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Append 58 modifier for total knee done in global period of diagnostic scope

08/25/2014

Question: Our surgeon did a diagnostic knee scope (29870) and, based on the results, determined that the patient required a total knee replacement. If he does the total knee replacement (27447) inside the 90-day global period for 29870, would he get paid half on the 27447 because of the 90-day global? Should we append modifier 78 to the total knee code?

Use new MUE list to stop bilateral modifier, unit-of-service errors

08/25/2014

by: Julia Kyles

You have a new tool to stop denials and overpayments caused by claims that exceed the number of allowed services, per patient, per day, including improper reporting of bilateral procedures.

CMS brings back related-claims denials

08/25/2014

CMS has brought back its “related claims” denial plan from last March — and this time it looks like the federal agency won’t take it back.

Medicare’s new medically unlikely edits for primary care doctors’ top-billed codes

08/25/2014

by: Laura Evans

For your reference, here are the MUEs that took effect July 1 that affect primary care practices the most. As you can see, CMS has expanded its presentation of these edits. MUEs limit the number of units of service for which a code may be billed by a provider for the same patient during one calendar day.

Neurology, family practice have highest denial rates for claims with 59 in 2012

08/25/2014

Practices should pay attention to CMS’ new modifiers for distinct procedural services (XE, XS, XP, XU) to avoid potential denials — especially neurologists and family practitioners.

CMS reopens Open Payments website, gives physicians until Sept. 8 for review

08/25/2014

by: Ben Hartman

Physicians now have until Sept. 8 to register, review and dispute the financial payments linked to them on the Open Payments website.

New CPT codes may make it easier to perform, get paid for chronic care

08/18/2014

by: Roy Edroso

Getting reimbursed by private payers for chronic care management services is difficult now, but CPT code changes could make it more likely in 2015.

Increase your practice, income by treating US veterans under new initiative

08/18/2014

by: Marla Durben Hirsch

Physicians looking to broaden their patient bases and increase their revenue may have a new way to do that: treating American service veterans when the Veterans Administration (VA) can’t.

Don’t get tripped up by high denial rates for assistant-at-surgery services

08/18/2014

by: Scott Kraft

Specific rules governing the use of four modifiers for assistant-at-surgery services, coupled with confusion over the medical necessity of the assistant, often drive high denial rates for the claims billed by the assistant.

Use these 3 tips to overcome common EHR challenges, increase your workflow

08/18/2014

by: Ben Hartman

Your electronic health records (EHRs) can make your practice more efficient if you fix common deficiencies that decrease workflow.

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