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Stick to the same DOS when adding up non-face-to-face prolonged care

04/24/2017

Question: When using the newly covered non-face-to-face prolonged service codes (99358, 99359), can you bill them with time that has been accumulated over several dates of service? I’m asking because this seems very conceivable from a clinical perspective.

Lab-code denial rates may augur increased scrutiny from auditors

04/24/2017

by: Richard Scott

You’ll find sky-high improper payment rates for several groupings of lab codes spanning glucose testing, urinalysis, blood counts and others, according to CMS data from the 2016 Improper Payments Report.

Outsourcing work now a norm for physician practices

04/21/2017

The rapid pace of change in healthcare has made it difficult for many practices to keep up with administrative tasks related to billing, claims, EHRs, and quality reporting—prompting many to outsource jobs to third-party vendors. And while most practices try to avoid the expense of farming work out, the complexity of some tasks makes it more efficient and cost-effective to hire an outside vendor rather than risk overwhelming their own employees.

It’s not something that every practice is doing, but it’s becoming more common in an era where burnout rates among physicians are reaching all-time highs, driven in large part by the demands of nonclinical work.

Review 9 rules for ABNs as you prepare to use the renewed form

04/17/2017

by: Julia Kyles

Get ready to switch to the new advance beneficiary notice of noncoverage (ABN), and use the new form as an opportunity to go over the ABCs of ABNs with administrative and clinical staff.

Take note of wound-therapy billing changes after hyperbaric oxygen edit

04/17/2017

by: Richard Scott

Watch your Medicare administrative contractor (MAC) for instructions about how to bill the topical application of oxygen when treating chronic wounds after Medicare revised its national coverage determination (NCD) on hyperbaric oxygen therapy.

Inertia grips health reform efforts; new legislation seeks telehealth expansion

04/17/2017

by: Richard Scott

Following the repeal-and-replace plan that didn’t muster a vote, reports circulated that Republican lawmakers were seeking to resuscitate the American Health Care Act (AHCA) or a revised version of the bill.

Protect yourself as FCA changes pit employee vs. employee

04/17/2017

by: Roy Edroso

Experts recently warned about the increasing odds that False Claims Act (FCA) charges, with the threat of conviction and imprisonment, will be brought against providers and other personnel who previously might expected just fines and takebacks. In this interview, an author of a new book about health care and the FCA talks about what practices should know.

Tighten medical record amendments to survive CERT auditor scrutiny

04/17/2017

by: Roy Edroso

Watch for simple errors such as proper signatures and dates when providers amend their medical records, as a Medicare administrative contractor (MAC) put out word that auditors are catching mistakes.

Many commercial payers — but not all — cover TCM services; check first

04/17/2017

by: Richard Scott

Question: Has anyone seen any information regarding commercial payers and reimbursement for transitional care management (TCM) services? I thought I saw an article stating that these codes would now be reimbursed by commercial payers, but I am unable to confirm this information. Please help.

Primary care highest billers of hyperbaric treatment code – but denial rates stiff

04/17/2017

by: Roy Edroso

Medicare allows hyperbaric oxygen therapy for conditions ranging from cyanide poisoning to necrotizing fasciitis to decompression illness. But a remarkable number of the Medicare claims for 99183 (Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session) were supplied under primary care in 2015, according to the most recent Medicare claims data. And for providers of any kind, the denial rates weren’t so hot.

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