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Duplicate claim modifiers save some payments — but let down many others

02/05/2018

Don’t count on three modifiers to automatically redeem otherwise duplicate claims: The most recent data show the overall denial rate on codes claimed with the modifiers went into double digits, with some individual codes performing especially badly.

Proposed conscience protection rule would require compliance shift, careful hiring

02/01/2018

by: Roy Edroso

A proposed rule seeks to strengthen conscience protections for providers who don’t wish to perform, refer for or provide information on procedures that offend their religious or moral sensibilities. If finalized, it will require you to expand your compliance programs — and possibly rethink your personnel decisions.

Payments for 99214 climb as claims hit highs, while other E/M codes fall

01/29/2018

by: Richard Scott

You may want to light a few candles to celebrate your recent success: As practices nationwide continue to pivot to higher-level E/M codes, they have faced little resistance and are returning record payments for some oft-used codes.

In #MeToo era, tighten up sexual harassment training and policies to avoid big settlements

01/29/2018

by: Roy Edroso

In an era of heightened awareness, it’s more important than ever to make sure your sexual harassment policy is clear, effective and followed.

CMS will hold claims over therapy cap exception; CHIP, Azar approved

01/29/2018

by: Roy Edroso

After Congressional inaction allowed the Medicare therapy cap exception to expire as of Jan. 1, CMS tells Part B News that it will hold all Medicare claims with the KX modifier “for a short period of time” to make billing those claims easier if, as hoped, Congress reinstates the exception retroactively.

When your PA indicates surgery, stick to global-period timelines to code correctly

01/29/2018

by: Richard Scott

Question: We have a physician assistant (PA) who sees a patient under the doctor’s supervision for the patient’s first few visits. During those visits, surgery is indicated and the patient then sees the physician to discuss and consent to surgery. Can the physician bill for this visit or is it considered part of the pre-op package? Sometimes surgery is already scheduled before the patient sees the physician. When the surgery is already scheduled but it is the physician’s first time seeing the patient, can this visit be billed?

NPPs, other lower-billing specialists see 99214 payments on the rise

01/29/2018

by: Richard Scott

The steady increase of 99214 encounters, which topped 103.6 million visits in 2016, was largely the product of non-physician practitioners (NPPs) and other specialty groups — including hematologists/oncologists, neurologists and urologists — filing more claims, according to a review of historical Medicare claims data.

As value-based wave breaks, 4 options for practices still stuck in fee-for-service

01/22/2018

by: Roy Edroso

Risk-averse practices, heads up: If you haven’t started your transition away from fee for service into value-based reimbursement, look at easy upside-only models to get in the swim or seek shelter in a larger organization.

Discover cost measure formulas and prepare for 2018 scoring impact

01/22/2018

by: Richard Scott

Clear up confusion about the two cost measures impacting your 2018 merit-based incentive payment system (MIPS) performance year by knowing which metrics CMS will use to assess Medicare spending and how many patients may be attributed to your practice.

HHS details new settlement option for providers awaiting hearings at ALJ level

01/22/2018

by: Josh Poltilove

Beginning Feb. 5, home health agencies and other providers with a low volume of pending appeals at the administrative law judge (ALJ) level will have a new option for resolution while avoiding the judges’ massive backlog of appeals.

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