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If resident doesn’t do the work, drop the GC modifier

07/11/2016

Question: I’m being told by the hospital that the resident does not always need to write a note and that our teaching physician may independently examine the patient, then “discuss” his visit with the residents. To me the GC modifier relays to Medicare that the resident is actively involved in the care of the patient, not just an observer. Is this correct?

CMS selects 196 practices to take part in value-based cancer care program

07/11/2016

by: Richard Scott

Nearly 200 provider groups will see an additional revenue opportunity though the Oncology Care Model, according to a CMS update.

New patient level 1 denials stay high — less so for NPs and PAs

07/11/2016

by: Roy Edroso

Generally, new patient E/M claims are a problem for providers. But, according to the most recent available data, 99201-99205 denials have been relatively calm overall between 2011 and 2014 — except for 99201, historically a tough sell and apparently not getting any easier. One major exception: Some non-physician practitioners (NPPs).

Brace for new burdens, risks in new OSHA rule requiring work injury reports

07/04/2016

by: Scott Harris

Prepare to walk a fine line between roles as a health care provider and an employer when a new rule takes effect Jan. 1 requiring work-related injuries and illnesses to be reported through an electronic database.

ICD-10-CM addendum provides details for new, current diagnosis codes

07/04/2016

by: DecisionHealth Staff

More than 3,000 changes and impactful revisions in tabular instruction are coming to ICD-10 when the fiscal year 2017 code set takes effect on Oct.1. CMS posted the final full addenda list along with an updated tabular, alphabetic index, neoplasm table, table of drugs and chemicals and index of external causes on June 22.

Splinted before surgery? If you’re admitted, the office charge goes away

07/04/2016

by: Roy Edroso

Question: We saw a patient in our office with a fractured ankle to which we applied a short splint (29515). He was admitted to our local hospital the same day and had ORIF [open reduction internal fixation] the following day. Medicare has denied our claim, saying he was an inpatient because of the admission. On what grounds can we appeal?

Specialties fare well with initial critical care services, struggle with add-on code

07/04/2016

by: Richard Scott

Among the five specialty groups that bill critical care codes 99291-99292 most often, the highest denial rate, for 99291 (Critical care delivery critically ill or injured patient, first 30-74 minutes), stands at a reasonable 8.3%, which is what cardiologists tallied in 2014.

Avoid shared-service billing, time miscalculations for critical care codes

07/04/2016

by: Richard Scott

Avoid miscalculating the time your providers spent with a critically injured patient when you report critical care services (99291-99292) to avoid an unintended upcharge – and a potential recoupment of payment.

Shared Savings rule finalized; lower-performing ACOs get a break

07/04/2016

by: Roy Edroso

The Shared Savings rule finalized on June 6 makes things slightly easier for new entrants in the Medicare ACO program — particularly those in high-cost areas.

OIG cites lax oversight of provider-based clinics, urges elimination of pay disparity

07/04/2016

by: Scott Kraft

The provider-based designation for physician clinics owned by hospitals continues to cause problems, including overpayments due to coding errors and lax oversight of whether facilities designated as provider-based clinics meet Medicare requirements, the HHS Office of Inspector General (OIG) charged in a recent report.

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