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Medicare Compliance & Reimbursement

Compliance Trends:
Keep These 4 Trouble Spots On Your Radar Screen for 2011 and Beyond
The list includes EMR documentation, E/M coding, ACOs, and more. Looking to shore up your... Read more
Stark Law Update:
CMS Lightens Up On Stark Disclosure for Advanced Imaging
 Physicians will ring in 2011with a new patient notice requirement, if they provide a... Read more
Part B Mythbuster:
Start Prepping for ICD-10 Now With 3 Mythbusters
You'll need to implement the new 5010 claim form first to be ready for ICD-10. While the ... Read more
Screening Vs. Diagnostic:
Base Your Colonoscopy Exam Coding on Diagnosis
G codes are handy if the screening doesn't turn diagnostic. You know the deal: If your ph... Read more
Industry News:
OIG Offers 'Roadmap' for Avoiding Fraud and Abuse
Plus: Medicare payment suspension is serious business. The OIG recently asked medical sch... Read more
In other news
Once you're on a Medicare payment suspension, you shouldn't expect to get off it any time ... Read more
Reader Questions:
Consult Your Doc For Clot Procedure Details
Question: My physician performed an excision due to a painful clotted vein in the lower e... Read more
Reader Questions:
Resolve Secondary Payer Issues With Conversations
Question: Our doctor performed surgery on a patient 11 months ago. We just learned that t... Read more
Reader Questions:
99212 May Apply to Med Check
Question: The physician started an established patient on a new drug. Two weeks later, th... Read more
E/M Coding:
Tips Are Key to Deciphering 99213 From 99214
Avoid these upcoding mistakes. Do you recognize when your physician documents a 99214 b... Read more
Payment Plans:
Request A Reasonable Patient Payment Plan
Nominal payments don't create any obligation for you. Myth: If a patient is sending you $5... Read more
Part B Coding Coach:
3 Ways to Do Diagnosis Coding Right
Signs and symptoms may sometimes be your best choice. Choosing the right CPT procedure cod... Read more
Part B Mythbuster:
How to Make Your E/M Documentation Bullet-Proof Even With Few Symptoms
You may still be able to bill a level-four E/M visit for a patient with abnormal test res... Read more
HCPCS Coding:
Don't Forget About Q Codes With Your Casting Claims
Think Q4050 is out of your reach? Think again. If you aren't billing Q codes to Medicare ... Read more
Privacy:
New Red Flags Clarification May Exempt Physicians As 'Creditors'
But you should still make an effort to safeguard patient confidentiality, experts say. In... Read more
Industry News:
CMS Delays PECOS Denial Deadline
Good news: You won't face claims denials in January due to PECOS edits, thanks to an upda... Read more
Reader Questions:
Tackle Consultations on a Payer-By-Payer Basis
Question: I am still a little confused about the consultation codes 99241--99245 and 9925... Read more
Reader Questions:
Simplify DEXA Screening Issues
Question: If a patient has had DEXA exams for years and our doctor treated her for osteop... Read more
Compliance:
Glean These 3 Themes From the 2011 OIG Work Plan
Experts count the reasons to put rehospitalization on your radar screen. The annual HHS O... Read more
Compliance Tips:
Check Out This Combo of Compliance Shock Therapy, Smart HIPAA Moves, and More
This approach prevents staff from sending an unencrypted e-mail containing PHI. Ensuring c... Read more
Modifier:
Mind Your Modifiers When Your Physician Acts As Co-Surgeon
Coordinate surgeon claims or chance missed reimbursement. When coding surgical claims, pay... Read more
Part B Revenue Booster:
Scope Out Potential Level 4 and 5 E/Ms by Knowing Crucial HPI Facts
Watch out for CPT/Medicare differences when counting HPI elements. If you're not accurate... Read more
Billing:
Know Your State's Prompt Pay Laws -- And Appeal When Necessary
Medicare requires contractors to pay your clean claims within 30 days, but private payers ... Read more
Part B Mythbuster:
Know These 4 Myths About 99211
Hint: The 'nurse visit' code isn't just for nurses If you are one of the many coders confu... Read more
Industry News:
1 In Every 7 Medicare Patients Are Harmed In Hospital Says Report
