Part B News | Part B News

Case study: Lay the groundwork for a successful medical home transition

11/23/2015

Take the leap into a patient-centered medical home (PCMH) to gain new payment opportunities, but don’t jump in before you’ve conducted important preliminary steps, such as carefully preparing for payer negotiations.

Expanded pilot program to settle, avoid ALJ now available to Part B providers

11/23/2015

by: Josh Poltilove

An expanding pilot program could give you more opportunity to skip the wait for an administrative law judge (ALJ) to decide your appeals’ fate.

When claims audit looks bound for the DOJ, act first to avoid penalties

11/23/2015

by: Roy Edroso

Watch for warning signs that your possible overcoding pattern may get escalated from a Medicare administrative contractor (MAC) to the Department of Justice (DOJ) — and, if it looks like it will, take steps to beat the feds to the punch.

Ways providers can avoid slowing down the process of getting appeals heard

11/23/2015

by: Josh Poltilove

Prevent delays in your appeal being heard by an administrative law judge (ALJ) with these strategies.

AWV plus a physical: Medicare says don’t bill both at full cost

11/23/2015

by: Roy Edroso

Can I bill an annual wellness visit (AWV) and a preventive physical exam on the same day — G0438 with 99397, for example — and get them both paid by Medicare?

2016 fee schedule: Radiation therapy centers lose, indy labs win among specialties

11/23/2015

by: Roy Edroso

In 2016, the most striking change in “combined impact” is for radiation therapy centers, for which allowed charges had been estimated to increase in 2015 by 10% but will be reduced by 1% in 2016.

Experts: Respect rights of provider and patient when provider objects to ACP

11/16/2015

by: Roy Edroso

If a provider has a religious or moral objection to performing the new advance care planning (ACP) service, his or her conscience rights must be respected — but make sure the patient has an alternative.

Avoid denials, fraud by cutting back ‘exploding notes,’ other EHR gaffes

11/16/2015

by: Roy Edroso

An indictment for fraud based in part on misuse of electronic health record (EHR) macros is a warning that your use of such shortcuts may be leading your practice into danger.

Show evidence of distress if you changed EHR vendors and seek reporting exemption

11/16/2015

by: Richard Scott

Prepare for a new documentation requirement if you’ve recently switched electronic health record (EHR) vendors and you’re not able to meet meaningful use in 2015.

CMS adds an ‘alternate exclusion’ to meaningful use public health reporting

11/16/2015

by: Richard Scott

You’re eligible to claim an exclusion to two meaningful use public health reporting measures for stage 2 reporting in 2015, provided you previously didn’t intend to report to them.

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