Part B News | Part B News

Tools to use when patients can’t or won’t pay your practice

03/09/2015

Denying established patients access to your practice based on payment ability could get you in trouble for patient abandonment, according to William Maruca, attorney with Fox Rothschild in Pittsburgh.

Use 52 for discretion, 53 for necessity — and neither if the patient walks

03/09/2015

by: Roy Edroso

The reason your provider doesn’t perform an entire intended service or procedure will determine whether you’ll use modifier 52 (Reduced services) or 53 (Discontinued procedure) — or, if it’s the patient’s decision, no modifier at all.

CMS adds lung cancer screening, counseling to preventive services bucket

03/09/2015

by: Richard Scott

You can now provide lung cancer screening and counseling to patients covered under Medicare Part B and get paid for it, following the release of a new CMS national coverage determination.

Court expands definition of ‘referral,’ upholds conviction of gatekeeper doc

03/09/2015

by: Marla Durben Hirsch

The stakes for payment arrangements or other deals with providers that also treat your patients just got higher. The U.S. Court of Appeals for the Seventh Circuit has upheld the conviction of a doctor for certifying patients for home care services — even though he didn’t direct the patients to the agency that was paying him.

Put extra guidance in care plan to give NPPs incident-to leeway

03/09/2015

by: Roy Edroso

Question: A patient who is being followed by a physician for diabetes comes to the office and is seen by a mid-level/non-physician practitioner (NPP) at the practice.

Follow these 6 guidelines when making an addendum to the medical record

03/09/2015

by: Richard Scott

Question: I’m unclear about creating an addendum to an operative report. Here’s my situation: The physician conducted multiple procedures, all of which are included in the title of the note.

Scope procedures, imaging most likely codes to pay with 52, 53 modifiers

03/09/2015

by: Roy Edroso

Watch out for high denial rates on non-imaging codes when billed with modifier 52 (Reduced services).

CMS requires face-to-face visit before billing CCM, suggests obtaining consent then

03/02/2015

by: Roy Edroso

Make sure to have a face-to-face comprehensive E/M, annual wellness visit (AWV) or initial preventive physical exam (IPPE) with patients for whom you will provide chronic care management (CCM) services — or risk denials.

7 answers to PQRS questions to ensure you report accurately, avoid penalties

03/02/2015

by: Roy Edroso

In her recent webinar about the Physician Quality Reporting System (PQRS) for Part B News, PQRS expert Leslie Witkin, president of Physicians First, Orlando, Fla., took challenging questions from the audience and shared seven answers that every PQRS reporter should know.

CMS declares latest end-to-end testing week a success; providers uncertain

03/02/2015

by: DecisionHealth Staff

Between Jan. 26 and Feb. 3, 660 providers and billing companies submitted 14,929 ICD-10 test claims and 81% went through without a hitch, Medicare announced Feb. 25 in a report on end-to-end testing. But practices responding to DecisionHealth’s ongoing ICD-10 preparation survey give a less enthusiastic picture of testing.

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