44% of the total patients harmed could've been kept safe. In a recent post in www.detnews... Read more
Reader Questions:
Anatomy Offers Obturator Block Clues
Question: What codes should we submit for an obturator nerve block and obturator muscle i... Read more
Diagnosis Coding:
ICD-9 2011: Prepare for New Fluid Overload and Seizure Codes
Confirm documentation before you report the new morbid obesity codes. Come October 1, you... Read more
Auditing:
Weigh Surgical Risk to Select Correct E/M Level
These definitions take the mystery out of moderate vs high surgical management options. Yo... Read more
Part B Coding Coach:
4 Steps Unlock Ethical Unlisted Procedure Coding Payments
Referencing the nearest equivalent CPT code could be your key to getting paid. When CPT fo... Read more
Physician Notes:
Medicare Overpaid Providers $13 Million in 2007 Due to Place-of-Service Errors
Plus: Medicare Wastes Millions On Capped Rental Repairs. Entering your place-of-service (P... Read more
Part B Mythbuster:
Failing to Report X-Rays During the Global Will Cost You Money
Depending on how many x-rays you write off, you could be losing thousands. Myth: X-rays th... Read more
Industry News:
CMS Releases Payment Amounts for Flu Shots
PIllinois pediatrician sentenced after billing for vaccines she received for free. Forget ... Read more
Reader Questions:
Check If Exceptions Exist in Fracture Modifiers
Question: A parent brings her 14-year-old son to the emergency department with an injured... Read more
Enforcement Trends:
AHA to Federal Officials: Play Fair With the FCA
Provider group challenges what it sees as an inappropriate use of the law. The American H... Read more
Compliance:
3 Reasons Providers Fear the False Claims Act
Find out how this statute creates an uneven playing field that recently got bigger. Findin... Read more
Legal Strategies:
Hospitals Involved in Kyphoplasty Investigations Have Viable Defenses
If this allegation can be proven, the government might not even have a false claims case. ... Read more
Physician Notes:
Magic Number for Medical Record Retention is 6 Years, CMS Says
If your state laws require a period longer than that, then that's the time required, but s... Read more
Part B Revenue Booster:
6 Surefire Tips Boost Your Bottom Line
If you're not up to date on codes, you could be losing cash. Facing hard times in your pra... Read more
Part B Coverage:
Medicare to Cover Tobacco Cessation Counseling for All Smoking Beneficiaries
New coverage announcement is triumph for physicians who haven't collected in the past. If... Read more
Industry News:
Get Ready For Tougher Enrollment Screening
New regs would charge you for your trouble. Your Medicare payments are poised to come with... Read more
In Other News:
Feds Bust Organized Crime Medicare Fraud Scheme
The feds have taken down one of the huge Medicare fraud schemes of the type that is makin... Read more
Reader Questions:
The Hard Truth about Phone Call Pay
Question: Another physician told my doctor that he's receiving payment from his contracto... Read more
Reader Questions:
Medicare Won't Cover Trays
Question: How do I code products like laceration trays for minor wounds, suture trays, fa... Read more
Reader Questions:
Follow Signature Rules or Risk Payments
Question: One of our physicians likes to sign everything with just his initials, or somet... Read more
Consolidated Billing:
3 Simple Steps Put You on the Path to Capturing Payment for Your Nursing Facility Services
Determining whether a patient is in a Part A or Part B stay is your key to proper reimbur... Read more
Physician Notes:
Magic Number for Medical Record Retention is 6 Years, CMS Says
Plus: HHS believes Medicare Trust Fund will stay solvent through 2029. Medical practices ... Read more
Physician Reviews:
Face-to-Face Rule Brings New Round of Physician Headaches for Those Who Certify Home Health
Physicians must see patient 30 days before or two weeks after start of care -- and someti... Read more
Compliance:
Reference 3 'G' Codes for Early HIV Screening
Don't miss out on rapid test pay for high-risk beneficiaries. You can now show medical ne... Read more
Electronic Health Records:
What About 'Meaningful Use?'
