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When you challenge the feds on HIPAA, plan for defeat

12/16/2019

A large HIPAA breach settlement after a hospital system’s failure to follow the feds’ suggested solution is a reminder that when it comes to enforcement, the government is holding all the cards.

CMS reacts to opioid crisis with new codes for OUD treatment, bundled payments

12/16/2019

by: Jim Dresbach

Be on the lookout for three new codes related to opioid treatment and telehealth services that you can add to your repertoire starting Jan. 1, 2020, compliments of the final 2020 Medicare physician fee schedule.

Pinpoint signs, symptoms when coding for rare diseases under ICD-10-CM

12/16/2019

by: James Dresbach

Make sure your keystroke combinations for rare disease coding do not collect dust as an out-of-the-ordinary ailment could come across your path at any time. Keep in mind, finding the best ICD-10-CM code for a patient who has a rare disease can be a challenge.

Experts see little impact of planned CPT code 99201 deletion set for 2021

12/16/2019

by: James Dresbach

Beginning in 2021, you will have one less CPT code to tangle your billing cycles. The AMA plans to officially delete 99201 from the E/M code set that year, whittling down available office visit codes for new patients to four.

If secondary provider is out of network, so is their charge — but check state law first

12/16/2019

by: Roy Edroso

Question: One of our doctors assisted at surgery and found out later that, unlike the primary surgeon, he’s not credentialed with the payer under whose plan the patient is insured. Given that he’s not the billing provider, how will he be paid?

Multiple specialties zapped by 99201 denials as claims, revenue plummet

12/16/2019

by: James Dresbach

Nurse practitioners, orthopedic surgeons, general surgeons and family practice providers have all faced significant hurdles with their 99201 claims, with denial rates ranging from 10% to 22% in 2018, the latest year of available Medicare claims data. But no specialty matched chiropractic’s dismal return — a 100% denial rate on nearly 93,000 services, with a loss of $5 million.

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