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Exceptional performance MIPS bonus may not be worth chasing – but high scores are

02/04/2019

Merit-based Incentive Payment System (MIPS) bonuses for 2017 were lower than many participants expected — with the top “exceptional performance” bonus at a disappointing 1.88% of payments. But experts say your positive-score adjustment for 2019 should be better than that; and you have other reasons to go for high scores.

As Medicare revenue drops and costs rise, practices face hard choices

02/04/2019

by: Roy Edroso

If you perceive your Medicare revenue is going down rather than up, and by alarming levels, you’re not alone: a survey of practice managers commissioned by the Medical Group Management Association (MGMA) finds two-thirds of respondents reporting that these revenues are not only dropping but failing to keep up with the cost of keeping the practice open.

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 future payments.

Look to code description to determine correct units for problematic injections

02/04/2019

by: Richard Scott

Fine tune your pain-injection coding by reporting the correct level of units for an error-prone code and you’ll clean up your denials in no time. As it stands, many practices are incorrectly reporting HCPCS code J7322 (Hyaluronan or derivative, hymovis, for intra-articular injection, 1 mg) by missing on the units billed.

Modifier denial leap may have been a clue on investigated code

02/04/2019

by: Roy Edroso

Sometimes you can tell when CMS has its eye on a code from a sudden change in its denial rate — but only if you’re looking carefully, because it may just be happening under certain circumstances.

Patient records subpoenaed? Be careful how you answer or lose in court

01/28/2019

by: Roy Edroso

If a lawyer hits you with a subpoena for a patient’s protected health information (PHI), don’t panic — or you may not only violate the patient’s privacy rights under HIPAA, but also be subject to civil action under state law.

Perform hepatitis B screening at initial prenatal visit to secure optimal outcomes

01/28/2019

by: Richard Scott

Shore up the health of expectant mothers and their offspring by standardizing a process to perform hepatitis B screening during an initial prenatal visit and you’ll cut the risk of long-term disease while adding a few dollars to your accounts.

Properly document imaging even when it’s bundled into procedure code

01/28/2019

by: Laura Evans, CPC

Pay close attention to new documentation and coding guidance for radiological imaging in the 2019 CPT manual.

Be careful about Part D-covered vaccines to avoid payment issues

01/28/2019

by: Richard Scott

Question: I’m confused by vaccine coverage when some of the shots aren’t covered by my payer. For instance, I’m getting denials on tetanus vaccines. How do I know which ones are covered? And what should I do when a patient comes in needing a shot that my practice may not get paid for?

How to report, document body mass index (BMI) in ICD-10-CM

01/28/2019

by: Shannon McCall, RHIA, CCS,CCS-P, CPC, CEMC, CRC, CCDS, HCS-D

Question: Can an ICD-10-CM body mass index (BMI) code be used as a standalone code? If not, what documentation should we look for to justify the use of a BMI code?

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