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Remember absolute CCI edits for prolonged care visits

03/27/2017

Give providers an extra dose of billing and coding compliance when it comes to prolonged services by reminding them that Correct Coding Initiative (CCI) rules bar them from reporting certain services for the same patient on the same day. For example, the codes in the chart below may not be reported with prolonged service visits 99354-99355.

Denial rates for X modifiers, 59 produce mixed returns for common codes

03/27/2017

by: Richard Scott

You may not find the X-factor you need for getting your claims through with CMS’ quartet of X modifiers if new reporting numbers from Medicare tell us anything. However, in some cases you’ll find extra motivation – read: lower denial rates – to get more X modifiers on your radar.

New CMS data on X modifier denial rates

03/27/2017

Here from CMS are the X modifier denial rates from July 1, 2015 to June 30, 2016, compared with 2015 modifier 59 denial rates.

No insurance? Tag fees to your highest non-Medicare payers’ fees

03/26/2017

by: Roy Edroso

Question: What’s the best pricing policy for uninsured patients?

Millions projected to lose insurance under GOP proposal; Verma takes over CMS

03/20/2017

by: Richard Scott

Estimates from the Congressional Budget Office (CBO) released March 13 convey a dire portrait of health insurance coverage should the American Health Care Act (AHCA) go into effect — 14 million fewer individuals would have coverage in a year’s time and about 24 million would lose coverage by 2026.

New ICD-10 e-cigarette abuse, heart attack codes coming for use Oct. 1

03/20/2017

by: Laura Evans, CPC

In mid-April, practices will get a first look at many — but not all — of the ICD-10-CM code changes that will take effect Oct. 1. That’s when CMS releases the changes as part of the proposed Medicare inpatient hospital payment rule.

4 areas where telehealth, though under-covered, can bring in revenue

03/20/2017

by: Roy Edroso

For most providers, reimbursement for telehealth is spotty at best, but look to these key programs that will pay you for the remote work while setting you up for future success.

Turn to secondary insurance, talking points to avoid CCM copay barriers

03/20/2017

by: Richard Scott

If cost-sharing for chronic care management (CCM) services has turned patients off — as multiple practices told CMS during a Feb. 21 webinar — then you should stick to a script and explore secondary insurance coverage.

Fine tune your patient messaging to boost CCM rolls

03/20/2017

by: Richard Scott

Stick to direct and open conversations with your patients when discussing chronic care management (CCM) services and you may boost your patient buy-in. The following example, provided courtesy of consultancy West Corporation, gives you a head start with your CCM discussions.

5 steps to make sure insurance coverage, staff are prepared for disaster

03/20/2017

by: Roy Edroso

Question: I read about a doctor’s office that was destroyed in a fire, and it occurred to me that we don’t have a protocol for emergencies. What’s a good checklist?

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