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Look for remittance advice message about therapy G-codes, C-modifiers

05/06/2013

Medicare administrative contractors (MACs) are using warnings in the form of new remittance advice to let you know your therapy claims will not process without G-codes or C-modifiers starting July 1.

Case study: Reduce care costs by using data to educate doctors

05/06/2013

by: Karen Long

Break down by provider the cost per patient for one diagnosis to find and eliminate unnecessary variation and reduce the costs of care.

Hospital ownership, state rules just two stealth causes of NPP denials

05/06/2013

by: Scott Kraft

Services rendered by non-physician practitioners (NPPs) enable physician practices to lower the cost of providing care, but be mindful of state-specific scope of practice issues and private payer and Medicare policies to bill and get paid correctly.

Ask the expert: Don’t bill an E/M for a colonoscopy pre-screening without a complaint

05/06/2013

by: Lauren C. Williams

Question: Can an E/M visit be billed prior to or on the same day as a colonoscopy screening if it is just for a screening? If so, where does CMS state that?

Benchmark of the Week: Upper level E/M visits see huge utilization gains over 5 years, 2007-2011

05/06/2013

by: Lauren C. Williams

Even though denial rates for new and established patient E/M services remained stable since 2007 — even dipping slightly in 2011 — the rate at which providers have been billing level 4 and level 5 new and established patient E/Ms has grown tremendously, according to Part B News’ analysis of CMS claims data.

More TCM answers: Patient contact, F2F can be same visit; don’t bill CPO with TCM

04/29/2013

by: Roy Edroso

Part B News has more answers to readers’ questions about the transitional care management (TCM) codes, 99495 and 99496, providers could start billing this year. This week’s batch explains whether one visit can satisfy the patient contact and face-to-face meeting requirements; how to handle a claim rejection based on discharge paperwork; whether you can bill care plan oversight (CPO) with TCM; and whether emergency room visits qualify.

CMS to add fifth RAC for home health, DME, but physicians could see more audits

04/29/2013

by: Karen Long

Physician practices could see more scrutiny from the four recovery auditors (RAC) now that CMS plans to shift some of their workload to another contractor.

CMS tells Part B News that it expects to add a fifth RAC with a national focus on home health and durable medical equipment (DME) claims, leaving the rest of the RACs to split up the states and concentrate on other provider types.

7 ways to jumpstart your ICD-10 prep now that CMS confirms deadline

04/29/2013

by: Roy Edroso

CMS has given the whole industry a big heads-up on ICD-10, and many practices are behind schedule on preparedness. Don’t panic, our experts say — but do grab the best available resources, and get to work fast.

3 tips to prepare to become an ACO plus 5 steps to complete CMS’ application

04/29/2013

by: Karen Long

Practices can start the process May 1 to become accountable care organizations (ACOs) in 2014, but even before that, your practice should take three steps to ensure the ACO’s success.

PT services see high denial rates for electrical stimulation, other techniques

04/29/2013

by: Lauren C. Williams

The following graphs depict claims denial trends for therapy services listed on CMS’ “always therapy” code list that were billed in 2010 and 2011. These codes are eligible for the therapy cap rule, which requires use of the KX modifier (Requirements specified in the medical policy have been met) when therapy services for a single patient exceed $1,900 (PBN 1/14/13).

Note: Claims billed with the KX modifier were not included in the analysis because the modifier became active Jan. 1, 2011, and was not listed in CMS’ claims database. (Visit www.cms.gov/Medicare/Billing/TherapyServices/AnnualTherapyUpdate.html to download the full “always therapy” list. Look for more about the therapy cap in an upcoming issue of Part B News.)

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