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Beef up documentation to justify E/M with procedures to prepare for new code pairs

07/22/2013

If you haven’t worried much about denials when reporting E/M codes with your surgical procedures because no National Correct Coding Initiative (CCI) edits bundled them — here’s a heads up: Now they do.

Check therapy coverage policies to determine whether to give patient ABN

07/22/2013

by: Karen Long

Use local coverage determinations (LCDs) and policy manuals to determine whether the therapy services you provide above the $3,700 threshold are medically necessary. If not, issue an advance beneficiary notice of noncoverage (ABN).

Keep track of PECOS data to avoid delayed or revoked payments

07/22/2013

by: Roy Edroso

HHS’ Office of Inspector General (OIG) has found that provider data in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) and National Plan & Provider Enumeration System (NPPES) are a mess – and CMS’ response may be trouble for practices down the road.

Enrollment rules clarified around partnerships, director title

07/22/2013

by: Scott Kraft

Next time you are enrolling a group practice or revalidating enrollment information, know the difference between a member of your group practice’s board of directors and a person who has “director” in his or her title. It could save you from making an error in section 6 of your CMS-855B group enrollment form, CMS clarified in a recent transmittal.

Benchmark: Impact of proposed 2014 Medicare physician fee schedule by specialty

07/22/2013

by: PBN staff

See how your specialty fares under the proposed 2014 Medicare physician fee schedule.

Changes to incentive programs proposed by CMS for 2014; pay cut not specified

07/15/2013

by: Scott Kraft

You’re going to have to wait a bit longer to determine exactly how much of a pay cut you potentially face in 2014 — and, if history is any indication, potentially longer than that to figure out whether Congress plans to address the cut with a permanent remedy or another one-time correction.

CMS proposes to add complex care coordination codes in 2015, sets steep requirements

07/15/2013

by: Roy Edroso

You may receive payment from new codes for complex chronic care management services starting in 2015, but CMS isn’t saying how much it will be yet — and the proposed requirements appear steep, including arranging patient access to 24/7 care and possibly designating the practice as a medical home.

Practices could use telehealth in place of face-to-face visit for TCM codes

07/15/2013

by: Karen Long

Practices might not have to ensure patients visit their offices within seven or 14 days of hospital discharge to bill transitional care management (TCM) codes if CMS finalizes a piece of the proposed 2014 physician fee schedule.

Smaller practices could earn value-based bonuses, and more from rule

07/15/2013

by: PBN staff

Several of CMS’ ideas in the proposed 2014 Medicare physician fee schedule could affect your practice. Here are more of the notable proposals from the rule, many of which Part B News will cover in more detail in the weeks ahead.

More proposed 2014 Medicare physician fee schedule coverage

07/15/2013

by: PBN staff

Several of CMS’ ideas in the proposed 2014 Medicare physician fee schedule could affect your practice. This is a continuation of coverage started in the print version of Part B News.

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