Medicare Compliance & Reimbursement
Reimbursement:
Prepare For 10.1 Percent Pay Cut Unless Lawmakers Act Soon
Congress may not vote on proposed fee schedule changes until January If you were hoping ... Read more
Prepare For 10.1 Percent Pay Cut Unless Lawmakers Act Soon
Congress may not vote on proposed fee schedule changes until January If you were hoping ... Read more
Radiology:
Watch For OIG Scrutiny Of Imaging Claims
Stay on your toes to keep advanced imaging claims on the straight and narrow Watch out: Y... Read more
Watch For OIG Scrutiny Of Imaging Claims
Stay on your toes to keep advanced imaging claims on the straight and narrow Watch out: Y... Read more
Compliance:
Keep Anti-Kickback Compliance In Mind During Holidays
Make a list -- and check it twice before giving gifts Bear too many gifts this holiday se... Read more
Keep Anti-Kickback Compliance In Mind During Holidays
Make a list -- and check it twice before giving gifts Bear too many gifts this holiday se... Read more
Compliance:
Take A Fresh Look At Your Beneficiary Gift-Giving
Regulators could construe goodwill as influence You may feel compelled to help disadvanta... Read more
Take A Fresh Look At Your Beneficiary Gift-Giving
Regulators could construe goodwill as influence You may feel compelled to help disadvanta... Read more
Claims Accuracy:
Healthcare Practices Threw Away $259 Million Last Year
ASCs boast low error rates; general practices show the highest If the latest CERT report ... Read more
Healthcare Practices Threw Away $259 Million Last Year
ASCs boast low error rates; general practices show the highest If the latest CERT report ... Read more
Claims Accuracy:
Medicare Paid $1.7 Billion In Upcoded E/M Claims
But CERT report reveals improvements in coding accuracy If your favorite code is 99205, w... Read more
Medicare Paid $1.7 Billion In Upcoded E/M Claims
But CERT report reveals improvements in coding accuracy If your favorite code is 99205, w... Read more
Part D:
Team Up With Docs To Keep Benefits Strong
Don't send an exceptions request without this backup Pharmacies, take note: With a new pl... Read more
Team Up With Docs To Keep Benefits Strong
Don't send an exceptions request without this backup Pharmacies, take note: With a new pl... Read more
PQRI:
Final Rule Introduces 60 New PQRI Measures For '08
Smoking cessation counseling may net you a bonus next year The 2008 Fee Schedule final ru... Read more
Final Rule Introduces 60 New PQRI Measures For '08
Smoking cessation counseling may net you a bonus next year The 2008 Fee Schedule final ru... Read more
Industry Notes:
MedPAC Proposes 1.2 Percent Payment Boost In 2009
Plus: Prepare to lose $14,000 for Bexxar and Zevalin treatments At its meeting Dec. 6-7, ... Read more
MedPAC Proposes 1.2 Percent Payment Boost In 2009
Plus: Prepare to lose $14,000 for Bexxar and Zevalin treatments At its meeting Dec. 6-7, ... Read more
Part D:
Study 2008 Immunization Changes Now
New year + new policy = more money Community pharmacists are still fairly new to health c... Read more
Study 2008 Immunization Changes Now
New year + new policy = more money Community pharmacists are still fairly new to health c... Read more
Vaccinations:
Give Your Business A Booster With This Plan
Seek help from coalitions for quick start Take a new look at Part D's new immunization po... Read more
Give Your Business A Booster With This Plan
Seek help from coalitions for quick start Take a new look at Part D's new immunization po... Read more
SNFs:
X-Ray Fees Add Up Over Time
Payments for SNF patients may seem small, but don't write them off If you write off X-ray... Read more
X-Ray Fees Add Up Over Time
Payments for SNF patients may seem small, but don't write them off If you write off X-ray... Read more
HCPCS 2008:
New Codes May Ease Supprelin LA Claims
And HCPCS now includes Lucentis code Hot on the heels of the new CPT 2008 introduction, y... Read more
New Codes May Ease Supprelin LA Claims
And HCPCS now includes Lucentis code Hot on the heels of the new CPT 2008 introduction, y... Read more
Reimbursement:
CMS Avoids Coverage For Substance Abuse Codes
Medicare also gives no payment to several new CPT codes The Centers for Medicare & Me... Read more
CMS Avoids Coverage For Substance Abuse Codes
Medicare also gives no payment to several new CPT codes The Centers for Medicare & Me... Read more
Patient Education:
Speed Up Status Updates With These Tips
A new missive from the feds helps clear up controversy about documentation You should hav... Read more
Speed Up Status Updates With These Tips
A new missive from the feds helps clear up controversy about documentation You should hav... Read more
CCI edits:
New Modifier Makes MUEs More Palatable in 2008
Append GD to thwart medically unlikely edits If you need a way to override a medically un... Read more
New Modifier Makes MUEs More Palatable in 2008
Append GD to thwart medically unlikely edits If you need a way to override a medically un... Read more
Home Care:
Prospective Payment System Refinements Top HHAs' Worry List
Agencies in South, rural areas to see biggest PPS hit Home health agencies should take th... Read more
Prospective Payment System Refinements Top HHAs' Worry List
Agencies in South, rural areas to see biggest PPS hit Home health agencies should take th... Read more
Industry Notes:
Medicare Unveils New E-Prescribing Proposal
Also: Find all your flu billing resources in one place On Nov. 13, Mike Leavitt, secretar... Read more
Medicare Unveils New E-Prescribing Proposal
Also: Find all your flu billing resources in one place On Nov. 13, Mike Leavitt, secretar... Read more
Coverage:
Medicare Hangs Up On Phone, Online E/M
Anticoagulation management is still bundled for 2008 Don't get too excited about some of ... Read more
Medicare Hangs Up On Phone, Online E/M
Anticoagulation management is still bundled for 2008 Don't get too excited about some of ... Read more
Part D:
Here's How To Protect Your Patients -- And Claims -- For 2008
Beware: Strict new transition requirements may apply You know that a patient who's new to... Read more
Here's How To Protect Your Patients -- And Claims -- For 2008
Beware: Strict new transition requirements may apply You know that a patient who's new to... Read more
Reimbursement:
Less Payment For Moh's Micrographic Surgery Next Year
Fee schedule final rule continues IVIG payments, boosts home visits Warning: Start watchi... Read more
Less Payment For Moh's Micrographic Surgery Next Year
Fee schedule final rule continues IVIG payments, boosts home visits Warning: Start watchi... Read more
Reimbursement:
Prepare Now For 10.1-Percent Payment Drop In January
But anesthesiologists boost their pay by one-third The Centers for Medicare & Medicai... Read more
Prepare Now For 10.1-Percent Payment Drop In January
But anesthesiologists boost their pay by one-third The Centers for Medicare & Medicai... Read more
Compliance:
A Reprieve For Many Common Joint Ventures
But your imaging suite could be a money loser now Good news: You don't have to rethink al... Read more
A Reprieve For Many Common Joint Ventures
But your imaging suite could be a money loser now Good news: You don't have to rethink al... Read more
Coding Coach:
Follow These HPI Tips For Bulletproof E/M Coding
Hint: Simply mentioning inactive conditions could lead you down the wrong path The 1997 d... Read more
Follow These HPI Tips For Bulletproof E/M Coding
Hint: Simply mentioning inactive conditions could lead you down the wrong path The 1997 d... Read more
PQRI:
You Won't Know Your Share Of $1.35 Billion Pie Until The End
Next year's project adds 45 quality measures If you stayed away from the Physicians Quali... Read more
You Won't Know Your Share Of $1.35 Billion Pie Until The End
Next year's project adds 45 quality measures If you stayed away from the Physicians Quali... Read more
Industry Notes:
2009 Could Bring A 15-Percent Decrease In Your Reimbursement
Plus: You get a little more breathing room on NPI requirements Congress continues to figh... Read more
2009 Could Bring A 15-Percent Decrease In Your Reimbursement
Plus: You get a little more breathing room on NPI requirements Congress continues to figh... Read more
CPT 2008:
Look For Drug-Abuse Questions In E/M Notes, And Add To Your Revenue
Doctor must document time, structured questionnaireHeads up: If a patient comes in and see... Read more
Look For Drug-Abuse Questions In E/M Notes, And Add To Your Revenue
Doctor must document time, structured questionnaireHeads up: If a patient comes in and see... Read more
HOME HEALTH:
Adapt To New Reimbursement Strategy With These 3 Tips
OASIS accuracy can make or break your agency in 2008Home health agencies can't avoid the 2... Read more
Adapt To New Reimbursement Strategy With These 3 Tips
OASIS accuracy can make or break your agency in 2008Home health agencies can't avoid the 2... Read more
LABS:
Let MPFS Status Indicators Show You How To Get Paid
Harness fee schedule policy rules for the PC/TC modifiersThe Medicare Physician Fee Schedu... Read more
Let MPFS Status Indicators Show You How To Get Paid
Harness fee schedule policy rules for the PC/TC modifiersThe Medicare Physician Fee Schedu... Read more
SNFs:
Don't Bill Until You Have Submitted MDS
CMS announces a change in its stance on default ratesIf you forget to do a minimum data se... Read more
Don't Bill Until You Have Submitted MDS
CMS announces a change in its stance on default ratesIf you forget to do a minimum data se... Read more
MACs:
CMS Names New Medical Administrative Contractors
Make sure your new MAC is working to earn its bonusesSay goodbye to your carriers in seven... Read more
CMS Names New Medical Administrative Contractors
Make sure your new MAC is working to earn its bonusesSay goodbye to your carriers in seven... Read more
PART B MYTHBUSTER:
Are Your Audits Making Your Coding Better Or Worse?
Find out before it's too late if your auditor knows the scoreMyth: Any coder can perform a... Read more
Are Your Audits Making Your Coding Better Or Worse?
Find out before it's too late if your auditor knows the scoreMyth: Any coder can perform a... Read more
INDUSTRY NOTES:
CMS Inches Closer To Replacing ICD-9 Codes
Plus: Could a Senate subcommittee hearing on competitive bidding bring changes?The United ... Read more
CMS Inches Closer To Replacing ICD-9 Codes
Plus: Could a Senate subcommittee hearing on competitive bidding bring changes?The United ... Read more
ENROLLMENT:
Know The Re-Enrollment Ropes -- Or Risk All
Even a new phone number can trigger an 855 submissionBe prepared for a challenge when it's... Read more
Know The Re-Enrollment Ropes -- Or Risk All
Even a new phone number can trigger an 855 submissionBe prepared for a challenge when it's... Read more
UROLOGY:
Do Payor-Specific Research Before Your Next S2900 Claim
Here's how to ensure your robotic-assist coding is living up to its potentialMyth: You can... Read more
Do Payor-Specific Research Before Your Next S2900 Claim
Here's how to ensure your robotic-assist coding is living up to its potentialMyth: You can... Read more
COVERAGE:
Study--Drug-Coated Stents Save Medicine 5.4 Percent
CMS backs off from threats to restrict off-label coverageThe drug-coated stent debate cont... Read more
Study--Drug-Coated Stents Save Medicine 5.4 Percent
CMS backs off from threats to restrict off-label coverageThe drug-coated stent debate cont... Read more
MEDICAL EQUIPMENT:
For Bidders, New Game May Be 'Wait And See'
Seniors' access to care could suffer if DMEPOS suppliers are fewThe feds remain mum about ... Read more
For Bidders, New Game May Be 'Wait And See'
Seniors' access to care could suffer if DMEPOS suppliers are fewThe feds remain mum about ... Read more
HOME HEALTH:
Get A Sneak Peek At P4P
Demonstration project may be a sign of things to comeEven if your home health agency (HHA)... Read more
Get A Sneak Peek At P4P
Demonstration project may be a sign of things to comeEven if your home health agency (HHA)... Read more
CPT 2008:
Tobacco Counseling, Phone E/Ms Getting Easier To Report
CPT puts time on coder's side in 2008If figuring the level of service for telephone E/Ms h... Read more
Tobacco Counseling, Phone E/Ms Getting Easier To Report
CPT puts time on coder's side in 2008If figuring the level of service for telephone E/Ms h... Read more
INDUSTRY NOTES:
A Comeback For House Calls
Plus: Now might be the time to invest in a snappy new Web siteThe American Academy of Home... Read more
A Comeback For House Calls
Plus: Now might be the time to invest in a snappy new Web siteThe American Academy of Home... Read more
PART B MYTHBUSTER:
Don't Let Consult Requests Tie You In Knots
Some specialists are asking for the moon, primary-care physicians complainMyth: Consult re... Read more
Don't Let Consult Requests Tie You In Knots
Some specialists are asking for the moon, primary-care physicians complainMyth: Consult re... Read more
UROLOGY:
Stop Handing Out ABNs For Renal Tumor Ablations
No cystoscopy? No problem next yearGood news: You can stop using the 52 modifier when your... Read more
Stop Handing Out ABNs For Renal Tumor Ablations
No cystoscopy? No problem next yearGood news: You can stop using the 52 modifier when your... Read more
CONSULTS:
Craft A Bulletproof Consult Request Form
When is a request for a consult too much information?Your consults could slow to a trickle... Read more
Craft A Bulletproof Consult Request Form
When is a request for a consult too much information?Your consults could slow to a trickle... Read more
Clip And Save:
Consult Request Form
It's time to streamline your consult request form. Here's the standard form that consultan... Read more
Consult Request Form
It's time to streamline your consult request form. Here's the standard form that consultan... Read more
OPHTHALMOLOGY:
No More Unlisted Code For Lucentis Next Year
Prepare to specify your doctor's approach to retina surgeryHeads up: If your ophthalmologi... Read more
No More Unlisted Code For Lucentis Next Year
Prepare to specify your doctor's approach to retina surgeryHeads up: If your ophthalmologi... Read more
PART D:
Steer Clear Of This Subsidy Roadblock
'Extra help' may be an extra challenge in 2008Changes in an obscure federal formula could ... Read more
Steer Clear Of This Subsidy Roadblock
'Extra help' may be an extra challenge in 2008Changes in an obscure federal formula could ... Read more
OIG ALERT:
There's Gold In Them There Knees, Hips
Ortho device makers pay $311 million to settle anti-kickback chargesFederal prosecutors ar... Read more
There's Gold In Them There Knees, Hips
Ortho device makers pay $311 million to settle anti-kickback chargesFederal prosecutors ar... Read more
STARK LAW:
Inducements Must Be On The Table Before Doctor Comes
You can't change the terms of relocation bonuses after the relocation has happenedNow that... Read more
Inducements Must Be On The Table Before Doctor Comes
You can't change the terms of relocation bonuses after the relocation has happenedNow that... Read more
CPT 2008:
Medicare May Soon Cover FDG-PET Scans For Infection
CPT descriptor changes pave the way for coverageWith all the bad news that's hit imaging l... Read more
Medicare May Soon Cover FDG-PET Scans For Infection
CPT descriptor changes pave the way for coverageWith all the bad news that's hit imaging l... Read more
INDUSTRY NOTES:
Senate Stymied On Medicare Payment Fixes
Plus: Keep sending your cancer patients to federally approved clinical trialsSaving your M... Read more
Senate Stymied On Medicare Payment Fixes
Plus: Keep sending your cancer patients to federally approved clinical trialsSaving your M... Read more
PART D:
Dodging The Donut Hole Gets Trickier Next Year
Watch for these Part D traps in 2008For Part D prescription drug plans, the race is on to ... Read more
Dodging The Donut Hole Gets Trickier Next Year
Watch for these Part D traps in 2008For Part D prescription drug plans, the race is on to ... Read more
BENEFITS:
Insurers Keep Big Picture Of 2008 Benefits Top Of Mind
Drug benefits are trending upwardCommunity pharmacists and consumer advocates are watching... Read more
Insurers Keep Big Picture Of 2008 Benefits Top Of Mind
Drug benefits are trending upwardCommunity pharmacists and consumer advocates are watching... Read more
DOCUMENTATION:
Are Your Nurses' History Notes Becoming Audit Bait?
