Home | News & Analysis
Part B News
Provider denial trends when using modifier 52 by specialty, 2007-2011
02/28/2013
by: Lauren C. Williams
In 2011, claims with modifier 52 appended were denied 45% of the time (PBN 1/7/13). But a closer look at those claims show that nearly a third of the codes billed, which amassed at least 1,000 claims, saw 100% denial rates.
2 tips for proper modifier 52 use
02/28/2013
by: Lauren C. Williams

Don’t let the overall high denial rates keep you from getting paid for incomplete services. Keep these tips in mind when billing modifier 52.

 
OCR to providers: Watch for ‘human frailty’ breaches, encryption issues
02/25/2013
by: Roy Edroso
Two top officers of the main enforcement bureau for HIPAA privacy and security rules addressed the Annual HIPAA Summit in Washington, D.C., on Feb. 19, giving providers some clues as to what their investigators will be looking for in the age of the “mega-rule.” Among their focal points: training, data breaches, encryption and use of protected health information (PHI) in marketing.
 
More waiting for PECOS surrogate program but other small changes speed enrollment
02/25/2013
by: Karen Long
CMS is “a ways off” from getting a surrogate program up and running for the Provider Enrollment, Chain and Ownership System (PECOS).
The program will legalize a now noncompliant but common practice of non-physician staff using the doctor’s username and password to enroll in PECOS.
 
State laws, pay-for-performance making telehealth harder to ignore
02/25/2013
by: Roy Edroso
Telehealth technology can be a worthwhile investment for your practice if you’re involved or expect to be involved in pay-for-performance models. And though Medicare isn’t expected to expand eligibility for telehealth reimbursement anytime soon, your state may require your private insurers to do so.
 
New telehealth pharmacologic management code
02/25/2013
by: Roy Edroso
Psychiatrists and prescribing psychologists can use a new telehealth G-code to join the eight others that debuted last month, CMS announced Feb. 1. CMS added the code G0459 for inpatient telehealth pharmacologic management, including prescription, retroactively effective Jan. 25.
 
HIPAA tips from the Summit co-chair
02/25/2013
by: Roy Edroso
At the HIPAA Summit in Washington, D.C., co-chairman Alan S. Goldberg, adjunct professor of health law at George Mason University, went through a list of HIPAA to-dos worth sharing with our readers:
 
 
Expect fewer psychotherapy codes, new add-on for medication management
02/25/2013
by: Laura Evans and Julia Kyles
Your staff has new billing rules to follow for several psychiatric services this year. CPT 2013 eliminates the majority of the codes, but the deletion of the pharmacological management code (90862) may have the biggest impact.
Provider telehealth billing trends, denial rates with mods. GT and GQ, 2010-2011
02/25/2013
by: Lauren C. Williams
The following graph represents providers’ billing patterns and utilization of telehealth services from 2010 to 2011. Overall, telehealth services are underutilized, with medication management (90862) being the top-billed service followed by psychiatric diagnostic interviews (90801) and level 3 established patient E/Ms (99213).
CMS answers 7 key transitional care management billing questions
02/14/2013
by: Lauren C. Williams and Laura Evans

You’ve been able to bill CMS’ new transitional care management (TCM) codes, 99495-99496, for nearly two months. Make sure your claims get paid right the first time by listing the correct date of service and heeding other unreleased CMS billing guidance from an exclusive Part B News interview with the agency.

 
Prev Next

Login

User Name:
Password:
Forgot password
Welcome to the new Part B News Online. If you are a returning user having trouble logging in, please click here.
Quick Links
Learning Opportunities
See more...
Forum

The Forum is temporarily unavailable.

click icon to expand
Back to top
Privacy Policy
|
Terms of Use
|
© 2026 DecisionHealth, an HCPro Brand