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Providers, payers speed up pursuit of addressing social determinants of health

08/05/2019

As health care continues its push away from fee for service, your payers are accelerating ways to address patients’ health concerns that traditionally have fallen outside of the physician-provider relationship. From coding updates to evolving plan design, much of the focus is on one thing: social determinants of health.

CMS backtracks on E/M pay changes, pivots to documentation overhaul

08/05/2019

by: Part B News staff

You can dismiss a lot of the controversial updates to office E/M services, such as blended payment rates, that drew an outcry from the medical community. But you’re now on the clock to get in line with far-reaching documentation changes for these oft-used services, according to the 2020 proposed Medicare physician fee schedule released July 29.

Even FFS practices can gain from top ACO strategies on care coordination, AWVs

08/05/2019

by: Roy Edroso

If your practice wants to prepare for a transition to value-based care, experts advise following the successful strategies laid out by top accountable care organizations (ACOs) in a new report.

Specialty impact of PFS is pretty mild — but pity the eye doctors

08/05/2019

by: Roy Edroso

Readers of the 2020 proposed Medicare physician fee schedule (PFS) are probably trying to figure out how the new E/M rules will affect their reimbursement. But CMS has already looked at last year's volume and mix of services provided by each provider specialty and assessed the effect of the proposed fee schedule on them.

Avoid diagnostic errors to cut back on patient harm, costly malpractice

07/29/2019

by: Richard Scott

Delaying or making an error in a patient’s diagnosis can prove disastrous to the patient’s health and put your practice at risk for high-dollar malpractice claims. But staying extra alert to high-risk conditions, such as cancer, and closing the feedback loop can help you avoid costly outcomes.

Prep with training, forms for when you ‘go the limit’ on suicidal patients

07/29/2019

by: Roy Edroso

Prepare providers and staff for suicidal patients with a policy that backs them up when it becomes necessary to transfer these patients to appropriate psychiatric care — even against the patient’s wishes.

Crack codes at your own peril: Beware increased scrutiny of unbundled codes

07/29/2019

by: Marla Durben Hirsch

Review your claims to ensure that you’re not making bundling errors. The government has ramped up its review and enforcement of this problem.

Providers leaving notes unsigned? Let them attest — or make them work weekends

07/29/2019

by: Roy Edroso

Question: Some of my doctors are signing their charts for claims very late — weeks, even months late. Can I submit these claims? If a chart is signed too long after the encounter, is it invalidated?

Pivot to E/M codes when ear-wax removal fails to get the job done

07/29/2019

by: Richard Scott

Question: I have a common scenario that I encounter that I don’t know how to report. If my provider performs a technique to irrigate impacted cerumen in the clinic, but the removal of ear wax is not actually achieved, can I still report CPT code 69209 (Removal impacted cerumen using irrigation/lavage, unilateral)?

Blocked: Cerumen-removal revenue falls despite gains in 69209 claims

07/29/2019

by: Richard Scott

Practices are seeing a downward trend in revenue for cerumen-removal services even as the total number of claims was buoyed in recent years with the arrival of CPT code 69209 (Removal impacted cerumen using irrigation/lavage, unilateral).

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