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Medically unlikely edits, CCI v22.3 scorecard

09/26/2016

Changes effective Oct. 1.

Expect more scrutiny of deals between physicians, home health agencies

09/26/2016

Revisit agreements your practice has with home health agencies in light of the HHS Office of Inspector General’s (OIG’s) new alert about improper arrangements and conduct between home health agencies and physicians.

New vs. established: How to bill a new patient for IPPE, E/M in same encounter

09/26/2016

by: Roy Edroso

Question: A new patient comes for his Welcome to Medicare visit and a medical problem. This is his first time at the office. Do we bill “new patient” for the Initial Preventive Physical Exam (IPPE) and “established patient” for the E/M? Are there any circumstances under which a patient may go from new to established in the same encounter?

Contact your payer about vitamin B-12 injections if billing issues persist

09/26/2016

by: Richard Scott

Question: I’m confused about billing vitamin B-12 injections. An elderly patient was receiving 2,000 mcg every two weeks because of health issues. Our practice began receiving denials stating that Medicare would only pay for 1,000 mcg, as stipulated in our payer’s local coverage determination (LCD). Now the LCD is retired. In the meantime, the physician wants the patient to receive 1,000 mcg weekly. Can anyone shed light on this for me?

Most vitamin B-12 denial rates down while payments nudge up

09/26/2016

by: Richard Scott

Primary care providers, who bill vitamin B-12 injection code J3420 most often, saw a cut in denials and a gain in reimbursement between 2014 and 2015, which are the latest two years of available Medicare claims data.

Debridement codes the target of latest Correct Coding Initiative edits

09/19/2016

by: Richard Scott with additional reporting by Laura Evans, CPC

Shore up your documentation and be prepared to submit a modifier to get common debridement services paid for, as the latest edits from the Correct Coding Initiative (CCI) overwhelmingly target skin and wound debridement codes.

VA program enabling vets to use private providers hits road bump

09/19/2016

by: Marla Durben Hirsch

Providers who were looking to expand their patient bases by treating American service veterans should tread carefully. The program created to do that appears to have stumbled.

Watch time, threat to organ systems in documenting critical care in the office

09/19/2016

by: Roy Edroso

Critical care cases don’t happen often, but if you get one in your office, make sure you fulfill the requirements and document appropriately to justify the payment.

ICD-10 – How to ensure proper diagnosis coding as grace period ends

09/19/2016

by: Fran Wingerter

Have you heard the echoed sighs of relief throughout the health care community since last fall? Physicians, administrators and billing personnel commiserating with a resounding, “aw, that wasn’t SO bad”? They speak, of course, of the dreaded ICD-10 conversion that went into effect Oct. 1, 2015.

How to look up past fee schedule data

09/19/2016

by: Julia Kyles, CPC-A

Question: Where can I find the Colorado conversion factor for 2009, 2010, 2011?

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