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Injunction lifts transgender discrimination ban — but possible consequences remain

02/13/2017

An injunction against enforcement of certain anti-discrimination regulations seems to leave insurers and employers free to refuse certain procedures to transgender patients — but it does not necessarily protect them from legal action if they do.

Inspect mammography coding policies amid reporting upheaval

02/13/2017

by: Richard Scott

You may find yourself in a tricky situation when reporting mammography tests this year, as new CPT codes debuted but at least one major payer – CMS – is not equipped to process claims for them. But you can avoid mammography-coding mayhem this year with a close look at your payers’ policies.

Hypertension, immunization encounters linked to the highest total denials

02/13/2017

by: Richard Scott

Firm up your ICD-10 coding when your patient encounters are related to essential hypertension, immunization encounters, general adult and pediatric visits and other diagnoses tied to mass denials.

Delete 2 regulations for every new 1, orders Trump; HHS nominee Price pushed through

02/06/2017

by: Richard Scott

An executive order that President Donald Trump signed Jan. 30, which instructs departments and agencies to remove two regulations for every one issued, may have a significant impact on the medical practice industry. “For every new regulation issued, at least two prior regulations [must] be identified for elimination,” states the executive order.

Beyond QPP: Check your readiness for insurer-based physician incentive programs

02/06/2017

by: Roy Edroso

While nearly all Part B providers have to engage the Quality Payment Program (QPP) in some way to avoid pay cuts, voluntary incentive programs can increase your providers’ payments – without financial risk.

Be firm, follow due process when you suspect fraud in the office

02/06/2017

by: Richard Scott

Don’t get swept up in fraudulent activity that may be occurring in your office — whether it’s intentional or not — or you may wind up punching the jailhouse clock with some other medical practice personnel caught in the feds’ snares in 2016.

How to bill cognitive assessment G0505 and CCM services simultaneously

02/06/2017

by: Roy Edroso

Question: In the 2017 Medicare physician fee schedule, CMS specifically mentions that the newly billable G0505 (Cognition and functional assessment by the physician or other qualified health care professional in office or other outpatient) could be billed with chronic care management, transitional care management and other services. Under what circumstances would you legitimately bill CCM (99490) with G0505?

Can screening tests turn diagnostic? Not unless you were actually diagnosing

02/06/2017

by: Roy Edroso

Question: An EKG was ordered as a pre-op screening before cataract surgery, but it revealed a right bundle branch block. What diagnosis code would you choose to submit with the claim for the EKG?

Brief: Office for Civil Rights (OCR) comes out swinging in 2017

02/06/2017

by: Marla Durben Hirsch

OCR has been active in HIPAA compliance so far this year. It entered into its first settlement for missing the 60-day breach notification deadline Jan. 9. Presence Health agreed to pay $475,000 for the company’s failure to notify OCR in a timely fashion.

Brief: CMS updates Open Payments database

02/06/2017

by: Marla Durben Hirsch

CMS on Jan. 17 revised the Open Payments data set to reflect changes to the data. The updates include changes made to records, disputed records and deleted records.

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