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Avoid double dipping on venipuncture with specific lab services, watchdog warns

09/26/2019

Don’t get lax on how frequently you report venipuncture code 36415 (Collection of venous blood by venipuncture) or you may elicit auditing activity on a service that is grossly overreported under the Part B fee schedule.

Last call: Get ready as new Medicare cards, MBIs become mandatory on Jan. 1

09/23/2019

by: Roy Edroso

Mark your calendar: The end of the Medicare card and Medicare beneficiary identifier (MBI) transition period occurs on Dec. 31 – after which the new cards and numbers are de rigueur. Review the essentials and make sure you’re ready for the cut-off.

Take AUC testing year to see how well your reporting works — and how well docs take it

09/16/2019

by: Roy Edroso

The appropriate use criteria (AUC) “educational” year is soon to arrive, and it would behoove providers involved with advanced imaging to get in the swim before the results are made to count — which may require you to seek prior authorization for the affected tests.

Time is of the essence: Decipher how to use time-based E/M documentation standards

09/16/2019

by: Nancy M. Enos, FACMPE, CPC-I, CPMA, CEMC, CPC emeritus

In an ongoing effort to revise the documentation guidelines for E/M codes, CMS has proposed a new policy that includes elimination of history and physical exam as elements for code selection, allowing providers to choose whether their documentation is based on medical decision-making (MDM) or time (PBN 8/12/19).

Get ready to report even minor affiliations or risk your enrollment under new rule

09/16/2019

by: Roy Edroso

A sweeping new Medicare enrollment final rule with comment period will eventually require all providers and suppliers to report even modest relationships with other entities whose debts, exclusions, revocations and suspensions may affect you: The rule would allow providers and suppliers to be kicked out if HHS thinks even this secondhand relationship “poses an undue risk of fraud, waste or abuse.”

How to report E/M office codes when the physician is new but the patient is not

09/16/2019

by: Jim Dresbach

Question: We have a new physician that has recently joined our surgical group. Some patients from her previous practice have elected to follow her to our practice. Are these patients considered new or established? The patients are new to our practice and tax ID number; however, they are not new to the physician who is providing care to them.

Quarterly CCI update bundles numerous orthopedic procedures with allograft services

09/16/2019

by: Richard Scott with additional reporting by Roy Edroso

Alert your billing staff to several dozen code bundles that will restrict a range of same-day services, including some allograft procedures, when the latest Correct Coding Initiative (CCI) edits take effect Oct. 1.

Call for speakers: 2020 National Provider Enrollment Forum

09/10/2019

by: DecisionHealth staff

DecisionHealth, the publisher of Part B News, is currently seeking speakers to present at the 2020 National Provider Enrollment Forum, to be held April 19-22 in New Orleans.

As MIPS, practice hassles get harder, pay-for-performance gets more attractive

09/09/2019

by: Roy Edroso

Discouraging bonuses and ever-increasing requirements under the Merit-based Incentive Payment System (MIPS), along with other hassles of modern fee-for-service life, may be driving some providers out of business — or into new payment models, where CMS would prefer to see them.

2021 payment preview: Charges up 16% for some specialties, down 10% for others

09/09/2019

by: Richard Scott

The major modifications that CMS has proposed for oft-reported E/M office codes 99202-99215 would bring disruption to your documentation standards – but not only that. Depending on your specialty, the changes could substantially move the needle on your revenue stream.

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