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CPT 2014 preview: New codes, increased bundling for cardiology practices

08/26/2013

Expect to see at least 19 new cardiology procedure codes in CPT 2014, sources have confirmed to Part B News.

Incarcerated patients update: CMS tells providers to go ahead with appeals

08/26/2013

Don’t bother waiting to appeal a demand letter or request a payment adjustment on claims for allegedly “incarcerated” patients. Go right ahead, CMS says in newly released guidance. Just make sure you send your request for payment to the right authorities if your Medicare patient turns out to have been a ward of the state.

Avoid denials, low reimbursement with tips for correct allergy billing

08/26/2013

by: Karen Long

Bill the correct number of units when your practice mixes vials of antigens for allergen immunotherapy or you could risk denials or underbilling.

Close coder-biller communication is key to prevent repeat denials

08/26/2013

by: Jennifer Clampet

Move your billing and coding departments to the same floor to curtail repeated claim denials. An office’s ability to identify patterns of denials can depend on the flow of information between them, says Vicki Myckowiak, an attorney with Myckowiak Associates, P.C., in Detroit, who specializes in medical claim audits and appeals.

Practices share lessons of benefiting from concierge care while accepting Medicare

08/26/2013

by: Roy Edroso

Physician-owners who are tired of the bureaucratic hassles of Medicare frequently tell Part B News that they’d like to move to a different model. A 2012 physician survey by Merritt Hawkins found most respondents wanted to cut back their hours, and about 7% of them planned to do so by switching to a “concierge” or cash-only practice.

Benchmark: 4 of 5 high-utilization specialties billing 95165 see dips in denials

08/26/2013

by: Karen Long

Family practice was the only specialty among the top five billers of 95165 that saw an increase in denials between 2010 and 2011.

Waiting for details, practices see benefits, obstacles in PECOS surrogate program

08/19/2013

by: Karen Long

Third parties that want to enroll providers can use the Provider Enrollment, Chain and Ownership System (PECOS) instead of paper under the new surrogate program.

8 trouble spots on claims you can check to avoid denials, save money

08/19/2013

by: Roy Edroso

Stay out of contractors’ crosshairs and avoid denials with regular and spot audits of certain areas. Contractors are increasingly targeting E/M services, but E/Ms aren’t the only thing you should be monitoring.

Assess real damage from claims denials by looking at dollar loss value

08/19/2013

by: Scott Kraft

When you think about how to address a denials problem at your physician practice, one of the easiest ways to start is to look at the codes that have the highest denial rates as a percentage of overall claims filings. As good of a marker as that is for plugging financial leaks, it opens you up to a different type of risk — services with a relatively small rate of denial but high utilization will slip through the cracks, opening your practice up to persistent financial drips that wreak havoc with your bottom line.

ACA loophole allows for unpaid care for some health exchange patients

08/19/2013

by: Marla Durben Hirsch

Your practice may treat patients in new health insurance exchanges (HIE) but not get paid and be left to chase payments if those patients don’t pay their premiums.

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