Nurses can document chief complaint, but history should be in doctor's handwritingWarning:... Read more
Are Your Nurses' History Notes Becoming Audit Bait?
Nurses can document chief complaint, but history should be in doctor's handwritingWarning:... Read more
CODING COACH:
Apply These 5 Appeal-Winning Steps To Your Next Claim
It works: Empire Medicare covers rhinometry thanks to this coder's diggingIf you shudder a... Read more
Apply These 5 Appeal-Winning Steps To Your Next Claim
It works: Empire Medicare covers rhinometry thanks to this coder's diggingIf you shudder a... Read more
OIG ALERT:
Look For A Crackdown On Diagnostic Imaging
OIG also looking into incident-to billing, polysomnographyHeads up: If your practice owns ... Read more
Look For A Crackdown On Diagnostic Imaging
OIG also looking into incident-to billing, polysomnographyHeads up: If your practice owns ... Read more
BILLING:
One Phone Call May Solve A Simple Mistake
Run down this quick checklist to pinpoint the reason for a denialWhen you get a denial for... Read more
One Phone Call May Solve A Simple Mistake
Run down this quick checklist to pinpoint the reason for a denialWhen you get a denial for... Read more
REIMBURSEMENT:
Don't Treat A Second-Hand Problem Like A New Development
Don't bill Medicare for routine pre-operative chest X-rayA problem may be new to your doct... Read more
Don't Treat A Second-Hand Problem Like A New Development
Don't bill Medicare for routine pre-operative chest X-rayA problem may be new to your doct... Read more
INDUSTRY NOTES:
January Is Drop-Dead NPI Deadline, CMS Says
Plus: Prepare to fight a powerful insurance lobby to stop 10 percent pay cutYou can count ... Read more
January Is Drop-Dead NPI Deadline, CMS Says
Plus: Prepare to fight a powerful insurance lobby to stop 10 percent pay cutYou can count ... Read more
CPT 2008:
FOBT Code Will Become More Flexible In 2008
Plus: Prepare to see a new path to bill for retina surgeriesHeads up: CPT 2008 will elimin... Read more
FOBT Code Will Become More Flexible In 2008
Plus: Prepare to see a new path to bill for retina surgeriesHeads up: CPT 2008 will elimin... Read more
RESEARCH & REPORT:
Northeast Spends Most On Health Care
Do generous Medicaid benefits play a role? Someone living in the Northeast spends about $1... Read more
Northeast Spends Most On Health Care
Do generous Medicaid benefits play a role? Someone living in the Northeast spends about $1... Read more
PART D:
Enrollees Still Fall Through Subsidy Cracks
Drugs are still difficult for many seniors to afford, researchers sayA new study focusing ... Read more
Enrollees Still Fall Through Subsidy Cracks
Drugs are still difficult for many seniors to afford, researchers sayA new study focusing ... Read more
PQRI:
Prepare For 2008 Quality Reporting Now
Red flag: You can't resubmit botched claims just to fix PQRI problemsIf your clearinghouse... Read more
Prepare For 2008 Quality Reporting Now
Red flag: You can't resubmit botched claims just to fix PQRI problemsIf your clearinghouse... Read more
PART B:
Your Costliest Chart Audit Myths Exposed
Don't treat audits as punishment or probation, or you could lose moneyWatch out: How many ... Read more
Your Costliest Chart Audit Myths Exposed
Don't treat audits as punishment or probation, or you could lose moneyWatch out: How many ... Read more
PQRI:
Expect More Feedback From CMS Next Year
Money for 2007 bonuses is guaranteed--but 2008 funds aren'tDon't believe the rumors: Some ... Read more
Expect More Feedback From CMS Next Year
Money for 2007 bonuses is guaranteed--but 2008 funds aren'tDon't believe the rumors: Some ... Read more
The 3 Deadly Myths That Could Be Hindering Your E/M Chart Audits
Experts advise you to focus on your evaluation and management visits to reap the biggest r... Read more
Experts advise you to focus on your evaluation and management visits to reap the biggest r... Read more
AUDITS:
Uncover The Top Trouble Spots Lurking In Your Charts
Here's how to find hidden revenue in common code claimsHeads up: It's not enough to do reg... Read more
Uncover The Top Trouble Spots Lurking In Your Charts
Here's how to find hidden revenue in common code claimsHeads up: It's not enough to do reg... Read more
INDUSTRY NOTES:
NPI Nightmares Aren't Over Yet
Plus: PDP premiums predicted to climbIf you've been having trouble accessing the National ... Read more
NPI Nightmares Aren't Over Yet
Plus: PDP premiums predicted to climbIf you've been having trouble accessing the National ... Read more
REIMBURSEMENT:
Senate Bill To Reinstate $20 Billion In Medicare Spending
Critics call for payment system reformStarting in January, Medicare reimbursements to phys... Read more
Senate Bill To Reinstate $20 Billion In Medicare Spending
Critics call for payment system reformStarting in January, Medicare reimbursements to phys... Read more
CODING:
3 Approaches, 3 Codes For Paravaginal Defect Repair
No more unlisted codes for laparoscopic Ob/Gyn surgeriesCPT 2008 will revise the descripto... Read more
3 Approaches, 3 Codes For Paravaginal Defect Repair
No more unlisted codes for laparoscopic Ob/Gyn surgeriesCPT 2008 will revise the descripto... Read more
NURSES:
Bill Opens Medicaid Door To Advanced Practice Nurses
S.59/H.R.2066 is a boon to Medicaid recipients, tooAdvanced practice registered nurses cou... Read more
Bill Opens Medicaid Door To Advanced Practice Nurses
S.59/H.R.2066 is a boon to Medicaid recipients, tooAdvanced practice registered nurses cou... Read more
COMPLIANCE:
Prepare For A Whole New Set Of Denials In January
MUEs sail past anatomy into the realm of clinical decision makingWarning: The controversia... Read more
Prepare For A Whole New Set Of Denials In January
MUEs sail past anatomy into the realm of clinical decision makingWarning: The controversia... Read more
CPT 2008:
New Vaccine Codes Are Official For Jan. 1, Even If They're Not In The Book
Inoculate yourself against ignorance of new vaccination codesYou'll have six new vaccinati... Read more
New Vaccine Codes Are Official For Jan. 1, Even If They're Not In The Book
Inoculate yourself against ignorance of new vaccination codesYou'll have six new vaccinati... Read more
MEDICARE:
Home Health And Long-Term Care Providers Prepare For Model Project
New CARE tool to bring major post-acute care placement changesThe Centers for Medicare &am... Read more
Home Health And Long-Term Care Providers Prepare For Model Project
New CARE tool to bring major post-acute care placement changesThe Centers for Medicare &am... Read more
PHARMACISTS:
Medicaid Cracks Down On Noncompliant Prescriptions
Overlooking this law will guarantee denialsMedicaid may be posed to pack another wallop to... Read more
Medicaid Cracks Down On Noncompliant Prescriptions
Overlooking this law will guarantee denialsMedicaid may be posed to pack another wallop to... Read more
INDUSTRY NOTES:
House, Senate Agree On Children's Health Bill
Plus: Decision rules out shortcuts in drug claim appeals processThe chances of averting a ... Read more
House, Senate Agree On Children's Health Bill
Plus: Decision rules out shortcuts in drug claim appeals processThe chances of averting a ... Read more
PHYSICIANS:
You Could Lose All Your Payments For 99325 Next Year
CPT 2009 may contain new combined echocardiography codeA provision in the 2008 Physician F... Read more
You Could Lose All Your Payments For 99325 Next Year
CPT 2009 may contain new combined echocardiography codeA provision in the 2008 Physician F... Read more
STUDIES & REPORTS:
New Research--Patients Need MTM Now
Group's call to action includes youAdd this study to the pile of evidence supporting ... Read more
New Research--Patients Need MTM Now
Group's call to action includes youAdd this study to the pile of evidence supporting ... Read more
CPT 2008:
You May See Money For Substance Abuse Counseling
But will Medicare actually pay for these new codes?Good news: If your doctor goes the extr... Read more
You May See Money For Substance Abuse Counseling
But will Medicare actually pay for these new codes?Good news: If your doctor goes the extr... Read more
CCI EDITS:
Avoid Spinal Surgery Denials By Heading CCI Changes
No modifier will overcome 13.3's hundreds of new surgery editsBad news: You can pretty muc... Read more
Avoid Spinal Surgery Denials By Heading CCI Changes
No modifier will overcome 13.3's hundreds of new surgery editsBad news: You can pretty muc... Read more
HOSPITALS:
Medicare Payments To Hospitals Cut By $20 Billion
Inpatient prospective payment systems changes lauded by LeapfrogStarting Oct. 1, 2007 Medi... Read more
Medicare Payments To Hospitals Cut By $20 Billion
Inpatient prospective payment systems changes lauded by LeapfrogStarting Oct. 1, 2007 Medi... Read more
COMPLIANCE:
Correct Coding Initiative HIts Catheterization, Prostate Surgery Hard
Make sure your documentation justifies an extra $100 per procedureHeads up: October's upda... Read more
Correct Coding Initiative HIts Catheterization, Prostate Surgery Hard
Make sure your documentation justifies an extra $100 per procedureHeads up: October's upda... Read more
PATIENT EDUCATION:
Lead The Way To Part D Subsidies
Make your mantra 'When in doubt, fill it out'If some of your customers are among the milli... Read more
Lead The Way To Part D Subsidies
Make your mantra 'When in doubt, fill it out'If some of your customers are among the milli... Read more
INDUSTRY NOTES:
Elderly Need Education On Immunizations, Screenings
Plus: Get ready to see less for Moh'sMedicare launched a 120-city bus tour this summer to ... Read more
Elderly Need Education On Immunizations, Screenings
Plus: Get ready to see less for Moh'sMedicare launched a 120-city bus tour this summer to ... Read more
COMPLIANCE:
Brace Yourself For Legal Muddles If Stark Proposals Go Through
Comments on the rules are split between pro and conA controversial plan to slash your deal... Read more
Brace Yourself For Legal Muddles If Stark Proposals Go Through
Comments on the rules are split between pro and conA controversial plan to slash your deal... Read more
DRUGS:
Use This Cheat Sheet To Beat Overlap Between Part B And Part D
Remember: As program evolves, so do claim categoriesKeep claims clean--and reduce your exp... Read more
Use This Cheat Sheet To Beat Overlap Between Part B And Part D
Remember: As program evolves, so do claim categoriesKeep claims clean--and reduce your exp... Read more
STARK LAW:
CMS Closes Another Loophole For Joint Ventures
Rural hospitals can pay some of your office's expenses when you recruitGood news: Your doc... Read more
CMS Closes Another Loophole For Joint Ventures
Rural hospitals can pay some of your office's expenses when you recruitGood news: Your doc... Read more
CODING:
Are You Incorrectly Limiting Yourself To Superficial Excisions?
Get the facts to boost your excision reimbursementWhen your physician performs lesion exci... Read more
Are You Incorrectly Limiting Yourself To Superficial Excisions?
