Part B News | Part B News

OIG to open up Open Payments data, compare Medicare cost, doctor payments

12/19/2016

It’s now more important than ever for physicians to check what pharmaceutical and medical device manufacturers have reported about payments made to them. The HHS Office of Inspector General (OIG) has decided that those payments warrant further scrutiny and has added it as a new topic of investigation to its 2017 Work Plan.

Hospital-based providers: Watch erroneous billing for stem cell transplants

12/19/2016

by: Richard Scott

Hospital billing offices should be careful when reporting claims for stem cell transplants involving CPT codes 38240 and 38241 because many are billed under inpatient status when they should really go to Medicare administrative contractors (MACs) under Part B.

Does ‘shall’ mean ‘must’? In law, maybe – but not in CMS, CPT manuals

12/19/2016

by: Roy Edroso

Question: A lawyer told us that when “shall” appears in official guidance, it means “must.” For example, because the CPT manual says that when counseling and/or coordination of care is more than 50% of an encounter, “time shall be considered the key or controlling factor to qualify for a particular level of E/M services….” He says that means we have to bill based on time for those encounters. Is he right?

Look beyond fee schedule to understand proper injection supervision rules

12/19/2016

by: Laura Evans, CPC

Question: What are the levels of supervision required for phlebotomy, injections or other services of medical assistants and nurses in the office setting? Please list source or link to the Medicare fee schedule database that you reference in your article.

Warning: HHS warns of HIPAA-related email phishing scam

12/19/2016

by: Richard Scott

Be careful before you open what appears to be a routine email related to HIPAA auditing because it may be a cleverly disguised scam email, warns HHS.

Watch common codes with double-digit denial rates when used with modifier 59

12/19/2016

by: Roy Edroso

Most codes that are frequently used with modifier 59 (Distinct separate service) have reasonable denial rates, but watch out for a few that seem to give providers trouble.

CCI update: Be wary of modifier 59, cerumen removal, other coding pitfalls

12/12/2016

by: Richard Scott

Audiologists should exercise caution when reporting lower-level cerumen-removal code 69209, and physicians delivering pulmonary services should heed episode-of-care guidelines, instructs the 2017 update to the National Correct Coding Initiative’s (CCI) policy manual.

21st Century Cures Act can bring your practice more money, breaks on MIPS, more

12/12/2016

by: Roy Edroso

All but certain to become law this month, the 21st Century Cures Act makes regulatory and financial changes that could have a direct impact on your practice in terms of merit-based incentive payment (MIPS) compliance, electronic health record (EHR) interoperability and even financial grants from HHS.

CCI update: Be wary of modifier 59, cerumen removal, other coding pitfalls

12/12/2016

by: Richard Scott

Out-of-network doctors’ obligations grow under state ‘surprise billing’ laws

12/12/2016

by: Marla Durben Hirsch

When you aren't contracted with a particular insurer, be prepared to disclose that fact to patients before you treat them. States are beginning to enact laws against “surprise billing” by requiring doctors to be up front about their out-of-network status and providing patients with cost estimates.

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