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Modifier 25 used on non-E/M codes gets surprisingly forgiving denial rates

07/16/2018

Modifier 25 (Significant, separately identifiable E/M service) is, as the name implies, supposed to be used with E/M codes to distinguish the work done on those codes from other services that would ordinarily be bundled with them. But some non-E/M codes were logged with 25 on claims, and a few had surprisingly low denial rates.

MedPAC: Give E/M services a big raise and cut procedure, surgical payments

07/09/2018

by: Richard Scott

Practices that report a lot of outpatient E/M codes would have a big reason to smile if CMS heeds new advice from the Medicare Payment Advisory Commission (MedPAC). In its latest Report to Congress, the commission calls for a significant payment increase for office-based E/M services — suggesting a 30% pay boost is not out of line.

In-house or outboard, check these 7 CCM steps to see whether you can do it

07/09/2018

by: Roy Edroso

Many primary care providers balk at doing chronic care management (CCM) because of perceived difficulties, a recent study notes, but it can be both clinically and financially worth the effort to assess of your ability to take it on or to farm the job out.

Don’t let IV bags with protected health information trigger costly penalties

07/09/2018

by: Marla Durben Hirsch

Secure recycling or other waste bins used to dispose of materials with any patient protected health information (PHI) — including medication bottles and intravenous bags — because HHS’ inspectors are on the lookout for HIPAA disposal violations.

Coding a vaper who wants to quit: Don’t confuse vaping with smoking

07/09/2018

by: Roy Edroso

Question: How do I bill if a patient comes in and asks for help quitting e-cigarettes -- that is, vaping? The patient does not smoke regular cigarettes or any other traditional tobacco products; in fact, he says vaping helped him quit cigarettes.

07/09/2018

by: Richard Scott

Family practice and internal medicine providers would be big winners under a revamped E/M payment scheme recommended by the Medicare Payment Advisory Commission (MedPAC).

From the Part B News blog

07/09/2018

Take note of the news that happens between Part B News issues by checking out the free Part B News blog at https://pbn.decisionhealth.com/Blogs/default.aspx. Here’s a sampling from this week.

As practice laws loosen, nurse practitioner wave rolls across the U.S.

07/02/2018

by: Richard Scott

By nearly any metric, these appear to be boom times for nurse practitioners: Their ranks are growing, salaries are up and job searches are through the roof.

7 ways to use MIPS data and scores to change your 2018 success strategy

07/02/2018

by: Roy Edroso

Data from your 2017 performance in the merit-based incentive payment system (MIPS) is now available and more is on the way. Use the information to improve your performance and your score in 2018.

New CMS request for information suggests changes coming to Stark Law

07/02/2018

by: Roy Edroso

A request for information (RFI) from CMS asks stakeholders about enforcement of the physician self-referral law in certain delivery models — and appears to be part of a trend toward Stark reform in the agency.

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