Get the facts to boost your excision reimbursementWhen your physician performs lesion exci... Read more
REIMBURSEMENT:
GAO Comes Down On Anesthesiologists' Side
A 32-percent pay hike could be coming your wayAnesthesiologists, rejoice. The Government A... Read more
GAO Comes Down On Anesthesiologists' Side
A 32-percent pay hike could be coming your wayAnesthesiologists, rejoice. The Government A... Read more
AMBULATORY SURGERY CENTERS:
CMS Doubles ASC Standards -- And Your Headaches
Make your voice heard, but also start preparing to complyHeads up: If your doctor's Ambula... Read more
CMS Doubles ASC Standards -- And Your Headaches
Make your voice heard, but also start preparing to complyHeads up: If your doctor's Ambula... Read more
INDUSTRY NOTES:
Seize Last Chance To Avoid 10-Percent Cut
Plus: Medicare will start rejecting claims with non-matching NPIsIt's crunch time: If Cong... Read more
Seize Last Chance To Avoid 10-Percent Cut
Plus: Medicare will start rejecting claims with non-matching NPIsIt's crunch time: If Cong... Read more
LEGISLATION:
Lawmakers Seek Fix For Jams In Part D Cash Flow
Bipartisan support encourages insidersA new bill in the U.S. Senate could lead to speedier... Read more
Lawmakers Seek Fix For Jams In Part D Cash Flow
Bipartisan support encourages insidersA new bill in the U.S. Senate could lead to speedier... Read more
SURGERY:
Add An Extra $200 To Your I&D Reimbursement
Identify the tell-tale signs that your physician's extra effort deserves extra dollarsEven... Read more
Add An Extra $200 To Your I&D Reimbursement
Identify the tell-tale signs that your physician's extra effort deserves extra dollarsEven... Read more
REIMBURSEMENT:
Prepare To Prove Monthly Home Visits Weren't Wasted Trips
Troubleshoot denials with our handy checklistWatch out: When your doctor makes house calls... Read more
Prepare To Prove Monthly Home Visits Weren't Wasted Trips
Troubleshoot denials with our handy checklistWatch out: When your doctor makes house calls... Read more
CODING:
Is Your Practice Losing $160 Every Time You Bill 55876?
Best bet: Be prepared to submit invoices and CPT book photocopiesMyth: You can't ever bill... Read more
Is Your Practice Losing $160 Every Time You Bill 55876?
Best bet: Be prepared to submit invoices and CPT book photocopiesMyth: You can't ever bill... Read more
PHARMACIES:
Don't Waste Your Time Billing Part D Vaccines
Say goodbye to G0377--and hello to collecting from patientsHeads up: You won't be able to ... Read more
Don't Waste Your Time Billing Part D Vaccines
Say goodbye to G0377--and hello to collecting from patientsHeads up: You won't be able to ... Read more
PART B:
Gain An Extra $1600 For Osteotomy
Just because something is 'bundled' doesn't mean you can't bill itMyth: If two procedures ... Read more
Gain An Extra $1600 For Osteotomy
Just because something is 'bundled' doesn't mean you can't bill itMyth: If two procedures ... Read more
PART D:
Tap These 5 Truths To Help Patients Win Coverage
Keep education in mind to counter off-label denialsAll too often, patients' myths and misc... Read more
Tap These 5 Truths To Help Patients Win Coverage
Keep education in mind to counter off-label denialsAll too often, patients' myths and misc... Read more
INDUSTRY NOTES:
Be Proactive In Opposing Return Of PRO Auditors
Plus: Patients will come armed with questions, thanks to new siteA new bill to reform the ... Read more
Be Proactive In Opposing Return Of PRO Auditors
Plus: Patients will come armed with questions, thanks to new siteA new bill to reform the ... Read more
COMPLIANCE:
'Professional Courtesy' Could Cost Tens Of Thousands
A bribe is still a bribe, attorneys warnWarning: If your doctor shows "professional courte... Read more
'Professional Courtesy' Could Cost Tens Of Thousands
A bribe is still a bribe, attorneys warnWarning: If your doctor shows "professional courte... Read more
REIMBURSEMENT:
Tough Times Hit Many Specialty Practices--Is Yours Next?
One practice resorts to borrowing to meet its payrollThink your practice is on an even kee... Read more
Tough Times Hit Many Specialty Practices--Is Yours Next?
One practice resorts to borrowing to meet its payrollThink your practice is on an even kee... Read more
NPIs:
Watch Out For Common NPI Billing Problems
You could be missing warnings of incorrect NPI/legacy number combosMany physician claims c... Read more
Watch Out For Common NPI Billing Problems
You could be missing warnings of incorrect NPI/legacy number combosMany physician claims c... Read more
CODING:
Harvest 'Low-Hanging Fruit' To Boost Your Profits
Avoid this common E/M trapSure, times have been especially challenging for many practices ... Read more
Harvest 'Low-Hanging Fruit' To Boost Your Profits
Avoid this common E/M trapSure, times have been especially challenging for many practices ... Read more
PART D:
New Guidance Gives You Green Light On Vaccines
Part D will cover administration in 2008Medicare Part D's new payments for vaccine adminis... Read more
New Guidance Gives You Green Light On Vaccines
Part D will cover administration in 2008Medicare Part D's new payments for vaccine adminis... Read more
NCCI 13.3 UPDATE:
Cardiologists Win Narrow Escape From Pacemaker/ICD Edits
Rescue your diskectomy-arthroplasty denials soonNeurosurgery news: One of the most trouble... Read more
Cardiologists Win Narrow Escape From Pacemaker/ICD Edits
Rescue your diskectomy-arthroplasty denials soonNeurosurgery news: One of the most trouble... Read more
INDUSTRY NOTES:
OIG To Oncologists--Tighten Your Belts
Plus: Don't let a CMS edit keep you from appealing radiology claimsCancer practices are do... Read more
OIG To Oncologists--Tighten Your Belts
Plus: Don't let a CMS edit keep you from appealing radiology claimsCancer practices are do... Read more
SURGERY:
A Few Extra Words In Your Documentation Could Add $140
If every excision looks the same, it's time to ask questionsPhysicians at Aurora Health Ca... Read more
A Few Extra Words In Your Documentation Could Add $140
If every excision looks the same, it's time to ask questionsPhysicians at Aurora Health Ca... Read more
PHARMACIES:
Medicaid Rate Proposal Could Come Back To Haunt Part D
Fair pay for pharmacies at stake in new legislation.A new Senate bill could help guard you... Read more
Medicaid Rate Proposal Could Come Back To Haunt Part D
Fair pay for pharmacies at stake in new legislation.A new Senate bill could help guard you... Read more
CARDIOLOGISTS:
Educate Yourself About Documenting Catheter Placement For Angiograms
Peripheral procedures could spell extra reimbursement.Watch out: You could be one of the c... Read more
Educate Yourself About Documenting Catheter Placement For Angiograms
Peripheral procedures could spell extra reimbursement.Watch out: You could be one of the c... Read more
REIMBURSEMENT:
One Tell-Tale Sign That A Follow-Up Visit May Be A Level Four
Don't shortchange yourself for 'routine' visits.Myth: If an established patient comes back... Read more
One Tell-Tale Sign That A Follow-Up Visit May Be A Level Four
Don't shortchange yourself for 'routine' visits.Myth: If an established patient comes back... Read more
PART D:
Off-Label Coverage War Heats Up
Pharmacists' role: Know when exceptions and appeals could help.A new report slamming the f... Read more
Off-Label Coverage War Heats Up
Pharmacists' role: Know when exceptions and appeals could help.A new report slamming the f... Read more
CODING:
Tackle The Top-3 ICD-9 Oncology Changes Before The Oct. 1 Deadline Hits
Tried-and-true tactics get your doctor's documentation on board with these more specific c... Read more
Tackle The Top-3 ICD-9 Oncology Changes Before The Oct. 1 Deadline Hits
Tried-and-true tactics get your doctor's documentation on board with these more specific c... Read more
ICD-9:
Size Up ICD-9 2008 Oncology Codes At A Glance
Red alert: Grace periods are in the past--prep now for the Oct. 1 deadline.Oncology is the... Read more
Size Up ICD-9 2008 Oncology Codes At A Glance
Red alert: Grace periods are in the past--prep now for the Oct. 1 deadline.Oncology is the... Read more
INDUSTRY NOTES:
Bill Could Clip Wings Of Drug Plan Marketers
The states should be the watchdogs, lawmakers say.Proposed limits on how Part D prescripti... Read more
Bill Could Clip Wings Of Drug Plan Marketers
The states should be the watchdogs, lawmakers say.Proposed limits on how Part D prescripti... Read more
PHYSICIANS:
Once Again, Congress Opts For A Short-Term Fix To Your Pay Crisis
Urge your senator to support House version of health bill.When it comes to Medicare legisl... Read more
Once Again, Congress Opts For A Short-Term Fix To Your Pay Crisis
Urge your senator to support House version of health bill.When it comes to Medicare legisl... Read more
REIMBURSEMENT:
Steer Clear Of Bundled Codes With 99143-99150
Look for systemic conditions that support moderate sedation.So your Medicare carrier (or p... Read more
Steer Clear Of Bundled Codes With 99143-99150
Look for systemic conditions that support moderate sedation.So your Medicare carrier (or p... Read more
MODIFIERS:
Don't Forget The GS Modifier For High-Hemoglobin ESRD Patients
Check out these sticky new guidelines for ESAs.The Centers for Medicare & Medicaid Ser... Read more
Don't Forget The GS Modifier For High-Hemoglobin ESRD Patients
Check out these sticky new guidelines for ESAs.The Centers for Medicare & Medicaid Ser... Read more
PART B:
Why Nominal Payments Don't Create Any Obligation For You
Exercise your right to request a reasonable patient payment plan -- here's how.Myth: If a ... Read more
Why Nominal Payments Don't Create Any Obligation For You
Exercise your right to request a reasonable patient payment plan -- here's how.Myth: If a ... Read more
CODING:
Take 5 To Get A Jump On How ICD-9 2008 Will Affect You
Use these tactics to help your physician's documentation line up with new specific coding ... Read more
Take 5 To Get A Jump On How ICD-9 2008 Will Affect You
Use these tactics to help your physician's documentation line up with new specific coding ... Read more
BILLING:
Throw Out Your Unlisted Codes For Electronic Brachytherapy
Find out what code you can use for this cancer-treatment system.If your physician has been... Read more
Throw Out Your Unlisted Codes For Electronic Brachytherapy
Find out what code you can use for this cancer-treatment system.If your physician has been... Read more
COMPLIANCE:
OIG Wants To Squeeze Your Drug Payments Further
Doxorubic and Interferon are at the top of the hit list.Warning: Your already low payments... Read more
OIG Wants To Squeeze Your Drug Payments Further
Doxorubic and Interferon are at the top of the hit list.Warning: Your already low payments... Read more
INDUSTRY NOTES:
Rural Counties Could Reap More Cash From Geographic Payment Fix
Plus: Doctor gets one-year sentence for false billing.Physicians who are getting sho... Read more
Rural Counties Could Reap More Cash From Geographic Payment Fix
Plus: Doctor gets one-year sentence for false billing.Physicians who are getting sho... Read more
LEGISLATION:
Don't Wait Until Year's End To Push For Pay Hike
Want a pay boost? Call your Congress member now.Good news: With a 10-percent Medicare phys... Read more
Don't Wait Until Year's End To Push For Pay Hike
Want a pay boost? Call your Congress member now.Good news: With a 10-percent Medicare phys... Read more
PHYSICIANS:
Democrats Push For Sweeping Medicare Changes
'Whole hospital' exemption could be on the chopping block.The CHAMP Act, currently facing ... Read more
Democrats Push For Sweeping Medicare Changes
'Whole hospital' exemption could be on the chopping block.The CHAMP Act, currently facing ... Read more
HEALTH IT:
Get Up-To-Date On What A National 'Network Of Networks' Is Up To
National Health Information Network up and running.If the multifaceted nature of health in... Read more
Get Up-To-Date On What A National 'Network Of Networks' Is Up To
National Health Information Network up and running.If the multifaceted nature of health in... Read more
LEGISLATION:
You May Be Able To Say Goodbye To Annual PayCut Scares
CHAMP Act could K.O. imaging reimbursement.No more cliffhangers: The proposed Children's H... Read more
You May Be Able To Say Goodbye To Annual PayCut Scares
CHAMP Act could K.O. imaging reimbursement.No more cliffhangers: The proposed Children's H... Read more
CMS TRANSMITTALS:
Avoid Billing Medicare For 78609
Also: No NPI, no electronic funds.Heads up: Medicare's Internet-Only Manual (IOM) incorrec... Read more
Avoid Billing Medicare For 78609
Also: No NPI, no electronic funds.Heads up: Medicare's Internet-Only Manual (IOM) incorrec... Read more
PART D:
Many Pharmacies Participate In All Regional Plans
Key finding: Part D coverage doesn't limit pharmacy choice.When it comes to pleasing Part ... Read more
Many Pharmacies Participate In All Regional Plans
Key finding: Part D coverage doesn't limit pharmacy choice.When it comes to pleasing Part ... Read more
PHARMACIES:
New Bill Brings Hope For PBM Reforms
Kickbacks are one concern.Stay tuned this summer for developments in a new effort to level... Read more
New Bill Brings Hope For PBM Reforms
Kickbacks are one concern.Stay tuned this summer for developments in a new effort to level... Read more
CODING:
Watch For Routine Services And Count The Extra Reimbursement
Grab an extra $120 with gall bladder removal.When your general surgeon removes a patient's... Read more
Watch For Routine Services And Count The Extra Reimbursement
Grab an extra $120 with gall bladder removal.When your general surgeon removes a patient's... Read more
FRAUD & ABUSE:
Watch Out For Added Fraud Audits
Are PSCs laying down on the job?Medicare contractors may be turning up the heat on your cl... Read more