Check out CMS's Final Rule to get the scoop on meaningful use requirements. Ever since CM... Read more
Industry News:
Medicare Drug Plans Slated for Double-Digit Hikes in 2011
At least seven of the top 10 National plans will charge higher premiums. Millions of sen... Read more
Reader Questions:
Limit Prolonged Services to Highest Category in 1 Instance
Question: Can the prolonged codes (+99354, Prolonged physician service in the office or o... Read more
Stark Compliance:
Offering In-Office Advanced Imaging Services? Get Ready to Enlighten Your Patients About Ownership, Other Options
Find out what CMS has proposed and what this new Stark reporting mandate could portend. P... Read more
Compliance Trends:
Be Aware of These 2 Additional New Stark Provisions
If you run afoul of Stark, here's a potentially easier way out. The Affordable Care Act h... Read more
Modifiers:
E/M Services Call for Modifier 25, But Only When Necessary
You'll be putting your practice in the crosshairs if you misuse this modifier. Knowing wh... Read more
Fraud & Abuse:
ZPICs Take Down Home Care Providers
You might be next on the fraud contractors' hit list, experts warn. You could be in for a... Read more
Industry News:
Internet Fuels Increase in Healthcare Fraud
Government needs to police Internet more carefully. Waste, fraud, and abuse in the United... Read more
Reader Questions:
Catch Up on Incomplete Claims
Question: Our surgical practice has a few claims that have missing or incorrect informati... Read more
Reader Questions:
Base Dx Code on Reason for Test
Question: A patient comes into the emergency room for a fall from a ladder, and the ER do... Read more
Reader Questions:
Anatomy Offers Obturator Block Clues
Question: What codes should we submit for an obturator nerve block and obturator muscle i... Read more
Compliance:
Focus on Your Compliance Plan Now Or Pay Later
Enhanced fraud-fighting atmosphere makes your plan more important than ever. If the feds s... Read more
PQRI:
CMS Proposes Making PQRI Reporting Easier in 2011
Plus: CMS reveals common errors from previous PQRI quarters. Collecting your PQRI bonus co... Read more
Part B Coverage:
Medicare to Cover Tobacco Cessation Counseling for All Smoking Beneficiaries
New coverage announcement is triumph for physicians who haven't collected in the past.&nbs... Read more
Self-Audits:
Know What Benchmarking Against 'Bell Curves' Can Do For You And What It Can't
Remember: Chart audits are still your most powerful weapon in the war against miscoding al... Read more
Physician Notes:
Physician's Assistant Accused of Ordering Unnecessary Tests That Clinic Fraudulently Billed to Medicare
Clinic used "Cappers" to fraudulently bill Medicare The Dept. of Justice not only caught a... Read more
Industry News:
Ambulance Companies Go All Out to Grab a Bigger Piece of the Federal Pie
Prosecutors pursue new vehicles of Medicare fraud As a settlement in a district court case... Read more
Industry Notes:
Medicare Needs Whistleblowers, But Is It Worth the Time, Money, and Risk?
It's not just monetary rewards they're after, report shows. While whistleblowing may seem... Read more
Reader Questions:
Modify Eye Codes Just Like E/M Codes
Question: I just started working in an ophthalmologist's office and I have a question abo... Read more
Reader Questions:
Get the Scoop on Billing Before Credentialing
Question: Our practice has a new physician coming on board to replace a retiring doctor. ... Read more
Compliance:
Get the 'Rest of the Story' About 5 Common Compliance Beliefs
True or false? Being unaware of accidental overpayments can't invoke false claims liabili... Read more
What Do You Think? Is There Really More Healthcare Fraud and Abuse These Days?
