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Key to critical care is in documentation of condition, not patient location

02/09/2015

Don’t automatically bill for a critical care service because the patient is being seen in an intensive care unit or emergency department. While those are the more likely locations for critical care, the service can be billed in any place of service, including the physician’s office.

Document critical care work, especially outside the hospital, to avoid denials

02/09/2015

by: Roy Edroso

If you think you’ve got a case for using critical care codes but you’re not working a crash cart, double-check the billing criteria because few such claims pass muster outside the hospital.

PECOS updates will allow users to edit PECOS, NPPES at same time and more

02/02/2015

by: Roy Edroso

Here’s a roundup of significant changes expected in April or July to the Provider Enrollment, Chain and Ownership System (PECOS), as explained by David Zetter, president of Zetter Healthcare Management Consultants, Mechanicsburg, Pa.

HHS: Medicare, private payers gear up for swift shift to quality-based pay

02/02/2015

by: Julia Kyles and Richard Scott

Expect to receive reimbursement based on how your patients fare next year as Medicare pushes forward on an ambitious plan to tie up to 85% of its traditional payments to quality or value by the end of 2016.

CCI: Adopt new rules for allergy tests and other services to avoid denials

02/02/2015

by: Richard Scott

Watch the way you bill allergy testing and immunotherapy — as well as audiologic testing, multiple fracture repair and other common services — to secure your rightful reimbursement.

Check changes, put in procedures to keep ever-changing IT HIPAA compliant

02/02/2015

by: Roy Edroso

Put extra tech in place — such as a patch program that covers all your software and a secure mobile gateway that people might actually use — to make sure your electronic health records (EHR) and other health IT doesn’t slip out of compliance and cause HIPAA violations.

Opt-out also an option to order or refer services for Medicare patients

02/02/2015

by: Scott Kraft

CMS will allow eligible providers to opt out of Medicare but still order and refer services, according to a Jan. 14 announcement from the federal Medicare agency.

Denial rates on top allergy skin test codes, 2013 vs. 2012

02/02/2015

by: Roy Edroso

Allergy test code billing is full of pitfalls, and the latest CCI update makes them even trickier (see story).

Avoid 2016 PQRS, value-modifier penalties by meeting approaching deadlines

01/26/2015

by: Richard Scott

You have time to submit your physician quality reporting system (PQRS) data for 2014 and avoid a 2% pay cut in 2016, but you’ll have to hurry — reporting deadlines arrive as early as Feb. 28.

As hospitals squeeze M.D.s, lure them to your practice with perks, performance goals

01/26/2015

by: Roy Edroso

Experts confirm that while hospitals retain their financial advantage in recruiting physicians, shifts in compensation models and other factors may be alienating them, which gives you a chance to lure some good doctors to your practice by providing a better experience.

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