Watch Out For Added Fraud Audits
Are PSCs laying down on the job?Medicare contractors may be turning up the heat on your cl... Read more
PHARMACISTS:
Come October, Rates For Generics May Get Scary
Beware final rule for Medicaid payments.If your revenue includes Medicaid payments, read t... Read more
Come October, Rates For Generics May Get Scary
Beware final rule for Medicaid payments.If your revenue includes Medicaid payments, read t... Read more
PHYSICIANS:
You Can Still Bill A Level-4 E/M Visit For A Patient With Abnormal Test Results
How to make your E/M documentation bulletproof -- even with few symptoms.Myth: You can't b... Read more
You Can Still Bill A Level-4 E/M Visit For A Patient With Abnormal Test Results
How to make your E/M documentation bulletproof -- even with few symptoms.Myth: You can't b... Read more
MODIFIERS:
Get Straight On Modifiers 52 And 53
Don't forego discontinued-procedure pay due to modifier confusion.When your physician disc... Read more
Get Straight On Modifiers 52 And 53
Don't forego discontinued-procedure pay due to modifier confusion.When your physician disc... Read more
CODING:
Discover Why A 'Shadow Audit' Could Be Your Salvation
Avoid 3 deadly sins of coronary intervention documentation.If your arterial stent document... Read more
Discover Why A 'Shadow Audit' Could Be Your Salvation
Avoid 3 deadly sins of coronary intervention documentation.If your arterial stent document... Read more
INDUSTRY NOTES:
Revised SCHIP Legislation Could Affect Medicare Payments
Plus: More than a third of doctors don't support the PQRI.Lawmakers have made some changes... Read more
Revised SCHIP Legislation Could Affect Medicare Payments
Plus: More than a third of doctors don't support the PQRI.Lawmakers have made some changes... Read more
NCCI 13.1 UPDATE:
Find Out How Angioplasty Edits Affect HCPCS Codes G0392-3
Make sure you're getting the most out of your claims.Angioplasty codes didn't escape the N... Read more
Find Out How Angioplasty Edits Affect HCPCS Codes G0392-3
Make sure you're getting the most out of your claims.Angioplasty codes didn't escape the N... Read more
PHYSICIANS:
Find Out What Could Put Small Physician Practices Out Of Business
New CMS proposal could force you to scrap most imaging deals.Medicare isn't just threateni... Read more
Find Out What Could Put Small Physician Practices Out Of Business
New CMS proposal could force you to scrap most imaging deals.Medicare isn't just threateni... Read more
PHARMACISTS:
Step Up Communications With Docs To Keep Payments Steady
Promoting generics when appropriate can help.A new study suggests that helping physicians ... Read more
Step Up Communications With Docs To Keep Payments Steady
Promoting generics when appropriate can help.A new study suggests that helping physicians ... Read more
QUALITY-OF-CARE:
Get More Answers To Your Last-Minute PQRI Questions
Don't forget modifiers for measures that don't fit the facts.You may just be starting to s... Read more
Get More Answers To Your Last-Minute PQRI Questions
Don't forget modifiers for measures that don't fit the facts.You may just be starting to s... Read more
HIPAA:
Clear Up Your 'Job Shadowing' Confusion
You can't hide in the privacy rule's shadows.Is your facility bustling with students, trai... Read more
Clear Up Your 'Job Shadowing' Confusion
You can't hide in the privacy rule's shadows.Is your facility bustling with students, trai... Read more
CODING:
Doc On Summer Vacation? Ease Locum Tenens Headaches In 3 Steps
Brush up on the ins and outs of locum tenens billing.Scenario: One of your physicians will... Read more
Doc On Summer Vacation? Ease Locum Tenens Headaches In 3 Steps
Brush up on the ins and outs of locum tenens billing.Scenario: One of your physicians will... Read more
INDUSTRY NOTES:
Switch To Q Codes For Albuterol, Levalbuterol
Backlog of patients trying to bail out of Medicare Advantage plans.Effective July 1, Part ... Read more
Switch To Q Codes For Albuterol, Levalbuterol
Backlog of patients trying to bail out of Medicare Advantage plans.Effective July 1, Part ... Read more
PQRI:
Strategy--Communicate With Partners To Make Sure You're On The Same Page
Your business partners could sabotage your PQRI ramp-up.You may be all primed to go with t... Read more
Strategy--Communicate With Partners To Make Sure You're On The Same Page
Your business partners could sabotage your PQRI ramp-up.You may be all primed to go with t... Read more
READER QUESTION:
Make Sure Your PTs Meet New Certification Requirements
Should physical therapists bill under their own provider numbers?Question: Can a physical ... Read more
Make Sure Your PTs Meet New Certification Requirements
Should physical therapists bill under their own provider numbers?Question: Can a physical ... Read more
LEGISLATION:
Annual Pay Cuts Could Be A Thing Of The Past
But specialties may face their own spending targets.Every year, physicians face a nail-bit... Read more
Annual Pay Cuts Could Be A Thing Of The Past
But specialties may face their own spending targets.Every year, physicians face a nail-bit... Read more
REIMBURSEMENT:
Good News For Anesthesiologists, Bad News For Everyone Else
Cardiologists, ED docs would suffer most from 9.9-percent cut.Bad news: Your Medicare paym... Read more
Good News For Anesthesiologists, Bad News For Everyone Else
Cardiologists, ED docs would suffer most from 9.9-percent cut.Bad news: Your Medicare paym... Read more
ENROLLMENT:
If You're Having Trouble With Your Medicare Enrollment, It May Be Your Own Fault
10 mistakes that could scuttle your Medicare enrollment applications.Don't expect your Med... Read more
If You're Having Trouble With Your Medicare Enrollment, It May Be Your Own Fault
10 mistakes that could scuttle your Medicare enrollment applications.Don't expect your Med... Read more
PQRI:
Here Are The Answers To Your Last-Minute PQRI Questions
Get extra credit for tracking patients' hemoglobin A1C more often.As practices ramped up t... Read more
Here Are The Answers To Your Last-Minute PQRI Questions
Get extra credit for tracking patients' hemoglobin A1C more often.As practices ramped up t... Read more
NEUROSURGERY:
Don't Bill 22855 And 22845 Unless You Can Prove They're Separate
Put a stop to x-stop denials with communication.Heads up: Some Medicare carriers may try t... Read more
Don't Bill 22855 And 22845 Unless You Can Prove They're Separate
Put a stop to x-stop denials with communication.Heads up: Some Medicare carriers may try t... Read more
HIPAA:
Experts Reveal How To Keep Security-Rule Violations At Bay
5 easy ways you can batten down your workstations' hatches.Even the most advanced internal... Read more
Experts Reveal How To Keep Security-Rule Violations At Bay
5 easy ways you can batten down your workstations' hatches.Even the most advanced internal... Read more
INDUSTRY NOTES:
Managed-Care Growth Could Slow Due To Marketing Woes
Plus: AMA doesn't want the government meddling in how physicians treat patients.Seven larg... Read more
Managed-Care Growth Could Slow Due To Marketing Woes
Plus: AMA doesn't want the government meddling in how physicians treat patients.Seven larg... Read more
PART B:
Avoid Reporting 99211 For Diagnostic Testing Services
Audiologists should be heard and not seen (by your doctor).Myth: Audiologists should bill ... Read more
Avoid Reporting 99211 For Diagnostic Testing Services
Audiologists should be heard and not seen (by your doctor).Myth: Audiologists should bill ... Read more
CONSULTS:
Don't Cut The Requesting Doctor Out Of The Loop
Treatment, tests don't mean the visit's not a consult.Good news: One carrier issued a new ... Read more
Don't Cut The Requesting Doctor Out Of The Loop
Treatment, tests don't mean the visit's not a consult.Good news: One carrier issued a new ... Read more
NPIs:
Now's The Time To Double-Check Your Information In The Database
Hurry up and wait for NPI database access.Just when it seemed like your troubles with obta... Read more
Now's The Time To Double-Check Your Information In The Database
Hurry up and wait for NPI database access.Just when it seemed like your troubles with obta... Read more
CMS TRANSMITTALS:
Make Sure Each NPI Matches Up To Only One UPIN -- Or You Could Be In For Headaches
Medicare could auto-deny 100 percent of suspicious claims.Watch out: Medicare's Program Sa... Read more
Make Sure Each NPI Matches Up To Only One UPIN -- Or You Could Be In For Headaches
Medicare could auto-deny 100 percent of suspicious claims.Watch out: Medicare's Program Sa... Read more
CODING:
No Modifier Will Save You From New Digestive Surgery Edits
Watch your laparoscopy coding on the same day as surgery.The latest version of the Correct... Read more
No Modifier Will Save You From New Digestive Surgery Edits
Watch your laparoscopy coding on the same day as surgery.The latest version of the Correct... Read more
CRITICAL CARE Here's What You Need When Reporting Critical Care -- And What You Don't
Dodge critical care mistakes by dispelling 2 myths.A physician can provide critical care j... Read more
Dodge critical care mistakes by dispelling 2 myths.A physician can provide critical care j... Read more
CCI 13.2:
CCI Grants Relief From Spinal Surgery Edits
Also, check out this modifier change for reporting 38745 with 19303.CPT 2006 gave you some... Read more
CCI Grants Relief From Spinal Surgery Edits
Also, check out this modifier change for reporting 38745 with 19303.CPT 2006 gave you some... Read more
REIMBURSEMENT:
Do You Know The Critical Ingredients For A Successful Critical Care Claim?
Test yourself with this sample scenario.Now that you've busted the below two critical care... Read more
Do You Know The Critical Ingredients For A Successful Critical Care Claim?
Test yourself with this sample scenario.Now that you've busted the below two critical care... Read more
HIPAA COMPLIANCE:
How To Write A Business Associate Contract
Where to go to see a sample doc.If you find yourself flummoxed when confronted with the ch... Read more
How To Write A Business Associate Contract
Where to go to see a sample doc.If you find yourself flummoxed when confronted with the ch... Read more
NPIs:
Don't Leave Your Home Address In The Database
At last, you can look up other doctors' NPIs.Any day now you can download a new database f... Read more
Don't Leave Your Home Address In The Database
At last, you can look up other doctors' NPIs.Any day now you can download a new database f... Read more
PAY-FOR-PERFORMANCE:
'Combined Approach' To P4P May Work Best, Demo Results Indicate
Medicaid managed-care P4P demo reveals solutions for future programs.Providers won't coope... Read more
'Combined Approach' To P4P May Work Best, Demo Results Indicate
Medicaid managed-care P4P demo reveals solutions for future programs.Providers won't coope... Read more
LEGISLATION:
Rural Health-Care Facilities Could See A Big Boost In Medicare Reimbursement
Bill would increase the payment-rate cap for rural health clinics.A new bipartisan, Rural ... Read more
Rural Health-Care Facilities Could See A Big Boost In Medicare Reimbursement
Bill would increase the payment-rate cap for rural health clinics.A new bipartisan, Rural ... Read more
MEDICARE PART B:
Think You Can't Bill Medicare For 2 Screenings Per Year? Think Again!
Don't miss out on extra diabetes reimbursement.Fact: The United States spends $100 billion... Read more
Think You Can't Bill Medicare For 2 Screenings Per Year? Think Again!
Don't miss out on extra diabetes reimbursement.Fact: The United States spends $100 billion... Read more
CODING:
Don't Attract Carrier Scrutiny With The Wrong Diagnosis Code
You can bill fracture code only once.Wrong: A patient with a bone fracture still has the f... Read more
Don't Attract Carrier Scrutiny With The Wrong Diagnosis Code
You can bill fracture code only once.Wrong: A patient with a bone fracture still has the f... Read more
COMPLIANCE:
Hospital Ownership--If Doctors Want Out, They Can't Profit From Their Clout
Don't raise suspicions with hospital buyout.If your doctor wants to bail out of owning par... Read more
Hospital Ownership--If Doctors Want Out, They Can't Profit From Their Clout
Don't raise suspicions with hospital buyout.If your doctor wants to bail out of owning par... Read more
HIPPA:
Use These Simple Guidelines To Secure Your HIPAA-Security Training
From the ground up: Tips for building your security training program.Are you certain your ... Read more
Use These Simple Guidelines To Secure Your HIPAA-Security Training
From the ground up: Tips for building your security training program.Are you certain your ... Read more
FRAUD & ABUSE:
Consults, NPP Billing Lead To Big Payouts
Incident-to billing and POS still under OIG's microscope.Three physicians agreed to repay ... Read more
Consults, NPP Billing Lead To Big Payouts
Incident-to billing and POS still under OIG's microscope.Three physicians agreed to repay ... Read more
MEDICARE PART B:
Make Sure You Cover Your Diagnosis-Code Bases
Lesion-removal ignorance could be costing your practice money.Myth: Medicare won't pay for... Read more
Make Sure You Cover Your Diagnosis-Code Bases
Lesion-removal ignorance could be costing your practice money.Myth: Medicare won't pay for... Read more
PQRI:
Some Practices Decide The PQRI Bonus Won't Add Up
Is it worth the extra effort?Eye Center of Central Georgia was preparing to participate in... Read more
Some Practices Decide The PQRI Bonus Won't Add Up
Is it worth the extra effort?Eye Center of Central Georgia was preparing to participate in... Read more
MODIFIERS:
How 'Unrelated' Is 'Unrelated To The Original Surgery'?
When you should use the 79 modifier for post-operative issues. Although many providers ar... Read more
How 'Unrelated' Is 'Unrelated To The Original Surgery'?