The answer may surprise you. In reality, healthcare may have become a lucrative new stomp... Read more
Modifiers:
Learn the Tricks to Untangling Differences in Modifiers 58, 78, and 79
Don't miss out on extra pay when global period resets. Just because you routinely append ... Read more
Industry News:
Why Pharma Whistleblowers Are A Harried Lot
82% of whistleblowers in NEJM study were subjected to pressures by their company. When Co... Read more
Industry Notes:
Medicare Strike Force Pumps Up The HEAT
Going by its track record HEAT is certainly living up to its name. The Health Care Fraud ... Read more
Payment Trends:
Beware: RACs May Be Triggering MAC Attacks
If you do get a notice of a probe review, don't do this. SNF providers may not be the onl... Read more
Medicare Part C:
Make Sure You're on the Same Page With Medicare Advantage Plans
Take heed: Some plans may require frequent recertifications for skilled care. Failing to ... Read more
Reader Question:
Counting Nerve Conduction Test Per Limb Will Result in Denials
Question: I coded my physician's diagnostic testing recently that included nerve conducti... Read more
Recovery Audit Contractors:
RACs ID Insufficient Documentation As Weakness Among Practices
Stay on top of RAC requests so you're able to meet all request deadlines. Recovery audit ... Read more
Medicare Payment:
CMS Reps Outline Impact of PPACA on 2011 Fee Schedule
Plus: Medicare enrollment Web site adds additional resource files. The ink is barely dr... Read more
Part B Coding Coach:
FAQs: Double Your E/M Payout on Some Counseling 'Domination' Claims
Here's when you can code past the three E/M component levels. The physician provides an e... Read more
E/M Best Practices:
Master New Patient E/Ms or Leave Cash on the Table
Financial fallout can be considerable if you eschew new patient codes too often. For medi... Read more
Physician Notes:
DOJ Arrests 94 People in One Day for Medicare Fraud Totaling Over $250 Million in Alleged False Billing
Plus: OIG Estimates $137 Million In KX Overpayments For DME. When the Medicare Fraud Stri... Read more
Industry News:
Medicare Won't Pay Unless Patient Stays In Hospital For At Least 3 Days
Outdated regulation covering nursing home stays still applies. Medicare rules can at time... Read more
Reader Questions:
I&D Area Can Deflate 10060 Option
Question: Our physician performed a level-four E/M service in the emergency department fo... Read more
Reader Questions:
Assess Multiple Procedures Across Multiple Spinal Levels
Question: During an operative session, my neurosurgeon performed the following procedures... Read more
Reader Questions:
Evaluate HPI Level to Narrow E/M Choice
Differentiate brief history of present illness from extended with these tips. Question: O... Read more
PQRI:
Not All Doctors in Your Practice Must Participate in PQRI to Collect Incentive
Plus: Look for 2009 incentive payments this fall, CMS says. If all of your physicians are... Read more
Part B Payment:
Proposed 2011 Fee Schedule Offers Vast Benefits for Primary Care Practices
CMS incorporates PPACA regs into next year's fee schedule -- but proposes deeper cu... Read more
Medicare Forms:
Test Your 5010 Readiness With At Least 25 Claims, CMS Says
No word yet from CMS on whether the 1500 form will change soon. If you're considering tes... Read more
Part B coding Coach:
FAQs: Double Your E/M Payout on Some Counseling 'Domination' Claims
Here's when you can code past the three E/M component levels. The physician provides an E... Read more
Assess HPI Level to Help:
Narrow E/M Choice
Differentiate brief history of present illness from extended with these tips. Question: O... Read more
Industry News:
The Health Reform Bill: Are Seniors Seeing the Benefits Yet?
CMS kick-starts reform by filling Part D "doughnut hole." Good news for the nation's seni... Read more
Reader Questions:
Patient Becomes 'Established' After First Visit
Question: A patient came to our office and saw one neurologist, but when the patient came... Read more
Compliance:
Follow These 5 Strategies When Providing Freebies to Patients
Would offering free dietary counseling be okay in this scenario? Offering free services o... Read more
Legislative Update:
Reform Bill Gives Nod to Free Services for Financially Needy Patients
Home health agencies could get on board with this.  In the past, a provider that off... Read more
Fighting Fraud:
Fighting Fraud Major Challenges in Fighting Fraud
Resolving these roadblocks may be the key to collecting additional funds, new testimony i... Read more
Diagnosis Coding:
The 2013 Date for ICD-10 Implementation Won't Change, CMS Says
Plus: CMS has proposed freezing the ICD-9 codeset after next year. If you were hoping tha... Read more
Hospice:
Hospice Use May Grow If Concurrent Care Demo Takes Off
PPACA isn't all bad news for hospice providers. Many terminally ill patients refuse to el... Read more
Industry News:
CMS Issues Fraud Alert As "Doughnut Hole" Rebate Checks Are Mailed
Fraudsters, in the meantime, are already in action! On June 18, Jane Glenn Haas of the Or... Read more
Diagnosis Coding:
Your Physician's Notes Reveal Diagnosis Codes -- You Just Have to Know Where to Look
If the doctor does not circle a diagnosis, it may be up to you to find one. Don't let an ... Read more
Billing:
Speed Up New Patient Registration With These 5 Tips
A smart billing capture process can prevent claim-submission headaches. If you're trying ... Read more
PQRI:
Medicare Advantage Plans May Disburse PQRI Bonuses
Plus: You still have time to get in on this year's PQRI bonus incentive program. If you'r... Read more
Enforcement:
Discover Where the Senior Medicare Patrol Project is Most Active
New York and Michigan have beefed up their SPM rosters, while other states, such as S. Ca... Read more
Coding Accuracy:
Don't Let Foot FBR Definition Fool You
Survey says: Incision required for foot FBR. A girl limps into the ED with a splinter in ... Read more
Compliance:
Avoid This Common Chiropractic Documentation Mistake
Treatment plans are a must, experts say. You've treated your chiropractic patient, you've... Read more
Reader Question:
Examine X-Ray and Fluoro on Same Date
Question: When, on the same date, the radiologist places a central venous access device u... Read more
Reader Question:
No Way Around Carrier's Standby Policy
Question: One of our anesthesiologists monitored a patient's vital signs during excision ... Read more
Healthcare Reform Legislation:
New Drug Sample Reporting Requirement Packs 3 Compliance Concerns
HHS' ability to track drug samples ups the risks for doctors. Picture this: Health & ... Read more
Payment Trends:
Is the New Drug Sample Reporting Requirement a Message on the Wall for Pharma?
