifier-25 services

08/07/2017

Payments for E/M services appended with modifier 25 (Significant, separately identifiable E/M service) topped $2.5 billion in 2015, according to the latest available Medicare claims data.

Ortho, other specialties can bill CCM but watch the coding fine print

07/31/2017

by: Richard Scott

Question: We've had a request from one of our physicians to report chronic care management (CCM) code 99490 using osteoarthritis as one of the qualifying factors. Has anyone used this in the orthopedic setting? The CCM guidelines mention three conditions that must be met to bill, and I’m wondering if the patient has to meet all three of the criteria and not just some or part of it.

Set your clock to report proposed prolonged preventive service codes

07/31/2017

by: Richard Scott

Get ready to add two new codes to your mix in 2018 and you’ll gain a revenue opportunity when you see patients for a prolonged period during a visit involving one of 19 Medicare-covered preventive services.

You can stop patients recording their visits — but do you want to?

07/31/2017

by: Roy Edroso

Depending on your state laws, you may be able to prevent patients from recording their encounters with your providers — but you might prefer to use the opportunity to educate and build trust with them instead.

Treating veterans? Check for, return overpayments before the VA asks

07/31/2017

by: Marla Durben Hirsch

If your practice provides private health care services to veterans through one of the Veterans Health Administration’s initiatives, heads up: The Veterans Administration (VA) has discovered that a computer error caused it to reimburse private providers at the wrong rate, and it will be retrieving overpayments.

Senate Obamacare repeal efforts fail (Updated)

07/31/2017

by: Roy Edroso

In the early morning hours of Friday, July 28, the Senate voted down the last-ditch "skinny" Obamacare repeal bill 51-49, making three unsuccessful Senate attempts to pass repeal-and/or-replace legislation in a week.

Under QPP, virtual groups not expected to get ancillary services exception

07/31/2017

by: Roy Edroso

Question: In the Quality Payment Program (QPP) proposed rule’s virtual groups section, CMS mentions “self-referral” a few times. Why did that come up?

Proposed prolonged status for these codes is great — but do the basics first

07/31/2017

by: Roy Edroso

CMS’ proposal to let 19 preventive services codes be billed with prolonged service add-on codes is good news to many providers. But it’s only good if they can get those codes accepted in the first place — and some of them have given providers trouble.

Focus on medical-decision making, time may newly define E/M services

07/24/2017

by: Richard Scott

You may find significant changes to E/M reporting in the near future, including a pivot away from two key elements — history and physical exam — that largely determine a given level of service for your most common patient encounters.

CMS previews preventive service add-on codes, dozens of new CPT codes

07/24/2017

by: Julia Kyles, CPC

Providers who believe the time spent on preventive services far exceeds the revenue they receive should take note: CMS intends to create add-on codes that will allow providers to report and be reimbursed for some preventive services that last at least 30 minutes longer than the typical time.

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