When you should use the 79 modifier for post-operative issues. Although many providers ar... Read more
REIMBURSEMENT:
3 Ways To Do Dx Coding Right
Signs and symptoms may sometimes be your best choice. Choosing the right CPT procedure cod... Read more
3 Ways To Do Dx Coding Right
Signs and symptoms may sometimes be your best choice. Choosing the right CPT procedure cod... Read more
ICD-9:
Check The Diagnosis--All Migranes Are Not The Same
Intractable versus non-intractable can set your reimbursement success. Before coding for ... Read more
Check The Diagnosis--All Migranes Are Not The Same
Intractable versus non-intractable can set your reimbursement success. Before coding for ... Read more
HIPAA:
Selecting Certified Software Is A Crucial Step On The Road To Compliance
The feds are making health IT a top priority--are you? The government is demanding increas... Read more
Selecting Certified Software Is A Crucial Step On The Road To Compliance
The feds are making health IT a top priority--are you? The government is demanding increas... Read more
CODING:
Key Steps To Making The Most Of Injection Claims
Train your MD to document the muscles clearly -- so you can code correctly. You may be sub... Read more
Key Steps To Making The Most Of Injection Claims
Train your MD to document the muscles clearly -- so you can code correctly. You may be sub... Read more
DME:
Prepare For Hassles With Winning DME Bidders
Doctors can't dispense DME to anyone else's patients.Attention: Now's the time to make sur... Read more
Prepare For Hassles With Winning DME Bidders
Doctors can't dispense DME to anyone else's patients.Attention: Now's the time to make sur... Read more
LEGISLATION:
You May Be Able To Continue Reporting On 2007's Quality Measures Into 2008
Slow down on pay for reporting/performance, senator demands.You could gain some breathing ... Read more
You May Be Able To Continue Reporting On 2007's Quality Measures Into 2008
Slow down on pay for reporting/performance, senator demands.You could gain some breathing ... Read more
PQRI:
Start Reporting Quality Indicators, Regardless Of Whether Your Doctor Met Them
Learn the PQRI ropes now--or get tied in knots.It's crunch time: If you don't start report... Read more
Start Reporting Quality Indicators, Regardless Of Whether Your Doctor Met Them
Learn the PQRI ropes now--or get tied in knots.It's crunch time: If you don't start report... Read more
DME:
Choose PQRI Measures You Know You Can Keep Up On
Why oncologists might have an advantage.There are two ways to choose which Physician Quali... Read more
Choose PQRI Measures You Know You Can Keep Up On
Why oncologists might have an advantage.There are two ways to choose which Physician Quali... Read more
MEDICARE PART D:
Get Some Closure By Billing 13160 For A Return To The OR
If it's in you log, it should be in your charge sheet.Times are getting tougher, and your ... Read more
Get Some Closure By Billing 13160 For A Return To The OR
If it's in you log, it should be in your charge sheet.Times are getting tougher, and your ... Read more
CODING:
Are You Setting This 59-Modifier Audit Bait?
Quick test can say for sure.Myth: If you do two bundled procedures in the same session but... Read more
Are You Setting This 59-Modifier Audit Bait?
Quick test can say for sure.Myth: If you do two bundled procedures in the same session but... Read more
ICD-9:
Don't Make Up Your Own Extra Digit For Incomplete ICD-9 Codes
No diagnosis? No problem, Code signs and symptoms -- and get paid.In the absence of a conf... Read more
Don't Make Up Your Own Extra Digit For Incomplete ICD-9 Codes
No diagnosis? No problem, Code signs and symptoms -- and get paid.In the absence of a conf... Read more
PHYSICIANS:
Successful Practices Offer Their Tips On Preparing For The PQRI
Alert: Your physician may be meeting quality measures, but not documenting.Practices are g... Read more
Successful Practices Offer Their Tips On Preparing For The PQRI
Alert: Your physician may be meeting quality measures, but not documenting.Practices are g... Read more
INDUSTRY NOTES:
Brace Yourself For More Audits Of Debridement Services
Plus: 60 percent of doctors could scale back on Medicare next year.Red alert: Nearly two-t... Read more
Brace Yourself For More Audits Of Debridement Services
Plus: 60 percent of doctors could scale back on Medicare next year.Red alert: Nearly two-t... Read more
ENROLLMENT:
You'll Have A Physician NPI Directory At Last
HHS to make info available on the Internet.You finally have a date that you can expect a N... Read more
You'll Have A Physician NPI Directory At Last
HHS to make info available on the Internet.You finally have a date that you can expect a N... Read more
PART B:
NPPs Can Help With The Tough Cases, Too
But you'll need to school your payors to get proper reimbursement.Myth: Non-physician prac... Read more
NPPs Can Help With The Tough Cases, Too
But you'll need to school your payors to get proper reimbursement.Myth: Non-physician prac... Read more
STUDIES & REPORT:
Part D Hurts Your Patients' Access To Psychiatric Drugs
Problems persist, researchers say.The verdict is in: Medicare Part D is bad news for patie... Read more
Part D Hurts Your Patients' Access To Psychiatric Drugs
Problems persist, researchers say.The verdict is in: Medicare Part D is bad news for patie... Read more
DME:
Encourage Medicare To Exempt Physicians From Accreditation Requirement
Master DME accreditation now -- or risk falling behind.Are you ready to seek accreditation... Read more
Encourage Medicare To Exempt Physicians From Accreditation Requirement
Master DME accreditation now -- or risk falling behind.Are you ready to seek accreditation... Read more
E-PRESCRIBING:
What E-Standards Will -- And Won't -- Do For You
One thing is for sure: You'll still be on your own with prior authorization.Looking for in... Read more
What E-Standards Will -- And Won't -- Do For You
One thing is for sure: You'll still be on your own with prior authorization.Looking for in... Read more
FRAUD & ABUSE:
Warning--Medicare Spent More Than A Billion Dollars On Improper Consults
Use modifiers in moderation, or face dire consequences.Heads up: Your use of the 25 and 59... Read more
Warning--Medicare Spent More Than A Billion Dollars On Improper Consults
Use modifiers in moderation, or face dire consequences.Heads up: Your use of the 25 and 59... Read more
PHYSICIANS:
Watch Out--These Common Billing Errors Trigger Rejections
Be prepared to record the same information more than once.You can't write the word "SAME" ... Read more
Watch Out--These Common Billing Errors Trigger Rejections
Be prepared to record the same information more than once.You can't write the word "SAME" ... Read more
MODIFIERS:
Check Surgeon's Notes, Talk To Surgeon To Make Sure Modifier 58 Applies
Look for plan or expanded procedure to justify 58 modifier.All the world may be a stage, b... Read more
Check Surgeon's Notes, Talk To Surgeon To Make Sure Modifier 58 Applies
Look for plan or expanded procedure to justify 58 modifier.All the world may be a stage, b... Read more
INDUSTRY NOTES:
Comment Now On Revised ABN
Plus: Check out CMS' worksheets that can help you to keep track of your PQRI quality indic... Read more
Comment Now On Revised ABN
Plus: Check out CMS' worksheets that can help you to keep track of your PQRI quality indic... Read more
PART B:
Heads Up, Physicians--The World Doesn't Always Revolve Around The Global Period
The end of surgery doesn't have to be the end of your reimbursement.Myth: You can't bill f... Read more
Heads Up, Physicians--The World Doesn't Always Revolve Around The Global Period
The end of surgery doesn't have to be the end of your reimbursement.Myth: You can't bill f... Read more
MEDICARE PART D:
Part D Formularies Could Look A Lot Different In 2008
Keep a close eye on these 3 Part D policy shifts.The feds have issued their final directiv... Read more
Part D Formularies Could Look A Lot Different In 2008
Keep a close eye on these 3 Part D policy shifts.The feds have issued their final directiv... Read more
COMPLIANCE:
Protect Patients By Noting These Part D Requirements
Formulary clarifications warrant close watch.The feds' final call letter notes two other f... Read more
Protect Patients By Noting These Part D Requirements
Formulary clarifications warrant close watch.The feds' final call letter notes two other f... Read more
ANESTHESIOLOGISTS:
Don't Cast Away Cast-Application Money
Gain an extra 5 anesthesia units by noting catheter placement.Are you reporting all the se... Read more
Don't Cast Away Cast-Application Money
Gain an extra 5 anesthesia units by noting catheter placement.Are you reporting all the se... Read more
HEALTH IT:
Ready Or Not, You're 3 Steps Closer To E-Prescribing
Don't let costs drive you away.Keep electronic prescribing on your Part D radar screen, or... Read more
Ready Or Not, You're 3 Steps Closer To E-Prescribing
Don't let costs drive you away.Keep electronic prescribing on your Part D radar screen, or... Read more
SLPs:
Look Out For More Descriptive Terms Under Dysphagia And Hearing Loss
Gear up for a slew of new 787.xx and 389.xx ICD-9s.The feds have released a tentative list... Read more
Look Out For More Descriptive Terms Under Dysphagia And Hearing Loss
Gear up for a slew of new 787.xx and 389.xx ICD-9s.The feds have released a tentative list... Read more
PHYSICIANS:
Change Is In The Air For Physicians Billing Medicare
Medicare could soon single out expensive doctors, bundle more services.Warning: Drastic mo... Read more
Change Is In The Air For Physicians Billing Medicare
Medicare could soon single out expensive doctors, bundle more services.Warning: Drastic mo... Read more
PQRI:
Look For Instances Of Your Doctors Providing Care Outside Their Specialties
You won't know if you're meeting PQRI requirements, but you can prepare.It's confusing and... Read more
Look For Instances Of Your Doctors Providing Care Outside Their Specialties
You won't know if you're meeting PQRI requirements, but you can prepare.It's confusing and... Read more
ICD-9 CODES:
Heads Up--Dysphagia, Genetic History Codes Gain Fifth Digits
Fit the correct lymphoma diagnosis to the drug to ensure payment. You'll have 54 new lymph... Read more
Heads Up--Dysphagia, Genetic History Codes Gain Fifth Digits
Fit the correct lymphoma diagnosis to the drug to ensure payment. You'll have 54 new lymph... Read more
REIMBURSEMENT:
6 Tips For Getting Paid For MAC Claims
Be prepared for your carrier to demand out-of-date modifiers.Don't take your carrier's ane... Read more
6 Tips For Getting Paid For MAC Claims
Be prepared for your carrier to demand out-of-date modifiers.Don't take your carrier's ane... Read more
CODING:
New Codes Will Distinguish Between Disease- And Drug-Related Diabetes
Your diabetes coding will become more accurate in late 2008.Hang in there: The long-awaite... Read more
New Codes Will Distinguish Between Disease- And Drug-Related Diabetes
Your diabetes coding will become more accurate in late 2008.Hang in there: The long-awaite... Read more
THERAPISTS:
4 Tips Uncover Some Hidden Cash-Saving Options
Don't give up in the face of per diem reimbursement.Therapy providers across the country a... Read more
4 Tips Uncover Some Hidden Cash-Saving Options
Don't give up in the face of per diem reimbursement.Therapy providers across the country a... Read more
HIPAA COMPLIANCE:
Avoid Rough Waters WIth A Business Associate Agreement
Have you hit the PHI creek without a paddle?Do you store your protected health information... Read more
Avoid Rough Waters WIth A Business Associate Agreement
Have you hit the PHI creek without a paddle?Do you store your protected health information... Read more
INDUSTRY NOTES:
Norwalk Out, Weems In At CMS
Plus: Beware of automatic consults in the ED.President Bush has nominated Department of He... Read more
Norwalk Out, Weems In At CMS
Plus: Beware of automatic consults in the ED.President Bush has nominated Department of He... Read more
PHYSICIANS:
Educate Your Practice's Staff On Quality Reporting And Perform A Test Run Soon
Less than 2 months remain to win 1.5 percent bonus.Are you ready to throw away thousands o... Read more
Educate Your Practice's Staff On Quality Reporting And Perform A Test Run Soon
Less than 2 months remain to win 1.5 percent bonus.Are you ready to throw away thousands o... Read more
SPECIALTY HOSPITALS:
New ASC Rule May Cap Doctors' Payments At Office Rates
CMS lets physician-ownership cat out of the bag.If your physicians own or operate a specia... Read more
New ASC Rule May Cap Doctors' Payments At Office Rates
CMS lets physician-ownership cat out of the bag.If your physicians own or operate a specia... Read more
HOME HEALTH:
CMS Throws The Brakes On Expanding Your CAS Payments
The only hope for many patients: clinical trials.You can stop looking out for asymptomatic... Read more
CMS Throws The Brakes On Expanding Your CAS Payments
The only hope for many patients: clinical trials.You can stop looking out for asymptomatic... Read more
HOME HEALTH:
OIG Adds To Blame-The-Providers Dogpile At Carriers
Report cites providers' dragging their feet when responding to requests for info.If you're... Read more
OIG Adds To Blame-The-Providers Dogpile At Carriers
Report cites providers' dragging their feet when responding to requests for info.If you're... Read more
THERAPISTS:
Cleanly Bill Your Attended Modalities
Check out this reader question to clear up confusion on therapy services billing.Question:... Read more
Cleanly Bill Your Attended Modalities
Check out this reader question to clear up confusion on therapy services billing.Question:... Read more
NPIs:
You Have Until May 2008 To Include Referring Docs' New Numbers
But new drop-dead NPI deadline may be as soon as July.That wiggle room you're supposed to ... Read more
You Have Until May 2008 To Include Referring Docs' New Numbers
But new drop-dead NPI deadline may be as soon as July.That wiggle room you're supposed to ... Read more
PRIVACY:
Take A Peek At This Site To Get A Privacy Rule Refresher
HHS launches new HIPAA privacy rule Web site.As we near the fourth anniversary of Health I... Read more
Take A Peek At This Site To Get A Privacy Rule Refresher
HHS launches new HIPAA privacy rule Web site.As we near the fourth anniversary of Health I... Read more
HIPAA:
Feds Get 'Hands On' With HIPAA Security Compliance
New security rule crackdown could strike you.A low-key approach to keeping tabs on your pr... Read more
Feds Get 'Hands On' With HIPAA Security Compliance
New security rule crackdown could strike you.A low-key approach to keeping tabs on your pr... Read more
INDUSTRY NOTES:
Your Quality Data Could Lead To Comparison Shopping
Plus: Concerns intensify regarding PCP shortage.Watch out: The quality data you prov... Read more
Your Quality Data Could Lead To Comparison Shopping
Plus: Concerns intensify regarding PCP shortage.Watch out: The quality data you prov... Read more