HHS could use the data it collects from drug companies to answer this key question. Start... Read more
Fraud and Abuse:
Look for Big Compliance Changes, Thanks to Healthcare Reform
One guilty-until-proven-innocent provision could shutter some blameless providers, expert... Read more
Part B Coding Coach:
Get Your Cut for Soft Tissue FBRs by Looking for Incision Evidence
Complicated FBRs, though rare, pay twice as much as simple ones. Ah, spring. The birds, t... Read more
Medicare Payment:
Medicare Officials Urge Advanced Imaging Providers Toward Accreditation
Plus: CMS won't say for sure whether your claims will actually face rejection if you aren... Read more
Compliance:
In 2009, Senior Medicare Patrol Project Collected Triple Its 2008 Amount
Despite fewer volunteers, the project continued full steam ahead into 2010. The governmen... Read more
Industry News:
Obama's Healthcare Reform Will Drive Up Costs
Government economists' report predicts possible rise in public's tab of 1 percent or more... Read more
Reader Question:
Don't Overlook Shared Visit Billing for Inpatients
Question: I know I cannot bill services incident-to in the hospital setting. Is there any... Read more
Compliance:
Study These Compliance Basics Before You Run Afoul of the OIG
Practice size does not matter when dealing with compliance -- even solo practitioner... Read more
Billing:
Has A Broken Payment Agreement Come To Dismissal?
Take these steps to end a Practice-Patient relationship without creating drama to the par... Read more
Medicare Forms:
CMS: Abbreviate Patient Name "John Doe, Jr." To "John Doe" And You'll Face Denials With New 5010
5010 form could change everything from your claims submission processes to your patient r... Read more
In Other News:
The OIG Has Some Words Of Advice For Practices Billing Claims For $50,000 Or More -- Double Check These Services, Or Subject Yourself To Scrutiny
According to a new audit report entitled "Review of High-Dollar Payments for Outpatient Se... Read more
Physician Notes:
At Least 1 MAC Processed Part B Claims Using 21 Percent 'Pricing Error'
21 percent pay cut averted but several claims still slip through the system. President Ob... Read more
Part B Coding Coach:
3 Sample Situations Boost Your Migraine Treatment Smarts
Acute episodes, check-ups are both routine for these patients. When migraine headache cod... Read more
Industry News:
Teething Problems: Grandfather Clause In Health Laws Can Result In Raw Deal For Consumers
Definition of "grandfathered" health plans still very vague. Depending on how the Obama a... Read more
Reader Question:
Differentiate Between Debridement and Wound Care Management Codes
Active wound therapy requires different documentation than debridement. Question: When th... Read more
Audits:
Take These Steps if You Find Out You'll Soon Be Paid a Visit From an Auditor
Prepare your compliance plan before an auditor strikes if you can -- but don't panic... Read more
E/M Coding:
Don't Bill High-Level E/M Codes Until You Read This
Sicker patients may not always mean higher MDM. If your physician bills a lot of high-lev... Read more
Acronyms Quiz:
Nail Your Acronym Deciphering Skills to Code Claims Accurately
Know the universal acronyms, then keep an eye out for regional acronyms as well. Do you k... Read more
Acro nym Quiz Answers:
Can You Decipher the Acronyms In Our Quiz? See How You Fared With These Solutions
Hint: When in doubt, check with the practitioners rather than guessing. For most coders, ... Read more
Physician Notes:
Even Non-Insulin Dependent Diabetics May Qualify for Blood Glucose Testing Equipment Coverage
Article in MLN Matters spells out coverage information for blood glucose self-testing sup... Read more
Compliance:
OIG Revisits Recommendation to Review Modifier 59 Claims
Modifier 59 misuse led to millions in overpayments. When the OIG talks, not everyone list... Read more
Part B Coding Coach:
Stay Out of These Common Biopsy Coding Pitfalls and Boost Claims Accuracy
