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3 strategies to stop high denials on inpatient E/M codes
10/10/2013
by: Scott Kraft
Denial rates are up across the board when you bill E/M visits for hospital inpatients, including initial patient visits (99221-99223) and subsequent visits (99231-99233), according to a Part B News analysis. While overall utilization for each code dipped slightly, they all saw a boost in denial rates. The high utilization of inpatient E/M services means that even minor denial rate boosts add up to millions of lost payment dollars for physician practices.
 
Reduce audit risk by proper sequencing of diagnosis codes
10/10/2013
by: Scott Kraft
Your practice relies on proper use of CPT codes to determine payment for the services your physicians provide. But it’s diagnosis codes that can raise your risk during an audit – improper sequencing of diagnosis codes and filling your claims with excess diagnosis codes will cause problems, experts tell Part B News.
Prepare for LCDs with applicable ICD-10 codes to be finalized, published by April 2014
10/10/2013
by: Scott Kraft
Identify the local coverage determinations (LCDs) for the services your practice’s physicians render most often so you know how things will change once ICD-10 hits and new codes will apply to existing LCDs, experts say. To help make sure you have enough time to be ready, CMS ordered Medicare Administrative Contractors (MACs) to publish the new LCDs online by April 10, 2014.
 
Denial rates on the rise for initial, subsequent inpatient E/M visits
10/10/2013
by: Grant Huang
Your odds of seeing a denial when billing new and established patient E/M visits are on the rise — no matter which of the six codes you select, according to a Part B News analysis of Medicare billing data from 2011-2012 featured in this week’s benchmark. The increases are relatively small, but with over 110.2 million inpatient services billed in 2012, even a mild increase in denial rates is costly to physicians.
Shutdown update: Medicare payments still unaffected, online PECOS temporarily down
10/10/2013
by: Grant Huang
As the partial shutdown of the federal government drags on, you can rest assured that routine CMS functions, like paying you for services rendered, will continue normally. Medicare’s enrollment functions, including the processing of enrollment applications and revalidations, also continue, but the Internet-based system to access enrollment isn’t working right now.
 
With E/M denials rising, avoid these 3 coding myths to stay afloat
10/03/2013
by: Roy Edroso
There’s a lot of misinformation out there about even the most common diagnoses and code sets. With the latest CMS data showing denials rising for higher-level E/M codes, make sure you don’t lose time or money by succumbing to these common myths. For example, some believe that if a doctor changes practices or specialties, the three-year clock gets restarted -- but this is untrue.
CMS: Shutdown won’t stop Medicare payments or enrollment, for now
10/03/2013
by: Grant Huang
You won’t have to worry about your Medicare payments being frozen as a result of the federal government being shut down starting Oct. 1. Fortunately, all Medicare Administrative Contractors (MACs) will continue normal functions during the shutdown, including the processing and payment of fee-for-service claims. However, the fate of other CMS activities remains uncertain.
Practices race the clock to get ready for ICD-10, but have concerns about productivity, vendors
10/03/2013
by: Scott Kraft
The next six months are when most physician practices expect to determine what they need to do to be ready for ICD-10 implementation on Oct. 1, 2014, followed by taking the necessary training and testing steps, according to a recent Part B News survey. While only about 6% of respondents said that they’re not preparing for ICD-10 because they believe it will be delayed again, close to 25% say they don’t believe they’ll be ready in time.
Avoid denied claims by using tools to verify patients’ insurance eligibility
10/03/2013
by: Karen Long
Check the insurance eligibility of your patients two to three days before their appointments to ensure proper billing and collections and to reduce the expense it takes your practice to fix delayed or denied claims. It could save your practice up to $3.32 per claim that it would cost to rework those claims. It's easier than ever thanks to a health reform provision that requires health plans to provide eligibility verification within 20 seconds.
5 steps to stop private payers from passing sequestration cuts to you
10/03/2013
by: Marla Durben Hirsch
You have no choice but to accept the automatic across-the-board sequestration 2% budget cuts to your Medicare fee-for-service claims that went into effect April 1. But many private payers have been using it as an excuse to reduce providers’ reimbursements with whom they have contracted, even though providers may not have to comply.
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