DME:
Good News--Therapists Exempt From Competitive Bidding Process
But you'll still need accreditation.It's official: The final rule implementing Medicare's ... Read more
Good News--Therapists Exempt From Competitive Bidding Process
But you'll still need accreditation.It's official: The final rule implementing Medicare's ... Read more
HOME HEALTH:
Why You Don't Need To Stop Providing Infrared Therapy For Diabetic Neuropathy
Medicare non-coverage could reduce your PPS payment rates by thousands unless you know the... Read more
Why You Don't Need To Stop Providing Infrared Therapy For Diabetic Neuropathy
Medicare non-coverage could reduce your PPS payment rates by thousands unless you know the... Read more
PHYSICIANS:
6 Myths That Could Turn Off Your Cash Flow
Learn the difference between 'requirements' and 'received wisdom.'You could be accepting p... Read more
6 Myths That Could Turn Off Your Cash Flow
Learn the difference between 'requirements' and 'received wisdom.'You could be accepting p... Read more
ED CODING:
Knowing Where To Look Can Provide All The Info For Proper Coding
Rely on physician's notes when selecting Dx codes.Incomplete documentation greatly damages... Read more
Knowing Where To Look Can Provide All The Info For Proper Coding
Rely on physician's notes when selecting Dx codes.Incomplete documentation greatly damages... Read more
HOSPITALS:
You No Longer Have To Adhere To Transmittal 65's Tricky Policies
Certain California PTAs can relax about losing their jobs.If you're a hospital-based inpat... Read more
You No Longer Have To Adhere To Transmittal 65's Tricky Policies
Certain California PTAs can relax about losing their jobs.If you're a hospital-based inpat... Read more
HIPAA:
HHS Security Guidance Targets Electronic PHI
Don't let HIPAA breaches trip up your facility.The Health Insurance Portability and Accoun... Read more
HHS Security Guidance Targets Electronic PHI
Don't let HIPAA breaches trip up your facility.The Health Insurance Portability and Accoun... Read more
HEALTH INSURERS:
Watch Your MA Plans' Pay -- Congress Is Sharpening Its Axe
CBO, MedPAC eyes your reimbursement as revenue source.Heads up, Medicare Advantage (MA) pl... Read more
Watch Your MA Plans' Pay -- Congress Is Sharpening Its Axe
CBO, MedPAC eyes your reimbursement as revenue source.Heads up, Medicare Advantage (MA) pl... Read more
CODING:
Don't Let Fear Of Concurrent Billing -- Curtail Your Critical Care
Patient must really be critically ill.Myth: Two providers can't bill for critical care for... Read more
Don't Let Fear Of Concurrent Billing -- Curtail Your Critical Care
Patient must really be critically ill.Myth: Two providers can't bill for critical care for... Read more
REIMBURSEMENT:
Keep Number Of Units Straight For 17003 and 17111
Only one diagnosis will get you paid for 17000-17004.Heads up: Relying on your carrier's l... Read more
Keep Number Of Units Straight For 17003 and 17111
Only one diagnosis will get you paid for 17000-17004.Heads up: Relying on your carrier's l... Read more
MA PLANS:
Medicare Advantage Leaves Traditional Medicare Recipients At A Disadvantage
Minorities contend that MA changes could cut quality of care.In an effort to find funding ... Read more
Medicare Advantage Leaves Traditional Medicare Recipients At A Disadvantage
Minorities contend that MA changes could cut quality of care.In an effort to find funding ... Read more
NPIs:
How You Can Navigate The NPI Gray Areas
Avoid payment hold-ups with 'good faith effort' on NPIs.If some of the payors you deal wit... Read more
How You Can Navigate The NPI Gray Areas
Avoid payment hold-ups with 'good faith effort' on NPIs.If some of the payors you deal wit... Read more
CONSULTS:
Agonizing Audits May Settle Consult Issue
But consult confusion will continue into next year.What's the difference between a consult... Read more
Agonizing Audits May Settle Consult Issue
But consult confusion will continue into next year.What's the difference between a consult... Read more
NPIs:
CMS Admits Defeat, Promises Progress On NPI-Sharing
Providers breathe a little easier with 1-year NPI extension.Good news: You'll have an extr... Read more
CMS Admits Defeat, Promises Progress On NPI-Sharing
Providers breathe a little easier with 1-year NPI extension.Good news: You'll have an extr... Read more
COMPLIANCE:
Don't Expect Everybody Else To Be Up To Speed In Time
Extra NPI leeway may be a trap--Watch for this glitch.You now have an extra year to get up... Read more
Don't Expect Everybody Else To Be Up To Speed In Time
Extra NPI leeway may be a trap--Watch for this glitch.You now have an extra year to get up... Read more
P4P:
Paying Medicare Physicians For Performance Doesn't Make Sense, Researchers Claim
Hospitals thrive but primary care applications falter.The concept of paying for performanc... Read more
Paying Medicare Physicians For Performance Doesn't Make Sense, Researchers Claim
Hospitals thrive but primary care applications falter.The concept of paying for performanc... Read more
CODING:
Are You Using Basic Modifiers Correctly? Time To Double-Check
Billing and rendering provider must be in the same group.You may think you know your ABCs ... Read more
Are You Using Basic Modifiers Correctly? Time To Double-Check
Billing and rendering provider must be in the same group.You may think you know your ABCs ... Read more
REIMBURSEMENT:
Here's A 2006-To-2007 Crosswalk Of Some Of Your Most Used Radiology Codes
Say goodbye to 2006 mammogram codes.CPT 2007 offers up a massive radiology code reorganiza... Read more
Here's A 2006-To-2007 Crosswalk Of Some Of Your Most Used Radiology Codes
Say goodbye to 2006 mammogram codes.CPT 2007 offers up a massive radiology code reorganiza... Read more
PAYMENTS:
Don't Miss Out On Reimbursement For Post-Bariatric Excess Skin Removal
Make sure your doctor signs off on nurse's portion of visit.Heads up: If you're letting yo... Read more
Don't Miss Out On Reimbursement For Post-Bariatric Excess Skin Removal
Make sure your doctor signs off on nurse's portion of visit.Heads up: If you're letting yo... Read more
PHYSICIANS:
Test Yourself Against These Coding And Compliance Pitfalls
4 deadly myths that could wreck your practice.Does your staff subscribe to any of the most... Read more
Test Yourself Against These Coding And Compliance Pitfalls
4 deadly myths that could wreck your practice.Does your staff subscribe to any of the most... Read more
INDUSTRY NOTES:
Medicare Already Has Toolkit For Finding Wasteful Doctors
Plus: Master the 1P, 2P and 3P modifiers to protect your bonus.Medicare could use "profili... Read more
Medicare Already Has Toolkit For Finding Wasteful Doctors
Plus: Master the 1P, 2P and 3P modifiers to protect your bonus.Medicare could use "profili... Read more
ENROLLMENT:
Enrollment Disasters Leave Practices In Cash-Flow Limbo
You could advance 4 months' credit to Medicare for new doctors.If your carrier is First Co... Read more
Enrollment Disasters Leave Practices In Cash-Flow Limbo
You could advance 4 months' credit to Medicare for new doctors.If your carrier is First Co... Read more
HOME HEALTH:
Be Sure Your Therapy Visit Number Fits Under A New Coverage Policy Limit
Stay alert: Therapy utilization guidelines to hit agencies.The feds and payers have had th... Read more
Be Sure Your Therapy Visit Number Fits Under A New Coverage Policy Limit
Stay alert: Therapy utilization guidelines to hit agencies.The feds and payers have had th... Read more
PHYSICIANS:
PQRI 'Cap' May Force You To Report More Services
Why you could do everything right and still not receive the 1.5-percent bonus.As paltry as... Read more
PQRI 'Cap' May Force You To Report More Services
Why you could do everything right and still not receive the 1.5-percent bonus.As paltry as... Read more
QUALITY REPORTING:
It's Not Too Early To Start Figuring Out How To Capture Quality Data
Improve communication between clinical and admin sides -- or lose out.While your physician... Read more
It's Not Too Early To Start Figuring Out How To Capture Quality Data
Improve communication between clinical and admin sides -- or lose out.While your physician... Read more
INPATIENT INSIGHTS:
Tip--Create A 30-Minute Buffer To Allow For Patient Breaks
Nail your 3-hour rule without cheating the system.Squeezing in those three required hours ... Read more
Tip--Create A 30-Minute Buffer To Allow For Patient Breaks
Nail your 3-hour rule without cheating the system.Squeezing in those three required hours ... Read more
CODING & COMPLIANCE:
Look For Questions That Go Beyond The Patient's 'Chief Complaint'
Don't turn your E/M claims into audit bait.When you assign an evaluation & management ... Read more
Look For Questions That Go Beyond The Patient's 'Chief Complaint'
Don't turn your E/M claims into audit bait.When you assign an evaluation & management ... Read more
REIMBURSEMENT:
Are You Ready For A Conversion Factor Of $34.14?
Senate hearing results in no answers.If the experts can't even figure out how to rescue yo... Read more
Are You Ready For A Conversion Factor Of $34.14?
Senate hearing results in no answers.If the experts can't even figure out how to rescue yo... Read more
NATIONAL PROVIDER IDENTIFIER:
You'll Have 'Guidance' By Deadline, CMS Promises
Will May bring you a shower of NPI-related denials?Heads up: There are just about two mont... Read more
You'll Have 'Guidance' By Deadline, CMS Promises
Will May bring you a shower of NPI-related denials?Heads up: There are just about two mont... Read more
CODING:
A Modifier Won't Help You To Override Dozens Of Edits Anymore
Start resubmitting denied cystourethroscopy, craniotomy claims.Heads up: The Correct Codin... Read more
A Modifier Won't Help You To Override Dozens Of Edits Anymore
Start resubmitting denied cystourethroscopy, craniotomy claims.Heads up: The Correct Codin... Read more
CCI 13.1:
You Can't Ever Bill Two Hospital Visits To The Same Patient On The Same Day
Don't bill chemodenervation with neurological testing.There's no reason you would ever hav... Read more
You Can't Ever Bill Two Hospital Visits To The Same Patient On The Same Day
Don't bill chemodenervation with neurological testing.There's no reason you would ever hav... Read more
HIPAA:
Stop, Drop And Roll To Extinguish Privacy Fires
What to do when a PHI violation occurs.If you're faced with one of your worst nightmares--... Read more
Stop, Drop And Roll To Extinguish Privacy Fires
What to do when a PHI violation occurs.If you're faced with one of your worst nightmares--... Read more
CODING:
Perfect Your Cholecystectomy Claims--Our Expert Advice Shows You How
Open versus laparoscopic is one of several important factors.Do you want to be sure that y... Read more
Perfect Your Cholecystectomy Claims--Our Expert Advice Shows You How
Open versus laparoscopic is one of several important factors.Do you want to be sure that y... Read more
PRIVACY:
Check Out This Tip For HIPAA-Compliant Psychotherapy
For mental health privacy, let patient notes prevail.While the Health Insurance Portabilit... Read more
Check Out This Tip For HIPAA-Compliant Psychotherapy
For mental health privacy, let patient notes prevail.While the Health Insurance Portabilit... Read more
QUALITY:
Thousands Of Dollars Could Depend On A Few Extra 'G' Codes
Make sure you know which quality measures apply.With your practice's margins narrower than... Read more
Thousands Of Dollars Could Depend On A Few Extra 'G' Codes
Make sure you know which quality measures apply.With your practice's margins narrower than... Read more
NPIs:
Get Ready For More Paperwork Headaches Under A Dual Number System For Surveys
NPIs won't replace Medicare numbers.Think the National Provider Identifier (NPI) numbers r... Read more
Get Ready For More Paperwork Headaches Under A Dual Number System For Surveys
NPIs won't replace Medicare numbers.Think the National Provider Identifier (NPI) numbers r... Read more
CODING:
You Can't Bill Radiation Therapy Management With X-Ray Guidance
CCI 13.1 will delete troublesome stereotactic edits.Radiation therapy providers have been ... Read more
You Can't Bill Radiation Therapy Management With X-Ray Guidance
CCI 13.1 will delete troublesome stereotactic edits.Radiation therapy providers have been ... Read more
DOCUMENTATION:
Don't Fall Into 'Double Dipping' Unless You're Sure You Can Justify It
How one statement could rescue your E/M coding levels.Question: Can you use the same eleme... Read more
Don't Fall Into 'Double Dipping' Unless You're Sure You Can Justify It
How one statement could rescue your E/M coding levels.Question: Can you use the same eleme... Read more
BILLING:
6 Tips To Make Billing The New AAA Screening Easy
Document your 'Welcome To Medicare' referral.Your practice may soon be receiving referrals... Read more
6 Tips To Make Billing The New AAA Screening Easy
Document your 'Welcome To Medicare' referral.Your practice may soon be receiving referrals... Read more
FRAUD & ABUSE:
Medicare Fraud-Hunters Expand Nationwide
Physician group urges CMS to have its RACs focus only on hospitals.The Recovery Audit Cont... Read more
Medicare Fraud-Hunters Expand Nationwide
Physician group urges CMS to have its RACs focus only on hospitals.The Recovery Audit Cont... Read more
COMPLIANCE:
Beware--An Office Visit Can't Count As A Hospital Admission
'Bounty hunters' may be scrutinizing your inpatient E/M visits.Myth: A physician can bill ... Read more
Beware--An Office Visit Can't Count As A Hospital Admission
'Bounty hunters' may be scrutinizing your inpatient E/M visits.Myth: A physician can bill ... Read more
HIPAA PRIVACY:
4 Privacy Rule Mistakes You Can't Afford To Make
Don't muddle your compliance with misinterpretations.Is your organization still struggling... Read more
4 Privacy Rule Mistakes You Can't Afford To Make
Don't muddle your compliance with misinterpretations.Is your organization still struggling... Read more
INDUSTRY NOTES:
Two At A Time Doesn't Count As 'Continuous,' Court Rules
Plus: Why most seniors aren't seeking generic alternatives.An anesthesiologist who routine... Read more
Two At A Time Doesn't Count As 'Continuous,' Court Rules
Plus: Why most seniors aren't seeking generic alternatives.An anesthesiologist who routine... Read more
ABNs:
Take Your Opportunity To Comment On New ABN Form
Say goodbye to payment up front for non-covered services.If the Advance Beneficiary Notice... Read more
Take Your Opportunity To Comment On New ABN Form
Say goodbye to payment up front for non-covered services.If the Advance Beneficiary Notice... Read more
BILLING:
You Can't Use ABNs To Collect Extra From Patients
The ABN is not a cure-all for your non-paid services.Confused by the extra paperwork ... Read more
You Can't Use ABNs To Collect Extra From Patients
The ABN is not a cure-all for your non-paid services.Confused by the extra paperwork ... Read more
EHRs:
Will Your E/M Notes Stand Up To EHR Audit Scrutiny?