Go beyond 11000 to 'site' specific codes, which can net your practice  upwards of $2... Read more
Industry News:
DOJ Targets Doctor For Medically Substandard Services
One patient dead and others seriously injured at Georgia hospital. Yet another case has c... Read more
Reader Question:
Consider Immediacy on Critical Care Claims
Know what constitutes a 'critical illness or injury.' Question: I've experienced some den... Read more
Enrollment Compliance:
Caveat Physicians: Don't Let Financial Ties to Manufacturers Create Legal Woes
3 ways to navigate increasing transparency of prescriber-supplier relationships. With the... Read more
Medicare Pay:
Congress Puts Off 21 Percent Pay Cut Until June 1
But because legislators missed the cutoff by one day, some claims were processed using a ... Read more
Split/Shared Visits:
CMS Clarifies Split/Shared Visit Rule Now That Consults Are No Longer Payable
Plus: CMS reps cite current Medicare law and advise that practices should report just one... Read more
Recovery Audit Contractors:
Don't Rack Up Unfair RAC Denials: Follow These 6 Rules for Appealing Payment Recoups
Even if you're wrong on an issue, check out this often overlooked escape hatch. RAC denia... Read more
RAC Apeals:
Don't Let RACs Shoot Down Your Whole Claim for A Small Error
These examples show how you may be able to recoup part of your denied claim, even if you ... Read more
Auditing:
President Obama Reveals Details of Expanded 'Payment Recapture Audit' Program
Plus: Get on board with CMS's RAC conference calls for the lowdown on up-to-the-minute RA... Read more
Biling:
2 Ways the New Healthcare Law Affects Medicare Pay
Hint: Timely filing rules will change, giving you less time to submit your claims going f... Read more
Industry News:
Are Medicare Cost-Saving Moves Having The Desired Effect?
No, shows study conducted after payments for bladder biopsies were sweetened. Medicare co... Read more
Enrollment:
Public Health, VA Practitioners Can Enroll In PECOS
But if they are accepted into PECOS to order/refer only, they can't use that NPI to bill ... Read more
ICD-10:
CMS, AHIMA Reps Aim To Bust ICD-10 Myths With Expert Answers
Hint: You will be able to find hard copy ICD-10 books, CMS confirms. The ICD-10 implement... Read more
99211 Visits:
Nix 'Nurse Visit Code' Errors By Taking This Quick Quiz
Should you bill for 99211 along with your injection codes? See if you can answer this and... Read more
Your Part B Questions Answered:
Think Twice Before Reporting Dual Scans
Question: Is it appropriate to report both a CT and CTA of the same anatomic area perform... Read more
Correct Coding Initiative:
Get To Know The New CCI 16.1 Code Bundles, Or Risk Unexpected Denials
New edits in spine, urology, catheterization, pathology, and other specialties could chan... Read more
Physician Notes; New Health Care Legislation May Benefit Practices, But Fails to Address SGR Formula
PPACA makes sweeping changes to the healthcare system but Medicare pay freeze not extende... Read more
Appeals:
Use This Sample Appeal Letter in Your Fight Against Modifier 25 Denials
Attach your procedure notes and the OIG's report to pack extra punch. Even if you follow ... Read more
Industry News; Doctors Brace for Looming Cuts, Seek Alternatives to Private Practice
Correctional facilities offer enticing options. If you make a list of low-paying jobs in ... Read more
AUDITING 202:
Stave Off Allegations That You've Wronged Medicare: Use This 3-Pronged Approach to Self-Audits
Consider using this individualized method for doing retrospective reviews. Audit not and ... Read more
PART B PAYMENTS:
Lock in New Ways to Improve Your Practice's Bottom Line
Tap these resources to optimize payment during Medicare's period of indecision. With Medi... Read more
RISK MANAGEMENT:
Counteract Outside Consultants From Turning Whistleblowers
Hiring these 2 types of auditors can help keep your inner workings secure. The latest whi... Read more
MODIFIER CODING QUIZ:
Do Your Services Warrant Use of Modifier 25?
