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Follow 6 rules when a provider requests patient records

02/18/2019

There are fewer hoops to jump through when another provider requests a practice’s patient records than when an attorney requests them. HIPAA’s privacy rule permits the sharing of patient protected health information (PHI) directly between providers for treatment, payment or operations, without the need to obtain a patient’s written permission.

To avoid denials, don’t forget the national drug code on vaccine claims

02/18/2019

by: Richard Scott

Question: I started receiving denials on some of my flu vaccine claims, and my Medicare administrative contractor (MAC) indicated that it couldn’t price the vaccine because I was missing the “NDC.” What is this, and how do I know when to use it?

AMA survey: Prior authorization bad for patients as well as providers, practices

02/18/2019

by: Roy Edroso

You already know that the prior authorization required on many procedures, services and drugs by private and Medicare Advantage plans can be an enormous hassle for your providers and staff. But the most alarming finding in the AMA’s latest physician poll on prior authorizations is that more than a quarter of respondents reported serious patient medical issues attributable to resulting care delays.

Have policy, procedures, provider checks to protect from vendor kickback scandals

02/11/2019

by: Roy Edroso

A sensational case involving kickbacks to doctors from a pharmaceutical company serves as a warning: Without effective policy and procedures for providers’ financial relationships with vendors, you risk serious damage to your practice.

Medicare Advantage program frees up copays, telehealth for eligible encounters

02/11/2019

by: Richard Scott

Prepare for greater levels of experimentation in plan design, copays and eligible service offerings among your Medicare Advantage payers as CMS opens up its hallmark value-based program to the nation.

What’s a ‘minimum’ assist? For modifier 81, a late entry

02/11/2019

by: Roy Edroso

Question: One of our surgeons recently performed a procedure in which she was assisted by a colleague – but only just a little. We’re debating whether this requires the use of modifier 81 (Minimum assistant surgery) rather than 80 (Assistant surgery).

Focus on 3 areas to get your annual depression screening claims through

02/11/2019

by: Richard Scott

Question: My practice has started to report more depression-screening services, but we’re still seeing a decent share of denials. My doctors want to make sure the claims are getting paid. What might I be doing wrong?

Briefs: Physician owes $1 million for fraud and PA faces jail time for kickbacks

02/11/2019

by: Marla Durben Hirsch

In this compliance-themed round-up, you'll get the details of a pain management doctor who must pay more than $1 million to resolve allegations of fraud and a physician assistant who faces jail time for accepting kickbacks.

Denial rates favor NPP surgical assistants over physicians for common procedures

02/11/2019

by: Richard Scott

When it comes to documenting a helping hand during common surgical procedures, practices tend to turn to modifier AS (Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery) rather than a range of CPT assistant-surgical modifiers — and find success in doing so.

Watch out for CMS’ claims reviews on high-price radiation oncology services

02/04/2019

by: Richard Scott

With a batch of Comparative Billing Reports (CBR) hitting providers’ inboxes in early 2019, CMS is putting practices on notice: You should be careful when reporting intensity-modulated radiation therapy (IMRT) services that may be part of a bundled package or risk further audit activity.

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