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On flu shots, check patient eligibility, bill correctly, appeal low payments

11/03/2014

Now that it’s flu shot season, here are seven tips to not only bill vaccinations correctly, but also get clarity with payers to avoid denials and underpayments.

Configure deals to ensure physicians avoid inducements, legal trouble

11/03/2014

by: Roy Edroso

Help your doctors avoid deals that could snare them in an enforcement net.

Improve employee productivity with proper tracking, growth opportunities

11/03/2014

by: Roy Edroso

Set relevant employee goals — but also encourage achievements that go beyond the expected — to create employee performance tracking processes that not only measure but can actually improve productivity of non-clinical staff.

Modifier 91: Find solution to denials triggered by lab service modifier

11/03/2014

by: Julia Kyles

A sharp increase in utilization, revenue and denials for claims associated with the modifier for repeat lab tests could combine to expose anesthesia and pain management practices to scrutiny, overpayment demands and fraud allegations.

Justice Department steps up use of the False Claims Act to prosecute health care fraud

11/03/2014

by: Marla Durben Hirsch

The department implemented a new procedure so that all new whistleblower cases accusing providers of violating the False Claims Act, which are filed with the department’s civil division, now will be shared with its criminal division as soon as the cases are filed to determine whether a parallel criminal investigation should be opened.

Recovery auditors collected $3.65 billion in overpayments in fiscal year 2013

11/03/2014

by: Marla Durben Hirsch

Recovery auditors collected $3.65 billion in overpayments in fiscal year 2013 and $102 million in underpayments, according to CMS’ latest report.

2013 data show denials up with lower-level new patient office visit E/M codes

10/27/2014

by: Roy Edroso

Watch out: Our latest Medicare data shows us that E/M denials have been going up — not so much for the high-level codes practices normally worry about, but for the lower ones, especially for new patients.

OIG proposes to clarify, increase anti-kickback safe harbor protections

10/27/2014

by: Marla Durben Hirsch

You soon may be able to offer patients transportation to your offices for appointments and receive payments from hospitals with fewer compliance risks, now that HHS’ Office of Inspector General (OIG) has proposed a new rule updating the anti-kickback statute and civil money penalty (CMP) law.

Base 7th character on treatment stage, not whether provider is new

10/27/2014

by: Laura Evans

Select the “active” treatment seventh character on ICD-10 injury codes based on whether the patient is undergoing active treatment for the injury — not whether the provider is seeing the patient for the first time, according to the latest update to ICD-10 coding rules.

Busier practices with more procedures best bets for hiring medical scribes

10/27/2014

by: Roy Edroso

If you’re thinking of hiring medical scribes, don’t just jump in — analyze the cost of the time your providers spend entering information into the electronic health record (EHR) against the cost of the service to see whether you can afford it.

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