Part B News
If workers’ comp patient comes back, treat him as a ‘new’ patient
11/05/2018
by: Roy Edroso
Question: A patient is seen for an IME (independent medical examination) for a workers’ compensation case. The carrier then decides they want us to treat the patient. Is that next visit a "new patient" or "established patient" visit?
4 of 5 enrollees in Medicare Advantage plans that require prior authorizations
11/05/2018
by: Richard Scott
The growing wave of Medicare Advantage (MA) plans may increase the administrative time your practice spends chasing down prior authorizations, as the bulk of MA patients – about 80% – are in a plan that requires one for at least some services, according to new analysis from Kaiser Family Foundation (KFF).
5 documentation do’s and don’ts: A risk-adjustment coding guide
10/29/2018
by: Richard Scott
You should capture the full range of a patient’s chronic conditions when coding under a risk-adjustment paradigm because your payments, and ultimately your coding compliance, may be affected. Beef up one crucial part of the process — provider documentation — to strengthen your efforts.
As younger doctors head for the exits, use job-sharing, other perks to slow attrition
10/29/2018
by: Roy Edroso
As burnout takes its toll, you may find providers — including those under traditional retirement age — leaving more quickly than you anticipated. Take steps now to smooth their transition and reduce the impact to your patients and your practice’s bottom line.
Catch rising wave of Medicare Advantage plans, get boost into value-based care
10/29/2018
by: Roy Edroso
The rise in Medicare Advantage plans offers practices a way to build not only their patient populations but also their pay-for-performance skills, experts say.
4 steps to create denial avoidance programs for coding, documentation
10/29/2018
by: Lynette Kramer, MA, RHIA
Direct your coding and documentation teams to take the same approach as leading practice denial-management programs to not only improve the way they manage and resolve existing denials but also to correct process deficiencies to prevent new denials.
KFF: 99% of Medicare beneficiaries can get Medicare Advantage coverage
10/29/2018
by: Roy Edroso
The growth in Medicare Advantage plans is impressive, but the penetration of those plans into heretofore underserved areas may be even more so, on the evidence of the Kaiser Family Foundation’s recent issue brief “Medicare Advantage 2019 Spotlight: First Look” by Gretchen Jacobson, Anthony Damico and Tricia Neuman.
Navigate AWVs versus physical exams; 4 tips to boost your AWV reporting
10/22/2018
by: Richard Scott
When a Medicare patient calls to request a routine physical, make sure your office is ready to pivot to – and communicate about – an annual wellness visit (AWV). Doing so will add dollars to your practice and insulate you from the threat of patients receiving non-covered services.
Protect PHI when it moves to and from business associates
10/22/2018
by: Marla Durben Hirsch

The recent settlement agreement between the HHS Office for Civil Rights (OCR) and the now-shuttered medical records storage company FileFax Inc. is a good reminder that providers and business associates need to comply with HIPAA and protect PHI not only when they possess or store it but also when they transmit it to each other.

New guidance on LCD requests make process more transparent – but success no more likely
10/22/2018
by: Roy Edroso

CMS has made what looks like large changes to the local coverage determination (LCD) process — but experts don’t think it will make it easier to get an inconvenient LCD changed.

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