Part B News | Search

Sort By:

MAC demand: Medical necessity controls coverage of preop E/M visits

4/15/2024

Pay close attention to medical necessity when a provider schedules a patient for a preoperative visit and you code the E/M visit. Even though a hospital may require preoperative clearance for surgery patients, Medicare controls whether it will pay for the visits. Surgeons may have more leeway than specialists when they perform certain preoperative visits, but they must still support medical necessity to protect their patients from an unexpected bill and the practice from unexpected denials.

FFS Medicare fades, as Medicare Advantage surges in enrollment

4/15/2024

The most recent CMS numbers show Medicare Advantage enrollment continuing to outpace traditional Medicare, and some measures suggest Part C has already beat fee-for-service Medicare to become the majority Medicare insurer.

HIPAA Q&A: Watch cybersecurity frameworks, health apps, texts

4/15/2024

In this week’s issue, Rebecca Herold, CDPSE, FIP, CISSP, CIPM, CIPP/US, CIPT, CISM, CISA, FLMI, HIPAA security and privacy training expert and CEO of Privacy & Security Brainiacs SaaS services, answers a range of questions about cybersecurity efforts, HIPAA compliance in health apps and much more.

Medicare Advantage rate rise miffs payers; blowback should be minor

4/15/2024

On April 2, CMS approved a final average 3.7% increase on the Medicare Advantage base rate for 2025, an adjustment Medicare Advantage organizations (MAO) and the insurers who run them found disappointing. While some advocates have suggested these plans will pull back on benefits, large changes are not expected in the short run.

3 last-minute tips to prepare your practice for the ICD-10 transition

10/5/2015

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).

Click here to read the full story.

CMS update: Code caregiver training services based on number of patients

4/8/2024

Update your staff with the latest information about caregiver training services (CTS) from CMS. A set of frequently asked questions on health-related social needs answers some lingering questions about the CTS for behavior management/modification (96202-96203) and functional performance (97550-97552).

Get your practice ready for HIPAA 5010 and ICD-10 transitions today

6/24/2010

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.

Know full descriptors for caregiver training services

4/8/2024

Use the latest guidance from CMS to correctly code caregiver training services. Here are the full descriptors that shed light on your coding and billing designs.

Time out: Encourage compliance with a stay of enrollment review

4/8/2024

Use Medicare’s new “stay of enrollment” rule to warn your staff: CMS’ easier option for non-compliance is still hard on the practice’s finances.

CMS’ loans for Change Healthcare hack may not be worth it: Expert

4/8/2024

Both CMS and UnitedHealth Group (UHG) have offered cash loans to practices impacted by the recent Change Healthcare hack. But an industry expert cautions that the CMS package might not be your best course of action.

1 2 3 4 5 ...

Login

User Name:
Password:
Remember me Forgot password
Welcome to the new Part B News Online. If you are a returning user having trouble logging in, please click here.