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Properly document imaging even when it’s bundled into procedure code

01/28/2019

Pay close attention to new documentation and coding guidance for radiological imaging in the 2019 CPT manual.

Be careful about Part D-covered vaccines to avoid payment issues

01/28/2019

Question: I’m confused by vaccine coverage when some of the shots aren’t covered by my payer. For instance, I’m getting denials on tetanus vaccines. How do I know which ones are covered? And what should I do when a patient comes in needing a shot that my practice may not get paid for?

How to report, document body mass index (BMI) in ICD-10-CM

01/28/2019

by: Shannon McCall, RHIA, CCS,CCS-P, CPC, CEMC, CRC, CCDS, HCS-D

Question: Can an ICD-10-CM body mass index (BMI) code be used as a standalone code? If not, what documentation should we look for to justify the use of a BMI code?

How to manage, move suspended claims along

01/28/2019

Question: How can I identify a suspended claim? Is there anything that can be done to move a suspended claim forward?

Elevated denials dog practices reporting Medicare-covered screenings

01/28/2019

by: Richard Scott

Practices and labs report millions of Medicare-covered screening services annually, yet some of the frequent fliers see denial rates approaching 50%, according to a Part B News analysis of Medicare claims data.

Coordinate hospital outreach efforts to succeed with TCM services

01/21/2019

by: Richard Scott

Stay dedicated to your transitional care management (TCM) program, particularly in the ongoing effort to wrap in eligible patients, and you stand to gain revenue and get up leg up in the larger shift to value-based care.

Look for motivated managers, ‘secret sauce’ when you outsource your billing

01/21/2019

by: Roy Edroso

If you’re thinking of transitioning your billing functions from in-house to outsourced, check out a few things besides the basic bottom-line numbers to make sure the relationship will be a happy one.

HCC fraud case a warning to check risk-adjustment coding on MA patients

01/21/2019

by: Roy Edroso

As the Department of Justice (DOJ) joins a large fraud case against providers that hinges on risk-adjustment coding under Medicare Advantage, make sure your coding is not suffering from similar issues that could make your practice vulnerable.

GAO: New payment rates for Part B lab tests may lead to billions in overpayments

01/21/2019

by: Sarah Gould

Medicare’s new method of calculating payment rates for laboratory tests, intended to reduce Medicare spending by $360 million in the first year, could cost the agency billions in overpayments, according to a recent report from the U.S. Government Accountability Office.

TCM utilization growth is impressive; denial rate drop even more so

01/21/2019

by: Roy Edroso

The specialties that are using transitional care management (TCM) codes 99495 and 99496 the most haven’t changed much since the codes were first paid by Medicare in 2013; what has changed is the rate of utilization — and, even more spectacularly, the rate of denial.\

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