Beware: Too much cutting and pasting could wound you.Your electronic health records (EHRs)... Read more
Will Your E/M Notes Stand Up To EHR Audit Scrutiny?
Beware: Too much cutting and pasting could wound you.Your electronic health records (EHRs)... Read more
TECHNOLOGY:
Even The Best Documentation May Not Stand Up In Court
Talk to your vendor now about improving your EHR.Don't wait until RTI International (RTI) ... Read more
Even The Best Documentation May Not Stand Up In Court
Talk to your vendor now about improving your EHR.Don't wait until RTI International (RTI) ... Read more
ENFORCEMENT:
Why Reviewing The Final Enforcement Rule's Provisions Could Save You Time And Money
HIPAA widens scope, toughens penalties with final rule.How much do you know about the prov... Read more
Why Reviewing The Final Enforcement Rule's Provisions Could Save You Time And Money
HIPAA widens scope, toughens penalties with final rule.How much do you know about the prov... Read more
SCHIP:
SCHIP Funding Could Run Out Before Reauthorization
Without a funding increase, 1.3 million children will lose their health insurance.While Wa... Read more
SCHIP Funding Could Run Out Before Reauthorization
Without a funding increase, 1.3 million children will lose their health insurance.While Wa... Read more
HIPAA SECURITY:
Laptops In The Field Okay--But Vulnerable, Guidance Says
Review security rule policies, feds urge.Make sure you didn't miss this in the winter-holi... Read more
Laptops In The Field Okay--But Vulnerable, Guidance Says
Review security rule policies, feds urge.Make sure you didn't miss this in the winter-holi... Read more
INDUSTRY NOTES:
Brochure Could Help You Avoid A Violation
Plus: New site may prevent communication gaps.If you have questions about what constitutes... Read more
Brochure Could Help You Avoid A Violation
Plus: New site may prevent communication gaps.If you have questions about what constitutes... Read more
RADIOLOGISTS:
Learn How 2007 TC Pay Cuts Will Cramp Your Radiology Budget
Bonus: Get the latest on AAA screening coverage.Keeping track of payor updates at this tim... Read more
Learn How 2007 TC Pay Cuts Will Cramp Your Radiology Budget
Bonus: Get the latest on AAA screening coverage.Keeping track of payor updates at this tim... Read more
HOSPITAL THERAPISTS:
Your Expectations Aren't Far From Part B Settings', CMS Says
Hospital rehabs: turn your eye to outpatient therapy policies.If you are happily settled i... Read more
Your Expectations Aren't Far From Part B Settings', CMS Says
Hospital rehabs: turn your eye to outpatient therapy policies.If you are happily settled i... Read more
PHYSICIANS:
CMS Introduces The New Physician Quality Reporting Initiative, But Will It Work?
The AQA Alliance and Institute of Medicine call for more comprehensive quality control sta... Read more
CMS Introduces The New Physician Quality Reporting Initiative, But Will It Work?
The AQA Alliance and Institute of Medicine call for more comprehensive quality control sta... Read more
CODING:
Nix NCCI Edit Headaches With This Override Tip
How to get extra reimbursement for bundled codes.Good news: Under certain circumstances yo... Read more
Nix NCCI Edit Headaches With This Override Tip
How to get extra reimbursement for bundled codes.Good news: Under certain circumstances yo... Read more
CLAIMS PROCESSING:
Make Sure Your Software Is Ready To Handle These Changes
Use these expert tips to prepare for the new UB-04 form.By May 23, all institutional paper... Read more
Make Sure Your Software Is Ready To Handle These Changes
Use these expert tips to prepare for the new UB-04 form.By May 23, all institutional paper... Read more
INDUSTRY NOTES:
Congress Re-Introduces Therapy Cap Repeal Bill
Plus: Not-guilty verdict in Medicare fraud case.The newly elected 110th Congress hasn't fo... Read more
Congress Re-Introduces Therapy Cap Repeal Bill
Plus: Not-guilty verdict in Medicare fraud case.The newly elected 110th Congress hasn't fo... Read more
CODING:
Good News--You Can Bill A Distinct E/M Visit Separately With This Bladder-Scan Code
Don't miss reimbursement opportunities with 51798.Do you know the score about bladder-scan... Read more
Good News--You Can Bill A Distinct E/M Visit Separately With This Bladder-Scan Code
Don't miss reimbursement opportunities with 51798.Do you know the score about bladder-scan... Read more
PHYSICIANS:
Check To Make Sure The FDA Approved Your Test Kit For Home Use
One wrong digit could send your 83037 claims into the denial pile.Code 83037, introduced l... Read more
Check To Make Sure The FDA Approved Your Test Kit For Home Use
One wrong digit could send your 83037 claims into the denial pile.Code 83037, introduced l... Read more
NEUROLOGY:
This Carrier Will Monitor NCS Billings For Problems
Don't bill nerve conduction studies unless you can document necessity.Watch out: If a manu... Read more
This Carrier Will Monitor NCS Billings For Problems
Don't bill nerve conduction studies unless you can document necessity.Watch out: If a manu... Read more
MEDICARE:
Health Care Costs Will Double In 10 Years, CMS Analysts Predict
Federal spending will rise; personal spending may fall.The Centers for Medicare & Medi... Read more
Health Care Costs Will Double In 10 Years, CMS Analysts Predict
Federal spending will rise; personal spending may fall.The Centers for Medicare & Medi... Read more
BILLING:
Inadequate Billing Codes May Restrict Consumer Access To Alternative Treatments
Sustaining a government-sponsored monopoly could cost $51 billion in savings.Department of... Read more
Inadequate Billing Codes May Restrict Consumer Access To Alternative Treatments
Sustaining a government-sponsored monopoly could cost $51 billion in savings.Department of... Read more
HOSPITALS:
Prepare For More Scrutiny Of Your Outpatient Billing
OIG work plan targets inpatient dialysis admissions--and much more.Now's the time to be ce... Read more
Prepare For More Scrutiny Of Your Outpatient Billing
OIG work plan targets inpatient dialysis admissions--and much more.Now's the time to be ce... Read more
REIMBURSEMENT ~ Update Your Modifier List And Check Your Enrollment Dates
Your claims could be on this carrier's greatest hits list.This is one "top 10" chart you d... Read more
Your claims could be on this carrier's greatest hits list.This is one "top 10" chart you d... Read more
LEGISLATION ~ Don't Get Your Hopes Up On Averting Pay Cut
Bush budget leaves doctors out in the cold, ACP warns. President Bush's 2008 budget propos... Read more
Bush budget leaves doctors out in the cold, ACP warns. President Bush's 2008 budget propos... Read more
COMPLIANCE ~ 3 Options To Keep Your Stake In Nuclear Medicine Or PET Scans
Refund any payments you received for doc-owned PET scans since January. Heads up: As of Ja... Read more
Refund any payments you received for doc-owned PET scans since January. Heads up: As of Ja... Read more
CODING ~ Look To Pancreatic Functioning (Not Insulin Use) When Using This Diagnosis Code
Insulin urban legend can make your life difficult. Myth: You should list your patient as h... Read more
Insulin urban legend can make your life difficult. Myth: You should list your patient as h... Read more
BILLING ~ Heads Up:
Medicare Denied Up To 300,000 Claims By Mistake
Are computer glitches eating your reimbursement? You need to be vigilant for computer bill... Read more
Medicare Denied Up To 300,000 Claims By Mistake
Are computer glitches eating your reimbursement? You need to be vigilant for computer bill... Read more
SPCEIALTY HOSPITALS ~ Have A Stake In A Specialty Hospital? Ask These 3 Questions Right Away
Texas 911 call could spell an emergency for specialty hospitals. The weather forecast for ... Read more
Texas 911 call could spell an emergency for specialty hospitals. The weather forecast for ... Read more
E/M CODING ~ Medicare Overspends Millions On Upcoded Inpatient Visits -- What You Need To Do
7 tips to keep your inpatient E/M coding on the up-and-up. The carriers are scrutinizing y... Read more
7 tips to keep your inpatient E/M coding on the up-and-up. The carriers are scrutinizing y... Read more
TRANSMITTALS ~ 3 Pump Codes No Longer Covered In SNFs
The faster you answer development letters, the sooner 45-day clock restarts. Carriers shou... Read more
The faster you answer development letters, the sooner 45-day clock restarts. Carriers shou... Read more
INDUSTRY NOTES ~ CMS Will Be Reporting On Your Quality To Patients
Plus: Now's your chance to comment on proposed standards. A new project to report on your ... Read more
Plus: Now's your chance to comment on proposed standards. A new project to report on your ... Read more
SPENDING:
Presidential Budget To Cut $100 Billion From Medicare, Medicaid
Democratic presidential hopefuls lambast 2008 budget.President Bush released his budget fo... Read more
Presidential Budget To Cut $100 Billion From Medicare, Medicaid
Democratic presidential hopefuls lambast 2008 budget.President Bush released his budget fo... Read more
CARDIOLOGY:
Avoid Waiting Until Patients Develop Symptoms To Look Into Stenting
Start identifying asymptomatic patients with advanced stenosis.Cardiologists could soon be... Read more
Avoid Waiting Until Patients Develop Symptoms To Look Into Stenting
Start identifying asymptomatic patients with advanced stenosis.Cardiologists could soon be... Read more
DIAGNOSIS CODING:
Take Advantage Of Larger Space For Diagnosis Codes In July
Urge your carrier to expand 1500 form to recognize multiple diagnoses.Complex patients req... Read more
Take Advantage Of Larger Space For Diagnosis Codes In July
Urge your carrier to expand 1500 form to recognize multiple diagnoses.Complex patients req... Read more
MEDICARE PART B:
Mistake--Listing Preop 'V' Codes As Primary Without Including Secondary Diagnosis
Don't let 'unacceptable' list scare you away from 'V' codes.Myth: You can never use "V" co... Read more
Mistake--Listing Preop 'V' Codes As Primary Without Including Secondary Diagnosis
Don't let 'unacceptable' list scare you away from 'V' codes.Myth: You can never use "V" co... Read more
CODING:
Don't Use 93508 For 'Roadmap To Stent Placement'
Be prepared to fight for reimbursement for 93508 with 92980.Is your cardiologist receiving... Read more
Don't Use 93508 For 'Roadmap To Stent Placement'
Be prepared to fight for reimbursement for 93508 with 92980.Is your cardiologist receiving... Read more
HIPAA:
Learn How OHCAs Can Slay The NPP Beast
Untangle the intricacies of OHCAs and NPPs.Knowing how to address the Health Insurance Por... Read more
Learn How OHCAs Can Slay The NPP Beast
Untangle the intricacies of OHCAs and NPPs.Knowing how to address the Health Insurance Por... Read more
COMPLIANCE:
Part B Payments 'Vulnerable To Fraud,' Watchdog Says
OIG is watching doctors' nursing home visits.Nursing homes could be hotbeds of inappropria... Read more
Part B Payments 'Vulnerable To Fraud,' Watchdog Says
OIG is watching doctors' nursing home visits.Nursing homes could be hotbeds of inappropria... Read more
INDUSTRY NOTES:
E-Prescribing Gets New Push From National Initiative
Plus: What health plans, providers can do to reduce Medicare costs.Insurers have long tout... Read more
E-Prescribing Gets New Push From National Initiative
Plus: What health plans, providers can do to reduce Medicare costs.Insurers have long tout... Read more
PHYSICIANS:
Warning--Use 77 Modifier And Make Sure Your Diagnosis Codes Are Different
Crackdown may hit your subspecialty consults extra hard.Heads up: You may be seeing a wave... Read more
Warning--Use 77 Modifier And Make Sure Your Diagnosis Codes Are Different
Crackdown may hit your subspecialty consults extra hard.Heads up: You may be seeing a wave... Read more
BILLING:
Why You Should Benchmark Your Denials
Check by payor, site procedure code and other factors.Are you keeping track of your denial... Read more
Why You Should Benchmark Your Denials
Check by payor, site procedure code and other factors.Are you keeping track of your denial... Read more
TRANSMITTALS:
Start Billing For Diabetes Self-Management Training
Bonus: Use this code for lumbar artificial disk replacement.Medicare will cover 10 hours o... Read more
Start Billing For Diabetes Self-Management Training
Bonus: Use this code for lumbar artificial disk replacement.Medicare will cover 10 hours o... Read more
CARDIOLOGY:
Medicare Dashes Coumadin Clinics' Hope For Reimbursement
Stick with 85610 and 99211 for Coumadin management.Providers were excited when CPT 2007 in... Read more
Medicare Dashes Coumadin Clinics' Hope For Reimbursement
Stick with 85610 and 99211 for Coumadin management.Providers were excited when CPT 2007 in... Read more
HEALTH IT:
EHRs Might Hold The Key to Cancer, Diabetes And Other Diseases
New databases make it possible to hold virtual clinical studies.The Department of Health a... Read more
EHRs Might Hold The Key to Cancer, Diabetes And Other Diseases
New databases make it possible to hold virtual clinical studies.The Department of Health a... Read more
SPECIAL REPORT:
New Plan To Reduce Health Care Costs Focuses On Increases In Health Care Outlays
Is $1.4 trillion in savings too little too late?The United States currently spends more th... Read more
New Plan To Reduce Health Care Costs Focuses On Increases In Health Care Outlays
Is $1.4 trillion in savings too little too late?The United States currently spends more th... Read more
FRAUD & ABUSE:
Miami Providers Beware--The Feds Have Their Eyes On You
Investigators find millions of dollars worth of improper Medicare payments.Miami appears t... Read more
Miami Providers Beware--The Feds Have Their Eyes On You
Investigators find millions of dollars worth of improper Medicare payments.Miami appears t... Read more
INDUSTRY NOTES:
Fed Chairman Urges Steep Medicare Cuts
Plus: Quality guidelines paid off for chronic patients.The right time to start slashing Me... Read more
Fed Chairman Urges Steep Medicare Cuts
Plus: Quality guidelines paid off for chronic patients.The right time to start slashing Me... Read more
RADIOLOGY:
3 Tips For Coping With THe Tough New Environment
Why imaging providers could go under due to cuts.It's a tough time to provide in-office im... Read more
3 Tips For Coping With THe Tough New Environment
Why imaging providers could go under due to cuts.It's a tough time to provide in-office im... Read more
MEDICARE:
MedPAC, CBO Gear Up To Save You From Pay Cuts
Urge Congress to listen to its advisors and scrap 10 percent cut.If the Medicare Payment A... Read more
MedPAC, CBO Gear Up To Save You From Pay Cuts
Urge Congress to listen to its advisors and scrap 10 percent cut.If the Medicare Payment A... Read more
REIMBURSEMENT:
12 Tips For Securing Your Share Of 1.5 Percent Payment Boost Next Summer
Here's how to navigate the new quality measures-based system.Starting July 1, a chunk of y... Read more
12 Tips For Securing Your Share Of 1.5 Percent Payment Boost Next Summer
Here's how to navigate the new quality measures-based system.Starting July 1, a chunk of y... Read more
PART B:
Medicare Part B Saves Big--But For Whom?
