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Don’t skip billing the primary procedure to avoid CCI, maximize money

01/14/2019

Question: The orthopedic surgeon performed a total shoulder arthroplasty to treat a fracture (code 23472) and in the same encounter, did an open treatment of a proximal humeral fracture (23615) and a biceps tenodesis (23430). Yet codes 23615 and 23430 are bundled as components of 23472 by National Correct Coding Initiative (CCI) edits.This is leading some at our practice to wonder whether it would be better to just submit the fracture reduction and tenodesis codes and skip billing for the arthrodesis. What is the correct response?

Make sure contract demands receipts on changes — or risk unhappy surprises

01/14/2019

by: Roy Edroso

Question: We have a commercial payer that dropped a sudden rate change on us with no notice; we only found out via a paid claim. The payer says it notified us of the change 30 days before the date by which we had to approve it, but we never received any notice at all. How can the payer expect to get away with this?

Take stock of most-reported codes under personal supervision rules

01/14/2019

by: Richard Scott

In 2019, you’ll find 205 services and procedures that require personal physician supervision, the most rigorous level of oversight for mid-level providers, according to a Part B News analysis of the 2019 final Medicare physician fee schedule.

2018 Quality Payment Program (QPP) data submission open through April 2.

01/14/2019

by: Roy Edroso

CMS opened the 2018 Data Submission Period for the QPP on Jan. 2, and it will run through April 2, 2019. During this period you can submit your reporting data and also make corrections to your submissions. After April 2 neither submission nor corrections will be accepted.

Prediction: The E/M documentation revisions will have little meaningful impact

01/07/2019

by: Richard Scott

Part B News editors surveyed readers and interviewed experts to come up with nine predictions of what will affect physician practices in 2019. Below is a sneak peek of the predictions; full predictions will appear in the Jan. 7 issue of Part B News.

Prediction: The E/M documentation revisions will have little meaningful impact. Heading into 2019, medical practices will find a few tweaks to the sanctioned documentation process for office visits. For instance, a mid-level practitioner can record a patient’s history or chief complaint, and the physician or non-physician practitioner (NPP) won’t have to re-enter the information in the medical record

E/M doc changes, ‘remote’ consult services will grow slowly in 2019

01/07/2019

by: Richard Scott and Roy Edroso

Part B News editors surveyed readers and interviewed experts to come up with nine predictions of what will affect physician practices in 2019.

PBN’s 2018 predictions: Some came true, some did not, some a mixed bag

01/07/2019

by: Richard Scott and Roy Edroso

Part B News staff holds ourselves accountable for our predictions every year by sharing with our readers how we fared with last year’s predictions. Here are 2018’s results.

CCM use rises steeply, fueled by primary care adoption and value-based care

01/07/2019

by: Roy Edroso

Part B News predicts in our lead story that chronic care management (CCM) utilization will reach 5 million claims in 2019, and data from the first three years in which Medicare paid for the service (2015-2017) suggests we’re on track — and that primary care providers are driving the increase.

For QPP 2020, fairer MIPS cost scoring emerges amid array of smaller changes

01/01/2019

by: Roy Edroso

2019 Correct Coding Initiative Policy Manual

01/01/2019

by: Correct Coding Initiative

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