Part B News | Part B News

09/19/2016

Find out which systems are impacted by the 42,000 new code bundles wrapped up in the Correct Coding Initiative (CCI) version 22.3 edits, effective Oct. 1.

Critical care office use plummets; urgent care picks up some slack

09/19/2016

by: Roy Edroso

Critical care codes used to be claimed twice as often in physician’s offices — but a steady drop and a recent denial surge for 99291 (Critical care, E/M of the critically ill or critically injured patient; first 30-74 minutes) has resulted in a 21st-century low of 4,982 claims utilization — and a high 56% denial rate.

Build in workflow, create a tagging system to succeed with CCM payments

09/12/2016

by: Richard Scott

Tip your cap to the many providers who found success in the first year of chronic care management (CCM) but also take a hard look at your CCM potential — you may be leaving money on the table for services you already provide.

New claims suggest 99214 becoming ‘new normal’ — but mind necessity when you code

09/12/2016

by: Roy Edroso

More practices are claiming level 4 established patient visits, and they seem to be going through — but make sure that in addition to all the elements you need to claim them, you have sufficient medical necessity to back them up.

Confirm a definitive diagnosis to select first-listed ICD-10 code

09/12/2016

by: Richard Scott

Get up to speed on ICD-10 coding guidelines to select the proper first-listed diagnosis – a nuanced calculation that contains a number of wrinkles in the outpatient setting.

ERISA challenge works on self-funded plans – but only if insurer broke the law

09/12/2016

by: Roy Edroso

Question: It is my understanding that the Employee Retirement Income Security Act of 1974 (ERISA) does not apply when the patient is employed by a company with a self-funded insurance plan. Is that true?

Most specialists performing chronic care management services succeeded

09/12/2016

by: Richard Scott

Dozens of specialties billed chronic care management (CCM) code 99490 in 2015, achieving a cumulative denial rate of 5.7% for the million-plus claims submitted.

2017 CPT changes affect moderate sedation, influenza vaccine, bunionectomy codes

09/08/2016

by: Laura Evans and Julia Kyles

As you page through your newly released 2017 CPT manual, the biggest change you’ll notice may be what’s missing: The list of more than 400 codes that were defined as including moderate sedation has been deleted from Appendix G.

E/M utilization flat in 2015 — but watch out for late baby boomers (Updated)

08/29/2016

by: Roy Edroso

A coming wave of Medicare-age beneficiaries with a strong interest in their own health care means you should expect an uptick in E/M claims over the next few years, despite recent small increases in E/M utilization shown by newly released Medicare data.

CMS seeking feedback on how to improve Open Payments program

08/29/2016

by: Marla Durben Hirsch

CMS seeks provider input to enhance the Open Payments program and update its reporting requirements.

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