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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).
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.
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.
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.
You’re probably elbows-deep in your ICD-10 transition prep as we speak, but take a moment to review a few points about the transition that experts say may be eluding even the most conscientious practice managers: 
Don’t count on the advance payment option. CMS brought up in its recent FAQs the possibility of advance payment on claims held up by ICD-10-related snafus. “If the Part B Medicare administrative contractors (MACs) are unable to process claims within established time limits because of administrative problems, such as contractor system malfunction or implementation problems, an advance payment may be available,” CMS said in FAQ No. 18.  “Physicians would be allowed to submit a single advance payment request for multiple claims for an eligible period of time.”
But advance payments will be available only if Medicare’s systems fail, points out Michelle Cavanaugh, an AHIMA-approved ICD-10 trainer and RCM manager for electronic health record (EHR) vendor Kareo in Irvin, Calif. “The prepayment request will not be available for the provider who is not prepared or whose software vendors are not ready to send ICD-10 claims. This is not a safety net.”
Don’t get caught up in wishful thinking. Advance payment remains what it has always been – a remedy for CMS’ screw-ups, not yours (PBN 6/16/08).
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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.

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.

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.

Question: I’ve heard that we can’t charge a patient more than $6.50 to provide a copy of medical records on a patient request. Is that true?


Start preparing now for HIPAA and ICD-10 transitions if you haven't done so already, top CMS officials reminded physician practices on June 15. These transitions - to the HIPAA 5010 standard for electronic claims transfers in 2012 and to the ICD-10 diagnosis code set in 2013 - seem far away, but you need to take advantage of the lead time to avoid major A/R disruptions and ensure your claims will get paid properly on day one.

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