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Details are key in negotiating better rates with payers

08/14/2017

Negotiating reimbursement rates with payers can be an uphill battle for small practices that have little leverage with large insurers, but those practices can improve their chances and show that they merit better payments by compiling detailed data on the things they do better than their competitors.

E/M codes with modifier 25 face drastic pay reduction for some practices

08/07/2017

by: Richard Scott

Watch your E/M claims appended with modifier 25 (Significant, separately identifiable E/M service) if your patients have insurance with a Medicare Advantage carrier that operates in 25 states – starting Aug. 1, payments for those E/M claims will get sliced in half.

NPPs are a proven productivity boost, but assess your practice before hiring

08/07/2017

by: Roy Edroso

A new survey supplies yet more evidence that hiring non-physician practitioners (NPPs) can increase your practice revenue – but check your practice for opportunities before making the decision.

Small practice? Medicare diabetes prevention program might not be for you

08/07/2017

by: Roy Edroso

Details on the Medicare version of the diabetes prevention program (MDPP), modified in the proposed physician fee schedule that came out last month and set to kick off in 2018, are still a little sketchy. But some observers already foresee problems for smaller suppliers — and even for physician practices that want to add it as a line of service.

CMS publishes advance copy of new interpretive guidelines to meet EM CoPs

08/07/2017

by: AJ Plunkett

No more excuses for getting ready to meet the new emergency preparedness Conditions of Participation (CoPs). CMS has published an advance copy of the interpretive guidelines for its surveyors and has provided a handy spreadsheet you can customize to show exactly what tags your organization will need to meet by Nov. 15.

Payments reach billions for medically necessary modifier-25 services

08/07/2017

by: Richard Scott

Payments for E/M services appended with modifier 25 (Significant, separately identifiable E/M service) topped $2.5 billion in 2015, according to the latest available Medicare claims data.

AMA pushes for prior authorization changes

08/07/2017

The AMA has unveiled a new position statement and a list of 21 suggested guidelines for how prior authorization (PA) protocols should be changed, a statement that’s gathered support from more than 100 organizations.

Ortho, other specialties can bill CCM but watch the coding fine print

07/31/2017

by: Richard Scott

Question: We've had a request from one of our physicians to report chronic care management (CCM) code 99490 using osteoarthritis as one of the qualifying factors. Has anyone used this in the orthopedic setting? The CCM guidelines mention three conditions that must be met to bill, and I’m wondering if the patient has to meet all three of the criteria and not just some or part of it.

Set your clock to report proposed prolonged preventive service codes

07/31/2017

by: Richard Scott

Get ready to add two new codes to your mix in 2018 and you’ll gain a revenue opportunity when you see patients for a prolonged period during a visit involving one of 19 Medicare-covered preventive services.

You can stop patients recording their visits — but do you want to?

07/31/2017

by: Roy Edroso

Depending on your state laws, you may be able to prevent patients from recording their encounters with your providers — but you might prefer to use the opportunity to educate and build trust with them instead.

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