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Losing touch with patients as you grow? Try these high-touch tricks to reconnect

08/27/2018

A study suggests large practices actually underperform small practices in cost of care and hospital readmissions, but you might redress the balance by engaging independent networks, educating your patients and using your imagination.

Nowhere to hide: Proposed rule would kill risk-free path to shared savings

08/27/2018

by: Roy Edroso

A proposed Shared Savings rule pushes risk onto all participants within a few years – and signals more risk in the future for all Medicare providers as well.

Supreme Court nominee likely pro-business, skeptical of government

08/27/2018

by: Angela Childers

With the upcoming vetting of Brett Kavanaugh for the soon-to-be vacant seat of Justice Anthony Kennedy on the U.S. Supreme Court, providers may see a pro-business ally whose past rulings show a skepticism of the power of administrative agencies.

Double-check critical care services reported with modifier 25

08/27/2018

by: Julia Kyles, CPC

Practices that bill for critical care services (99291-99292) should make sure everyone understands the coding rules for these high-value codes, as well as the use of modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) with critical care services. The combination of critical care and modifier 25 is on auditor radar and could trigger denials.

Promoting Interoperability hardship exception application opens; keep receipts

08/20/2018

by: Roy Edroso

The hardship exception application for the merit-based incentive payment system’s (MIPS’) Promoting Interoperability category, which opened Aug. 6, is simple to complete, but make sure you’ve got the goods to justify your case in case CMS decides to audit your claim.

7 tips to overcome E/M coding pitfalls amid increased auditing activity

08/20/2018

by: Richard Scott

While CMS is mulling possible changes to current E/M documentation guidelines, practices must continue to operate under the complex rules of the 1995 and 1997 versions — and under threat of an audit from multiple agencies and potential revenue loss when specific elements are missed or overlooked.

Stay clear of bundles, prove medical necessity for same-day visits

08/20/2018

by: Richard Scott

Question: I’m having a challenge with same-day billing. Here’s my situation: The doctor performs an injection with fluoroscopy at the hospital in the morning and then the patient comes to the office for a follow-up on the same day. The doctor would like to bill both services, but I feel like I’m double-dipping. Can I report both? Any help would be great!

Don’t code for foreign body removal when the foreign body isn’t there

08/20/2018

by: Roy Edroso

Question: A patient who steppad and cut herself on a piece of glass months earlier still complained of pain in the area, though the wound was healed. A CT scan showed increased density in the subcutaneous fat on the plantar aspect. Surgery revealed a large, thick, deep callus extending through the dermis down to the subcutaneous tissue and extensive scar tissue. These were excised but no foreign object was found. We’re using 28192 (Removal of foreign body, foot; deep) but is that correct — seeing as we didn’t actually find a foreign body?

CMS’ E/M pay proposals would tack on millions for many specialists

08/13/2018

by: Richard Scott

As practices absorb the lingering aftershock of CMS’ proposals targeting E/M services and documentation standards, the impact on a group’s bottom line remains a wide-open question. Yet a detailed analysis from Part B News signals that, should the agency’s core pay proposals come to pass, many providers are set to see a significant pay increase.

FY2019 coding guidelines: Changes align with recent Coding Clinic guidance

08/13/2018

by: Megan Batty

Starting Oct. 1, coding guidelines will no longer allow for a connection to be assumed between Takotsubo syndrome (I51.81) and hypertension.

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