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Prior authorizations causing many patients to abandon the plan of care, survey shows

07/01/2019

The regulatory burden linked to prior authorizations is getting worse, and it’s not only causing administrative headaches. It’s also leading to patients veering from the recommended course of treatment.

Want to banish burdens? Air your grievances, propose ideas to CMS now

06/24/2019

by: Richard Scott

If you want to diminish the red tape you must cut through when participating in federal health care programs, you have until Aug. 12 to let CMS know what it can do to ease your administrative hurdles, such as onerous documentation.

Heed employee charges of patient harassment — but be careful about banning the patient

06/24/2019

by: Roy Edroso

Physician practices have a duty to protect their employees from sexual harassment by patients with clear reporting procedures and follow-through. But you may want to consider your options before telling the accused patient not to come back for treatment.

Claiming modifier 22? Make sure it’s extra work, then make your case

06/24/2019

by: Roy Edroso

Question: Our surgeon performed an acetabular fracture (27254) and it took him a great deal longer than usual owing to the patient’s obesity. He wants to use modifier 22 (Increased procedural services) to be paid for the extra time. What do we have to give CMS to get that paid?

Big operations (total knee, shoulder) do well with 22, but what’s with the heat lamp?

06/24/2019

by: Roy Edroso

Modifier 22 (Increased procedural services) doesn't get claimed a lot. But on some of procedures for which it’s most often used — the ones for which you can easily see how extra work would be required — it has low denial rates. And there are some codes with 22 for which you have to wonder what the billers were thinking.

Veterans get more non-VA health access via practices, urgent care

06/24/2019

by: Roy Edroso

The U.S. Department of Veterans Affairs (VA) has issued a pair of rules offering people who have served in the U.S. military opportunities for covered health care outside the 1,255 health care facilities specifically designated for veterans.

Change mindset, and maybe chairs, to avoid alienating obese patients

06/17/2019

by: Roy Edroso

The growth of obesity in our society has naturally led to a growth in obese patients — and in sensitivities that should be addressed lest these patients lose faith in and even stop coming to their providers for help. Fortunately, this isn’t hard to do: It mainly requires for some providers a change in attitude and some small adjustments in office procedures — and maybe furniture.

Shared Savings now heavier lift for providers; prep more or go with easier new models

06/17/2019

by: Roy Edroso

As another Shared Savings application process starts, accountable care organizations (ACO) and wannabe-ACOs that have considered joining at some point should review their readiness to take on the increased levels of risk in that program. Or they may consider other models that may be more appropriate for them.

CCI bundles wrap up E/M codes, substance-abuse screening and more

06/17/2019

by: Richard Scott

Give your billing staff a heads up: You’ll find nearly 1,900 new procedure-to-procedure edits in the latest Correct Coding Initiative (CCI) update, which takes effect July 1. The quarterly update also revises the total unit count you can report per day for about 60 services, including X-rays and lesion-removal codes.

Hip X-rays remain most common extremity test but MRIs take top dollar

06/17/2019

by: Richard Scott

Providers report several million claims for hip, foot and shoulder X-rays every year but those services don’t pay out the most.

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