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Try high tech, high touch to urge slow-paying patients into the fast lane

05/06/2019

A recent survey shows that providers are having serious trouble getting timely payments from patients — and while high-deductible plans are, as usual, a suspected culprit, experts suggest that a more high-touch, high-tech approach from providers could help take up some of the slack.

Button down your infection control as measles, HAV outbreaks spread

05/06/2019

by: Roy Edroso

Recent measles outbreaks in the United States are a grim reminder that infection control is a matter of practice policy and should be reinforced at intervals to keep it effective.

Sharpen your CPT and ICD-10-CM coding for prostate cancer, PSA testing

05/06/2019

by: Shelley C. Safian, PhD, RHIA, CCS-P, CPC-I

Prostate cancer is the second most common form of cancer in American men, according to the American Cancer Society. The organization estimates that in 2019 more than 174,000 Americans will be diagnosed with prostate cancer and more than 30,000 will die from it.

Focus on opioid review regardless of history, prescriber when reporting AWVs

05/06/2019

by: Richard Scott

Question: Regarding the recent updates from CMS, do we need to document “opioid review” in the wellness visit note if the patient has not recently been on opioids? We have a general “drug use” question on our wellness forms but nothing specific to opioids. Secondly, if the patient is on opioids prescribed by another provider, do we need to document opioid review? When our providers prescribe opioids, we always document review, alternative treatment, failed treatment, etc., so that is not a concern.

Most patients prefer electronic bill-paying — but practices aren’t encouraging it

05/06/2019

by: Roy Edroso

It’s a common joke that medical offices are all that’s keeping the fax machine industry alive. But clinging to that particular outmoded telecommunications tool is not the only way the medical practice business is behind the curve electronically. InstaMed’s 2018 Trends in Healthcare Payments report, which surveyed providers, payers and patients, suggests that patients want to pay their physician practice bills online but some may not be doing so because the practices aren’t pushing it.

New Primary Cares model gives PCPs easy road to value-based pay starting in January

04/29/2019

by: Roy Edroso

HHS and CMS officials announced on April 22 a new, voluntary demonstration model for primary care providers that would introduce value-based payment as a partial (or in some cases complete) substitute for fee-for-service with varying levels of involvement and risk, to begin as soon as January 2020.

Anthem rolls out modifier 25 policy that could deny same-diagnosis E/M claims

04/29/2019

by: Richard Scott

Beware, reporters of modifier 25-appended E/M services: Anthem, one of the nation’s largest payers, has issued a policy update seeking to curtail claims for E/M codes submitted with the oft-used modifier for significant, separately identifiable E/M services.

CMS gives radiation therapy providers a break — but bigger changes may be coming

04/29/2019

by: Roy Edroso

CMS is letting radiation oncologists bill some E/Ms with superficial radiation therapy (SRT) that had previously been bundled. But those providers should look out: this may be a preliminary step before CMS puts in new regulations that may shake up their reimbursement.

Avoid denials with more specific diagnosis, documentation of anemia

04/29/2019

by: Joel Moorhead, M.D.

Providers tend to complain when they document a diagnosis of “anemia” and then receive a query from a payer requesting a more specific diagnosis. Such a query often causes frustration and yields a response like “anemia not otherwise specified” or “unable to determine.” To avoid queries for non-specific anemia diagnoses, brush up on documentation and coding requirements for different types of anemia in ICD-10-CM.

Radiation treatment codes decline in use in rocky regulatory environment

04/29/2019

by: Roy Edroso

Utilization of 77401 (Radiation treatment delivery, superficial and/or ortho voltage, per day) has been skyrocketing in recent years but CMS’ other radiation treatment codes have been going the other way.

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