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Use a modifier to overcome bundled codes involving advance care planning

08/29/2016

Question: I have a provider who is billing for CPT code 99497, which is advance care planning (ACP), and I’m receiving denials on some claims — but not others. For example, I get denied every time I bill 99497 with hospital code 99222. Yet my claims with 99232 go through successfully. Can you help?

The Stark Reality: Costly biller oversights, outdated fee schedules

08/29/2016

by: Stark Medical Auditing

Overcome billing errors with an inside look at the auditor's toolbox, including an investigation into laboratory services, fee schedule updates, IT system upgrades and more.

Wi-Fi can be OK – but keep security tight and watch 'public' Wi-Fi

08/29/2016

by: Roy Edroso

Question: Is our office Wi-Fi a HIPAA vulnerability when it comes to protected health information (PHI)?

NPPs billing of own office E/Ms increases while other specialties see drops

08/29/2016

by: Roy Edroso

Non-physician practitioners (NPPs) increased their billing of 99201-99215 in 2015, going up 17.4% for nurse practitioners (NPs) and 16.4% for physician assistants (PAs).

Negotiate for patient record access when rival practices close

08/22/2016

by: Roy Edroso

Increase your patient census and practice revenue when a nearby practice closes by striking a deal for limited access to patient records without paying for the privilege.

Avoid privacy pitfalls when a patient files for bankruptcy

08/22/2016

by: Marla Durben Hirsch

Pay close attention to what you send to court when you file a claim against a patient who is seeking federal bankruptcy protection. If you provide too much information, you can be liable for violating privacy rules established by the bankruptcy regulations, HIPAA and state law.

What are CMS requirements for post-operative reports?

08/22/2016

by: A.J. Plunkett

The following is an excerpt from CMS’ interpretive guidelines for its hospital surveyors, State Operations Manual Appendix A, Tag A-0959, Surgical Services Condition of Participation: §482.51(b)(6).

Withstand scrutiny of immediate post-op notes with this template.

08/22/2016

This sample template for immediate post-op notes is courtesy of Pikeville (Ky.) Medical Center. Pikeville leadership requires physicians to complete this form before the patient goes to the next level of care unless accompanied by the practitioner who did the procedure. Full post-operative reports should be completed according to hospital policy.

Warn physicians of the increasing scrutiny of hospital post-op notes

08/22/2016

by: A.J. Plunkett

Tell your physicians to expect more scrutiny of their post-operative records and more demand for immediate progress notes as CMS and The Joint Commission (TJC) crack down on failures in that documentation. Failure to comply may result in pressure from hospital leadership.

CMS on diabetes program: 12-month billing delay, no ceiling on payments

08/22/2016

by: Roy Edroso

Among the clarifications made on a CMS call about the proposed Medicare Diabetes Prevention Program (MDPP): Suppliers and providers will need a 12-month head start on the program before they can bill Medicare for it.

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