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With third rule and Jan. 1 deadline, No Surprises ushers in key billing changes

10/11/2021

The third rule related to the No Surprises Act provides details on independent dispute resolution (IDR) and qualifying payment amount (QPA) policies — and it’s proving unpopular with physician groups. However, it’s unlikely to undergo significantly changes before taking effect Jan. 1, 2022. Prepare your pricing and communications for big changes in this area.

Select correct CPT modifiers for multiple procedures, reduced services

10/11/2021

by: Sarah Gould

When coding with modifiers, it’s vital that you know whether you are coding for the physician or the facility, as some modifiers provide additional information about physician care while others clarify the volume and intensity of hospital resources used to deliver patient care.

Respect patient requests to withhold information from payers

10/11/2021

by: Julia Kyles, CPC

Question: We have an adult patient who is covered by her parents’ insurance. She is scheduled for a service but she said she’ll pay for it herself and we can’t bill insurance. According to the patient, this comes from HIPAA but we aren’t familiar with that part of the rule. Is there any official guidance about it?

Can I use modifier 78 if doctor leaves and returns? Only if patient goes too

10/11/2021

by: Roy Edroso

Question: Our M.D. performed surgery on a patient, finished the procedure and left the OR. The patient decompensated. Immediately, the M.D. was brought back into the OR to fix the problem, which he did. The patient did not leave the OR between the two procedures. Is this a case for modifier 78 (Unplanned return to the operating room by the same physician fol lowing initial procedure for a related procedure during the postoperative period)?

Pino appointment brings cyber, anti-discrimination focus to OCR

10/11/2021

by: Roy Edroso

The appointment of Lisa J. Pino to head the HHS Office for Civil Rights (OCR) brings cybersecurity expertise to the office as well as a record of advocacy for minority and gender identity rights.

Providers are using modifier 78 less, and getting fewer denials

10/11/2021

by: Roy Edroso

It looks as if providers have cut way back on their use of modifier 78 (Unplanned return to the operating room by the same physician fol-lowing initial procedure for a related procedure during the postoperative period). In 2019, the modifier appeared on a mere 94,255 claims, a major drop from 2015, when it was claimed more than 531,000 times.

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