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Despite uncertainty, practices accelerate into the wide-open world of value-based care

05/07/2018

The journey was not easy, nor is it complete, but the rewards are beginning to pile up for AMITA Health’s accountable care organization (ACO), a network in suburban Chicago that offers a striking example of the risk-and-reward environment underpinning health care’s seemingly unstoppable shift to value-based care.

CMS warns on wet AMD, cataract surgery billing; watch Lucentis shots, modifiers

05/07/2018

by: Roy Edroso

A note dropped in a recent MLN Connects suggests CMS is keeping an eye on wet age-related macular degeneration (wet AMD) or cataracts issues the Office of Inspector General (OIG) brought to its attention in 2014 and 2015.

New tax law limits deductibility of paid overpayments, settlements

05/07/2018

by: Marla Durben Hirsch

Paying a settlement or overpayment is never pleasant. But the new tax law has made it more onerous by greatly reducing the ability of providers to deduct the payment on their tax returns. To make matters worse, the Internal Revenue Service (IRS) hasn’t released much information on the new rules.

No sugarcoating it: Improve diabetes screening compliance to get claims right

05/07/2018

by: Richard Scott

Don’t veer from the frequency guidelines for hemoglobin A1c testing unless you can prove medical necessity and append the correct modifier if you’re performing the test in your office — otherwise you may be one of the many to see a denial on code 83036 (Hemoglobin; glycosylated [A1C]).

Despite warning, cataract claims steady since 2014 — but not with modifier 55

05/07/2018

by: Roy Edroso

Watch out for cataract surgery and other ophthalmological claims with modifier 55 (Postoperative management only). The modifier draws special contractor scrutiny for the post-op provider.

Neoplasms, eyes, external causes dominate proposed new ICD-10-CM codes

04/30/2018

by: DecisionHealth Staff

Providers could have 435 code changes to deal with starting Oct. 1 with 247 new codes, 139 revised codes and 49 invalidated codes, according to the hospital inpatient prospective payment system (IPPS) proposed rule released April 24.

As telehealth payments climb, OIG finds widespread billing errors

04/30/2018

by: Richard Scott

Practices that are ramping up their telehealth services should heed a recent OIG audit that found common errors on telehealth claims that may have – but maybe shouldn’t have – cleared CMS’ payment systems.

Set policy to handle impaired providers with process to assess, test, refer

04/30/2018

by: Roy Edroso

Have a process to route providers with drug and alcohol problems to appropriate treatment — being respectful of their rights while protective of your patients.

Resident can perform encounter solo, but teaching physician must confirm findings

04/30/2018

by: Richard Scott

Question: I have a question concerning residents and teaching physicians: If a resident sees a patient on Dec. 12 and the attending uses the date of service as Dec. 15, is this appropriate? The CMS guidelines for teaching physicians state that the physician must be “present” for the key components. I am hoping you can shed some light on this as I have reached out to CMS via email with no response.

Telehealth-based E/M encounters, psychotherapy services gain dollars

04/30/2018

by: Richard Scott

Providers are increasingly tapping into telehealth to conduct patient encounters, using the video-based technology to perform E/M services and psychiatric visits, according to a review of the latest Medicare claims data.

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