Take our quick quiz to determine whether you're appending modifier 25 appropriately. Your... Read more
MODIFIER QUIZ ANSWERS:
See These Quiz Answers to Determine Whether You're Using Modifier 25 Properly
Check out this expert advice to find out how you fared in our modifier 25 quiz. Do your m... Read more
YOUR PART B QUESTIONS ANSWERED:
Coding for Supplies Depends On Place of Service
Question: Can I use 99070 to report the use of supplies at our office? Answer: The AMA an... Read more
INDUSTRY NEWS:
Obama-Biden Plan Approval Sets Stage for Reform Action
Plan also promises tax credits on insurance premiums to those who need it. Universal heal... Read more
MEDICARE:
Don't Rack Up Unfair RAC Denials: Follow These 6 Rules for Appealing Payment Recoups
Even if you're dead wrong on an issue, check out this often overlooked escape hatch. RAC ... Read more
RAC MANAGEMENT:
RAC Appeals Target Misuse of Approved Reviews, Unfair Recoupment Amounts
Find out how rehab providers and a DME company are fighting back. Some providers aren't t... Read more
INDUSTRY NEWS:
U.S. Senate Delays Medicare Physician Cut By A Month
AMA writes to Senate seeking repeal of Medicare payment formula. In a statement posted on... Read more
BILLING:
3 Tips Help You Optimize Your Billing Department's Efficiency
Be proactive -- not reactive -- to A/R changes. With Medicare payment changes u... Read more
PART B CODING COACH:
3 Criteria Nail Down Your Payment When Reporting 99211
Don't leave $19 per visit on the table -- follow these rules to ensure you collect w... Read more
ICD-9 CODING:
Stop Asking 'Which Diagnosis Code Will Get My Claim Paid?'
Instead, code directly from the medical record. Medical coders face a lot of questions ea... Read more
INDUSTRY NOTES:
South Florida Medicare Racketeers Way Ahead Of The Law
Former drug dealers switching over to Medicare fraud as a lucrative career shift. From co... Read more
READER QUESTION:
Consider Using Incident-To Guidelines When Billing Follow-Ups
Know the rules before you try to bill incident-to. Question: One of our non-physician pra... Read more
PHYSICIAN PRACTICE:
Risk Managers to Physicians: 3 Strategies Keep Your Practice in the Safety Zone
Look for these legit reasons to explain an outlier practice pattern. Government agencies ... Read more
QUALITY ASSURANCE :
Does Your Hospital's Peer Review Program Catch Unnecessary Surgeries and Procedures?
Revamping this safety net protects patients and the hospital's reputation and compliance ... Read more
PART B ICD-9 CODING:
Stop Asking "Which Diagnosis Code Will Get My Claim Paid?"
Instead, code directly from the medical record. Medical coders face a lot of questions ea... Read more
PART B AUDITS:
Can You Spot These 7 Red Flags in Your Charts?
Notice the trouble signs before they turn into disasters. When you're auditing your chart... Read more
PART B CONSULTATION ELIMINATION:
Forget to Append Modifier AI to Inpatient Hospital Visit Claim? This MAC Will Still Reimburse You
Plus: You no longer need to list the ordering/referring physician as item 17 on your clai... Read more
FRAUD DETECTION UPDATE:
OIG Requests $40+ Million More Funds to Beef Up Fraud Detection
Ratchet up your documentation skills now. The OIG has been on a roll over the past year, ... Read more
INDUSTRY NOTES:
1.2 Million New Compliance Officers And Examiners Will Soon Be Needed
DOL predicts an 18% rise in demand for compliance professionals. According to a handbook ... Read more
INDUSTRY NOTES:
Medicare Reimbursement Changes Increase Bladder Cancer Treatment Costs
The changes are well-intentioned, but experts can't explain why they're not working. The ... Read more
HOSPITAL RISK MANAGEMENT:
Head Off the Specter of Surgeons Performing Unneeded Procedures
4 strategies can help, including knowing these key warning signs. Talk about a PR and leg... Read more
PART B CODING COACH:
Ensure Your Fair Share of Routine Exam Reimbursement by Playing by Medicare Rules
Ophthalmologists take note: No complaint may mean no coverage. Often, ophthalmologists do... Read more
Give Your Compliance Program This Quick Litmus Test
If your program fails on these key points, watch out. The time to find out that your comp... Read more
PHYSICIAN NOTES:
MedPAC Recommends 1 Percent Physician Payment Update for 2011
Plus: Recovery audit contractors post additional target areas that they plan to review go... Read more
CONSULT CODING QUIZ:
QUESTIONS: Test Your E/M Coding Skills Now That Consult Pay is Gone
Do you know how to report those services you used to code as consults? Take this quiz to ... Read more
CONSULT CODING QUIZ:
ANSWERS: Check Your E/M Coding Skills With These Quiz Answers
Hint: Only look to unlisted E/M codes when your MAC specifically tells you to. How did yo... Read more
PHYSICIAN NOTES:
Medicare Strike Force Nails Physical Therapist Who Helped Overbill Medicare by $2.375 Million
Plus: CMS debuts new Medicare tool that helps you spell out confusing terms, enrollment i... Read more
PHYSICIAN NOTES:
Make These Corrections to HCPCS 2010
Plus: CMS gives hospices extra time to comply with new requirements. You're probably just... Read more
INDUSTRY NEWS:
J&J PowerPoint Kickback Case Lesson: Keep Those Intentions Clean!
