Part B News
Medicare payment error may mean money owed to your physician practice
02/28/2013
by: Karen Long

Keep a close eye on payments you’re receiving from Medicare because at least one recovery auditor (RAC) has spotted underpayments being made under the wrong fee schedules, Part B News has learned.

 
Remittance advice change may make it easier to analyze, respond to unpaid claims
02/28/2013
by: Scott Kraft

Efforts to standardize the way payers communicate remittance advice remark codes (RARCs) and claim adjustment reason codes (CARCs) could eliminate some of the confusion providers now face when figuring out why claims are going unpaid, experts tell Part B News.

 
CMS to recoup AWV overpayments when physicians, facilities both bill
02/28/2013
by: Karen Long

You may have to pay back money from annual wellness visits (AWVs) that were billed first by a facility because CMS erroneously paid both claims for one service dating back to April 4, 2011.

 
Providers lag on HIPAA, audits show, and other findings from the HIPAA Summit
02/28/2013
by: Roy Edroso
Last week, we shared OIG concerns from the recent HIPAA Summit in Washington, D.C., about encryption issues and human error causing violations (PBN 2/25/13). But busy practice managers need to also focus on other areas to ensure HIPAA compliance, according to presenters at the Feb. 19-21 Summit.
 
Provider denial trends when using modifier 52 by specialty, 2007-2011
02/28/2013
by: Lauren C. Williams
In 2011, claims with modifier 52 appended were denied 45% of the time (PBN 1/7/13). But a closer look at those claims show that nearly a third of the codes billed, which amassed at least 1,000 claims, saw 100% denial rates.
2 tips for proper modifier 52 use
02/28/2013
by: Lauren C. Williams

Don’t let the overall high denial rates keep you from getting paid for incomplete services. Keep these tips in mind when billing modifier 52.

 
OCR to providers: Watch for ‘human frailty’ breaches, encryption issues
02/25/2013
by: Roy Edroso
Two top officers of the main enforcement bureau for HIPAA privacy and security rules addressed the Annual HIPAA Summit in Washington, D.C., on Feb. 19, giving providers some clues as to what their investigators will be looking for in the age of the “mega-rule.” Among their focal points: training, data breaches, encryption and use of protected health information (PHI) in marketing.
 
More waiting for PECOS surrogate program but other small changes speed enrollment
02/25/2013
by: Karen Long
CMS is “a ways off” from getting a surrogate program up and running for the Provider Enrollment, Chain and Ownership System (PECOS).
The program will legalize a now noncompliant but common practice of non-physician staff using the doctor’s username and password to enroll in PECOS.
 
State laws, pay-for-performance making telehealth harder to ignore
02/25/2013
by: Roy Edroso
Telehealth technology can be a worthwhile investment for your practice if you’re involved or expect to be involved in pay-for-performance models. And though Medicare isn’t expected to expand eligibility for telehealth reimbursement anytime soon, your state may require your private insurers to do so.
 
New telehealth pharmacologic management code
02/25/2013
by: Roy Edroso
Psychiatrists and prescribing psychologists can use a new telehealth G-code to join the eight others that debuted last month, CMS announced Feb. 1. CMS added the code G0459 for inpatient telehealth pharmacologic management, including prescription, retroactively effective Jan. 25.
 
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