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CMS 2012 data: Modifier GA doesn’t mean automatic denials

06/23/2014

The modifier GA (Waiver of liability on file) indicates that you gave the patient an advanced beneficiary notice of non-coverage (ABN), and you’re only supposed to do that if you have good cause to believe the claim will be rejected – otherwise you could get in trouble for issuing “blanket” notices (PBN 5/6/13). Yet surprisingly, only 21% of codes filed with GA have a 100% denial rate. And some of the codes most often submitted with GA are denied less often than they are without the modifier.

Protect your EHR hardship exception if CMS doesn’t confirm online submission

06/13/2014

by: Roy Edroso

Use workarounds such as a delivery and read receipt requests from your email program when submitting your meaningful use hardship exception form because reports indicate CMS confirmation emails have not been reliable.

RAC alert: Admitting, discharging docs must be same group, same specialty

06/13/2014

by: Roy Edroso

If your practice’s procedure is for physicians of different specialties to routinely admit and discharge the same patient from a hospital, revise that arrangement or risk losing as much as $107 per claim.

Try creative methods to teach your staff about HIPAA, OSHA, compliance issues

06/13/2014

by: Ben Hartman

Use face-to-face competition, online games and skits to give your staff and physicians, who are notorious for shirking regulatory training, an appealing reason to attend the mandatory sessions.

Modifier 22 – Be prepared to show your work when you report increased services

06/13/2014

by: Julia Kyles

Protect additional revenue you deserve for increased services by sharing the definition of modifier 22, documenting specifics of services and watching your carriers for announcements about the increased procedural services modifier.

Use medical content to attract traffic to your website, patients to your practice

06/13/2014

by: Roy Edroso

Add tip-oriented medical information and advice to your practice’s website to bring in new patients in a cost-effective way.

Prescription drug savings cards given to patients may run afoul of payer policy

06/13/2014

by: Scott Kraft

The discount cards physician practices often hand out to patients to help offset the copayments for pricey prescription drugs are in the sights of insurance payers, which believe the cards thwart efforts to set coverage tiers to control utilization of high-cost care. It’s unclear, however, whether payers can outright ban usage of the cards.

Denial rates on 10 procedures with modifier 22 for which CMS paid the most

06/13/2014

Modifier 22 (Increased procedural services) isn’t claimed a lot – in 2012, for example, it was only claimed on 154,904 procedures – but practices stand to lose revenue they deserve if they use the modifier incorrectly.

Use medical content to attract traffic to your website, patients to your practice

06/13/2014

by: Roy Edroso

Add tip-oriented medical information and advice to your practice’s website to bring in new patients in a cost-effective way.

Document ‘stories,’ encourage coder-doctor communication to beat E/M downcoding

06/06/2014

by: Roy Edroso

Let the new Office of Inspector General (OIG) report showing widespread downcoding serve as a warning: You gain nothing — not even protection from auditors — from the practice, which can be reduced by getting coders and doctors to work together.

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