3 precautions every provider should take when presenting financials. The feds -- who... Read more
REIMBURSEMENT:
Cover Cardiology E&M Coding Bases With 5 Smart Compliance Moves
Check out this succinct 'million dollar statement' to cinch documentation requirements. A... Read more
PART B PAYMENT:
Legislators Offer New Year's Gift With Temporary Medicare Pay Fix
Plus: You'll face a 10-day payment delay from MACs as they update their claims systems to... Read more
COMPLIANCE NEWS:
Are Internal Auditors Obligated to Report Adverse Findings to Medicare? Genesys Cardiology Qui Tam Lawsuit Raises Questions
The case stirs debate over the ethics of auditors turning complainants. Genesys Health Sy... Read more
CONSULT ELIMINATION:
New Modifier AI Allows Multiple Docs to Bill Initial Hospital Care
Modifier AI will denote the primary physician of record, now that consult coding is a thi... Read more
THERAPY BILLING:
Take a Quick Refresher on Therapy Supervision Rules
Keep incident to billing and assistant supervision issues separate. If you've been concen... Read more
PART B MYTHBUSTER:
Avoid Billing Locum Tenens For New Docs Who Aren't Yet Credentialed
Medicare doesn't consider locum tenens an appropriate billing scenario for an uncredentia... Read more
PHYSICIAN NOTES:
Not All OIG Audits Result In Bad News Or Accusations Of Wrongdoing
This New York cardiologist spent time under the OIG's microscope, only to learn he was bi... Read more
INDUSTRY NEWS:
Medicare Fraud Funds Extravagant South Florida Lifestyle
Marquez bought $55M worth cars, horses, and diamonds. On Jan 5, 2010, Ihosvany Marquez, o... Read more
In other news...
• Waiting for the Medicare therapy cap exceptions process to expire once again at the e... Read more
NURSING HOME COMPLIANCE:
Stave Off Kickback Allegations By Covering These 4 Compliance Bases
Find out what the OIG views as signs of illegal "swapping" arrangements. When reports of ... Read more
ENFORCEMENT:
OIG Recovered $21 Billion In 2009, With Plans To Stay "Aggressive" Going Forward
OIG keeps ophthalmology services, chiropractic, and ultrasound on its radar screen, along... Read more
Coding 2010:
Make These Corrections To CPT 2010
Plus: CMS announces new therapy cap amount  of $1,860 for 2010, and reveals results ... Read more
PART B PAYMENT:
CMS Will Offer Modifier To Denote Admitting Physician On Claims
With the changes to consult coding, it will be more important than ever to report hospita... Read more
PART B REGS:
CMS Transitioned Over 230,000 Providers' NPIs Into PECOS
Plus: Medicare officials stress that you should start ICD-10 readiness preparations soone... Read more
INDUSTRY NEWS:
Audiologist Lands Behind Bars For 6 Months
Plus: Home health false claims fraud uncovered. Fraud is fraud, no matter how old you are... Read more
READER QUESTION:
Counseling/Coordination Domination? Consider Time-Based Billing
Question: An established pregnant patient with a plan of care in place for her gastroesop... Read more
READER QUESTION:
Nail Down Sleep Study Type To Determine Coverage
Medicare has strict requirements about tests performed in the patient's home. Question: O... Read more
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