Part B News | Part B News

Proposed shared savings rule makes benchmarks more local to draw participants

02/08/2016

It may be easier for your practice to succeed with a Shared Savings accountable care organization (ACO) soon thanks to a new proposed rule.

MACs wield heavy influence when it comes to scoring E/M services

02/08/2016

by: Scott Kraft

Make sure your E/M claims get paid by keeping track of Medicare administrative contractors (MACs) that are increasingly setting their own policies for what does and doesn’t count when calculating history and exam components of services.

Check coverage determinations for when you need JW modifier with drug wastage

02/08/2016

by: Roy Edroso

Botox comes in multiple-use vials. Are we supposed to list our drug wastage with modifier JW (Drug amount discarded/not administered to any patient)?

NPP students at your practice? Check laws, contracts; verify competency

02/08/2016

by: Roy Edroso

We have been approached by a local college to provide training for its nurse practitioner (NP) and medical assistant students. What services can these students provide since they do not fit under the incident-to guidelines as they are not paid employees?

Don’t forget smaller TCM services — even when the patient goes back to hospital

02/08/2016

by: Roy Edroso

CMS says that we can claim transitional care management (TCM) codes 99495 and 99496 even if the patient goes back into the hospital during the 30-day period. Yet I have seen a presentation that says such charges will be denied. Is that so?

Chemo drugs drive volatile average payments for Part B drugs, 2010-2014

02/08/2016

by: Roy Edroso

In a comparison of average payments for 426 J-codes between 2010 and 2014, only 84 drugs did not see their payments change more than 10%.

Prepare now to secure incentives with an early glimpse of alternative payment models

02/01/2016

by: Richard Scott

Expect substantial incentives, an increase in quality reporting and the need to hire additional staff if you decide to transition to an alternative payment model (APM), the value-based delivery mechanism that will become a formal part of the Medicare physician fee schedule in 2019.

Use of new clinical staff prolonged service codes should be infrequent

02/01/2016

by: Laura Evans, CPC

Two new E/M prolonged service codes added in the 2016 CPT manual allow you to report extended observation services provided by clinical staff in the office. However, the reimbursement is low and occasions when you would use the codes should be rare, say coding experts.

Time calculation for new prolonged services codes applies to outpatient codes

02/01/2016

by: Scott Kraft

Take note of the AMA’s CPT Editorial Panel revision of the code descriptors for office-based prolonged services codes 99354 (Prolonged service, first 60 minutes) and 99355 (Prolonged service, each additional 30 minutes) to include the same language on how to count time applied to newly created prolonged services codes 99415-99416.

The Stark Reality: Beware of pitfalls with payment trends, contracts, insurance

02/01/2016

by: Stark Medical Audit and Consulting

Three auditing case studies show you how to improve your practice's charge-capture capability with a diverse set of solutions you can begin to implement today.

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