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To get assistant paid on '0' claims, tell why they’re needed

08/22/2016

Question: For CPT codes with an indicator of 0 (Assistant only allowed with supporting documentation), how do you recommend the surgeon document the need for an assistant? On our claims we have the assistant's name documented at the beginning of the op note, but then no further mention of his role throughout the procedure, and we've had several denials from Medicare after review of the records.

Default to E/M codes, check payer policies when conducting group visits

08/22/2016

by: Richard Scott

Question: I have a provider who does group counseling for drug and alcohol dependence, after which the provider writes individual progress notes for each patient. Would it be appropriate to bill an E/M code based on time or is there a more appropriate code to use? The provider is not a psychiatrist.

Group visits prove challenging for practices billing prevention, intervention codes

08/22/2016

by: Richard Scott

With few options and unfavorable outcomes, providers nationally face a difficult time gaining reimbursement when providing group visits for their patients.

ICD-10-CM guidelines clarify definition of ‘with,’ when to use bilateral codes

08/15/2016

by: Julia Kyles, CPC

Review the new ICD-10-CM guidelines before Oct. 1 to finalize your preparations for the new code set. After the update, be on the lookout for denials that may be triggered by payers that are relying on outdated information.

Consider care management, EHR readiness before jumping into CPC+

08/15/2016

by: Richard Scott

Weigh several elements, including your staffing structure, your use of electronic health records (EHR) and how quickly you’re ready to embrace change to determine if you should get behind CMS’ latest value-based model for primary care.

Keep an eye out for incident-to audits

08/15/2016

by: Roy Edroso

Heads up: Some action on the physician-supervision front may warn of a clampdown on incident-to and other supervisory claims.

Avoid balance billing – and sanctions – when you treat Medicare, Medicaid duals

08/15/2016

by: Richard Scott

Take a closer look at your billing practices for patients who are dually eligible under Medicare and Medicaid so that you’re not collecting cost-sharing or coinsurance unduly – an event that can lead to sanctions.

Follow these 8 tips to handle ransomware risk in light of OCR HIPAA guidance

08/15/2016

by: Marla Durben Hirsch

HHS’ Office for Civil Rights (OCR) has made it clear HIPAA is yet another headache to deal with if a provider is hit with ransomware. To reduce your risks, take these eight steps:

2015 Medicare round-up: Top codes, denials mainly flat; $1.58 raise per claim

08/15/2016

by: Roy Edroso

The 2015 Medicare utilization numbers are out, and for the most part they show only modest changes from the previous year. But on the whole providers got more money out of the system than in 2014.

New bundled payment programs may have hospitals seeking your help

08/08/2016

by: Roy Edroso

Experts say three new bundled payment models affecting hundreds of hospitals across the U.S. will not only push medicine deeper into value-based territory but also change the way many hospitals handle patient after-care — and encourage them to reach out to practices for help.

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