Legislative effect on quality of care is unclear.Physicians may have benefited from Part B... Read more
Medicare Part B Saves Big--But For Whom?
Legislative effect on quality of care is unclear.Physicians may have benefited from Part B... Read more
IRFs:
Heads Up--OIG Is Scrutinizing Your Transfer, Discharge Billings
UGS wastes no time correcting patient status codes.United Government Services (UGS) is pro... Read more
Heads Up--OIG Is Scrutinizing Your Transfer, Discharge Billings
UGS wastes no time correcting patient status codes.United Government Services (UGS) is pro... Read more
HEALTH IT:
Coming Soon To A Hospital Near You--A New Nationwide Health Information Network
New report on the health IT initiative details advances, future plans.The Department ... Read more
Coming Soon To A Hospital Near You--A New Nationwide Health Information Network
New report on the health IT initiative details advances, future plans.The Department ... Read more
PHYSICIANS:
Good Documentation Is The Key To Surviving An Audit
The bell curve won't shield you from modifier 25 scrutiny.Myth: If you bill mostly 99213s ... Read more
Good Documentation Is The Key To Surviving An Audit
The bell curve won't shield you from modifier 25 scrutiny.Myth: If you bill mostly 99213s ... Read more
INDUSTRY NOTES:
Start Sharing Those NPIs Now To Avoid A Crunch In May
Plus: Look to your Medicare FI for Unna boot coverage.Starting in May, you could have to l... Read more
Start Sharing Those NPIs Now To Avoid A Crunch In May
Plus: Look to your Medicare FI for Unna boot coverage.Starting in May, you could have to l... Read more
LEGISLATION ~ New Part D Bill May Not Lower Your Patients' Drug Prices
Congress passes legislation despite federal disapproval. Amidst heated debate over the eff... Read more
Congress passes legislation despite federal disapproval. Amidst heated debate over the eff... Read more
THERAPISTS ~ Your Professional Guidelines Will HelpYou With Updated Documentation Requirements
Beef up your documentation with new outcomes measurements. The Centers for Medicare and Me... Read more
Beef up your documentation with new outcomes measurements. The Centers for Medicare and Me... Read more
THERAPY CAPS ~ Check Out A Brand New List Of Applicable ICD-9 Codes
Say goodbye to the manual exceptions process -- for now. Right after the Centers for ... Read more
Say goodbye to the manual exceptions process -- for now. Right after the Centers for ... Read more
CODING ~ Introduction Of 'T' Code A Good Sign For This Spinal Stenosis Treatment
Welcome these new category III codes for 'X Stop' procedures. January is a time to adjust ... Read more
Welcome these new category III codes for 'X Stop' procedures. January is a time to adjust ... Read more
MA PLANS ~ Expanded Enrollment Period Makes Your Non-PDP MA Plan More Attractive
Warning: Last-minute tax law could spell doom for PDPs. For insurers offering a Medicare A... Read more
Warning: Last-minute tax law could spell doom for PDPs. For insurers offering a Medicare A... Read more
PHYSICAL THERAPISTS ~ Find Out How Auto Insurance Policies Could Tie Into Your Reimbursement
Take note: New Jersey's revolutionary bill could help you. You might laugh at the notion o... Read more
Take note: New Jersey's revolutionary bill could help you. You might laugh at the notion o... Read more
TRANSMITTALS ~ You'll Receive A Pay Hike For Telehealth Fees
Be prepared to re-enroll in Medicare if you enrolled prior to 2002. It's official: If you ... Read more
Be prepared to re-enroll in Medicare if you enrolled prior to 2002. It's official: If you ... Read more
CODING ~ G0394 Is Not For Screening -- Find Out What It Is For
Scratching your head over new mystery HCPCPS code? Here's what you need to know. Just when... Read more
Scratching your head over new mystery HCPCPS code? Here's what you need to know. Just when... Read more
HCPCS ~ CMS Deletes Brand-New Synvisc/Hyalgan Drug Code Before It Even Takes Effect
When it comes to Synvisc, ignore HCPCS 2007. Orthopedic coders were surprised to find the ... Read more
When it comes to Synvisc, ignore HCPCS 2007. Orthopedic coders were surprised to find the ... Read more
PHYSICIANS ~ Pay Attention To Your Non-Medicare Carriers' Policies On Multiple Lesions
Discover why lesion excisions don't need to add up. Myth: When you excise multiple lesions... Read more
Discover why lesion excisions don't need to add up. Myth: When you excise multiple lesions... Read more
HIPAA ~ HIPAA Sanctions:
From Warnings To Termination, You Must Show Determination
With sanctions policies, 'shame on you' just won't do. Not having a sanctions policy in pl... Read more
From Warnings To Termination, You Must Show Determination
With sanctions policies, 'shame on you' just won't do. Not having a sanctions policy in pl... Read more
INDUSTRY NOTES ~ Hospitals' Care-Quality Improvements Due To QIOs, CMS Says
Plus: Getting your 2007 payments should be smooth sailing. Care quality improved by 7.8 pe... Read more
Plus: Getting your 2007 payments should be smooth sailing. Care quality improved by 7.8 pe... Read more
INDUSTRY NOTES ~ Valentine's Day Is Your Deadline For Medicare Enrollment
CMS expects contractors to be able to handle paying claims at the correct 2007 rates from ... Read more
CMS expects contractors to be able to handle paying claims at the correct 2007 rates from ... Read more
IN OTHER NEWS
1. CMS patted itself on the back for slowing down spending on physician services. Th... Read more
1. CMS patted itself on the back for slowing down spending on physician services. Th... Read more
SNFs ~ More ICD-9 Blanks Don't Mean You'll Need To Come Up With More Codes
Get ready for a whole new Section I with MDS 3.0. Take one look at Section I in the propo... Read more
Get ready for a whole new Section I with MDS 3.0. Take one look at Section I in the propo... Read more
MDS ~ With ICD-10 On The Horizon, A New MDS May Be A Done Deal
Know when to expect MDS 3.0. If you're wondering what's going on with MDS 3.0, you'll welc... Read more
Know when to expect MDS 3.0. If you're wondering what's going on with MDS 3.0, you'll welc... Read more
HOSPITALS ~ Heads Up:
WPS Medicare Changes ROS Documentation Requirement, Only To Reverse Its Decision
Don't change how you report ROS to Medicare payers. The end of 2006 featured a decision by... Read more
WPS Medicare Changes ROS Documentation Requirement, Only To Reverse Its Decision
Don't change how you report ROS to Medicare payers. The end of 2006 featured a decision by... Read more
BILLING ~ ROS Level Helps To Determine E/M Level On Your Claims
Observe 10-system minimum for complete ROS. When a physician performs an evaluation and ma... Read more
Observe 10-system minimum for complete ROS. When a physician performs an evaluation and ma... Read more
HIPAA COMPLIANCE ~ Use This 4-Step Plan To Plug Holes In Your Privacy Compliance Program
Find the holes where protected health information could leak. You can reduce your practice... Read more
Find the holes where protected health information could leak. You can reduce your practice... Read more
INDUSTRY NOTES ~ Most Part D Enrollees Don't Plan To Switch In 2007
Part D program is still too complicated. Even though enrollees have a lot of ideas about h... Read more
Part D program is still too complicated. Even though enrollees have a lot of ideas about h... Read more
CODING:
Contact Your Carrier Now To Overturn Denials Of 29999 And Other Codes
You can't use a modifier to override nursing facility edits anymore.Correct Coding Initiat... Read more
Contact Your Carrier Now To Overturn Denials Of 29999 And Other Codes
You can't use a modifier to override nursing facility edits anymore.Correct Coding Initiat... Read more
THERAPISTS:
Your Raise Is Only $40 -- Now Experts Weigh In On What Will Affect You Most
CMS offers 3 key changes to the therapy cap for outpatients.The therapy cap will go from $... Read more
Your Raise Is Only $40 -- Now Experts Weigh In On What Will Affect You Most
CMS offers 3 key changes to the therapy cap for outpatients.The therapy cap will go from $... Read more
DOCUMENTATION:
Find Out What Therapy Documentation Practices You'll Need To Start Now
Catch some major documentation clarifications -- CMS spells them out.In addition to sendin... Read more
Find Out What Therapy Documentation Practices You'll Need To Start Now
Catch some major documentation clarifications -- CMS spells them out.In addition to sendin... Read more
SNFs:
The Way Your Rehab RUGs Shake Out In Your Facility Can Lead To A Shake Up With Your FI
Identify rehab RUG patterns that shout 'come audit me.'You need to identify RUG profiles t... Read more
The Way Your Rehab RUGs Shake Out In Your Facility Can Lead To A Shake Up With Your FI
Identify rehab RUG patterns that shout 'come audit me.'You need to identify RUG profiles t... Read more
MEDICARE PART D:
Democrats May Have The Wrong Idea About Negotiating Drug Prices, NCPA Claims
Why repealing the ban could be useless for Part D.Although many industry leaders cheered t... Read more
Democrats May Have The Wrong Idea About Negotiating Drug Prices, NCPA Claims
Why repealing the ban could be useless for Part D.Although many industry leaders cheered t... Read more
PHYSICIANS:
Why You Can't Use A Modifier To Override SRS Edits
New anesthesia, stereotactic radiosurgery codes on CCI's hit list.CPT 2007 brings a number... Read more
Why You Can't Use A Modifier To Override SRS Edits
New anesthesia, stereotactic radiosurgery codes on CCI's hit list.CPT 2007 brings a number... Read more
INDUSTRY NOTES:
You Can Breathe A Sigh Of Relief--Congress Extends Therapy Cap Exceptions Process
Plus: PTPN selects FOTO system to track patient progress.Congress passed H.R. 6111, ... Read more
You Can Breathe A Sigh Of Relief--Congress Extends Therapy Cap Exceptions Process
Plus: PTPN selects FOTO system to track patient progress.Congress passed H.R. 6111, ... Read more
LEGISLATION:
Warning--A Physician's Back Taxes Could Come Out Of Your Practice's Medicare Pay
Tell your Senator how you feel about the Levin-Coleman bill.How much do you know about you... Read more
Warning--A Physician's Back Taxes Could Come Out Of Your Practice's Medicare Pay
Tell your Senator how you feel about the Levin-Coleman bill.How much do you know about you... Read more
PART B:
Check With Your Local Carrier For Concurrent Critical-Care Coverage
2 doctors, simultaneous critical care could lead to denials.Myth: There's no national poli... Read more
Check With Your Local Carrier For Concurrent Critical-Care Coverage
2 doctors, simultaneous critical care could lead to denials.Myth: There's no national poli... Read more
HOME HEALTH:
Your Episode Calculations Are About To Get A Lot More Complicated
Prepare for major therapy threshold changes -- or face serious federal scrutiny.Home healt... Read more
Your Episode Calculations Are About To Get A Lot More Complicated
Prepare for major therapy threshold changes -- or face serious federal scrutiny.Home healt... Read more
SURGEONS:
Take The Time To Capture Your Time For PreOperative Visits
Cap could be once-in-a-lifetime opportunity -- to lose money.Heads up, surgery practices: ... Read more
Take The Time To Capture Your Time For PreOperative Visits
Cap could be once-in-a-lifetime opportunity -- to lose money.Heads up, surgery practices: ... Read more
AUDITS:
Feds Crack Down On Validity Of IRF Admissions
OIG orders millions of dollars of refunds from IRFs for Medicare overpayments.If you're a ... Read more
Feds Crack Down On Validity Of IRF Admissions
OIG orders millions of dollars of refunds from IRFs for Medicare overpayments.If you're a ... Read more
PHYSICIANS:
Practice 'Concurrent Audits' To Make Sure You're Not Missing Services
Your front desk is on the front lines of capturing reimbursement.Improving your practice's... Read more
Practice 'Concurrent Audits' To Make Sure You're Not Missing Services
Your front desk is on the front lines of capturing reimbursement.Improving your practice's... Read more
PHYSICIANS:
Goods News--Medicare Proposes Higher SNF Payments
2008 proposed rule sets out to update the market basket.If your rehab services get paid on... Read more
Goods News--Medicare Proposes Higher SNF Payments
2008 proposed rule sets out to update the market basket.If your rehab services get paid on... Read more
NPIs:
At Last, NPI Requirements Are Getting Clearer
You can use UPINs for referring physicians until May 2008.Your providers should already ha... Read more
At Last, NPI Requirements Are Getting Clearer
You can use UPINs for referring physicians until May 2008.Your providers should already ha... Read more
REIMBURSEMENT:
October Through December Could Be Your Cash-Losing Months
A half-dozen mistakes per week could spell $25,000 revenue drain.Times are getting tougher... Read more
October Through December Could Be Your Cash-Losing Months
A half-dozen mistakes per week could spell $25,000 revenue drain.Times are getting tougher... Read more