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Inertia grips health reform efforts; new legislation seeks telehealth expansion

04/17/2017

Following the repeal-and-replace plan that didn’t muster a vote, reports circulated that Republican lawmakers were seeking to resuscitate the American Health Care Act (AHCA) or a revised version of the bill.

Protect yourself as FCA changes pit employee vs. employee

04/17/2017

by: Roy Edroso

Experts recently warned about the increasing odds that False Claims Act (FCA) charges, with the threat of conviction and imprisonment, will be brought against providers and other personnel who previously might expected just fines and takebacks. In this interview, an author of a new book about health care and the FCA talks about what practices should know.

Tighten medical record amendments to survive CERT auditor scrutiny

04/17/2017

by: Roy Edroso

Watch for simple errors such as proper signatures and dates when providers amend their medical records, as a Medicare administrative contractor (MAC) put out word that auditors are catching mistakes.

Many commercial payers — but not all — cover TCM services; check first

04/17/2017

by: Richard Scott

Question: Has anyone seen any information regarding commercial payers and reimbursement for transitional care management (TCM) services? I thought I saw an article stating that these codes would now be reimbursed by commercial payers, but I am unable to confirm this information. Please help.

Primary care highest billers of hyperbaric treatment code – but denial rates stiff

04/17/2017

by: Roy Edroso

Medicare allows hyperbaric oxygen therapy for conditions ranging from cyanide poisoning to necrotizing fasciitis to decompression illness. But a remarkable number of the Medicare claims for 99183 (Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session) were supplied under primary care in 2015, according to the most recent Medicare claims data. And for providers of any kind, the denial rates weren’t so hot.

How to improve patient collection strategies when facing ACA, high-cost plans

04/10/2017

by: Richard Scott

Shorten your revenue cycle and keep cash flowing by taking a close look at how you’re collecting out-of-pocket fees from patients as cost-sharing continues to shift away from insurers.

Mind your risk-adjustment, diagnosis coding as whistleblower suits target MA claims

04/10/2017

by: Roy Edroso

Practices that do risk-adjustment coding for Medicare Advantage plans should watch their step as the government pursues two big fraud cases that hinge on risk-adjustment issues. So far, only insurers are in the line of fire — but that may not last.

New ACA repeal plans emerge in GOP talks; Part C, D plans get slight raise

04/10/2017

by: Roy Edroso

Hints in Congress of a new anti-Obamacare plan, big rules submitted to the Office of Management and Budget (OMB) and payment changes for Part C and Part D plans are among the big health care news items from Washington.

Pair claims-based quality measures with CPIAs to reduce MIPS workload

04/10/2017

by: Julia Kyles

Make selecting and performing clinical practice improvement activities (CPIA) easier for your practice by matching the activities with a provider’s quality performance efforts under the merit-based incentive payment system (MIPS).

Obesity counseling denials could be caused by billing by wrong type of provider

04/10/2017

by: Roy Edroso

Question: We’re getting denied on obesity counseling and can’t understand why. What could the reason be?

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