Medicare Compliance & Reimbursement
Part B Payment:
Final 2014 Fee Schedule Slashes Not as Steep as Proposed
Make congressional intervention your New Year’s wish. The Final 2014 Medicare Ph... Read more
Final 2014 Fee Schedule Slashes Not as Steep as Proposed
Make congressional intervention your New Year’s wish. The Final 2014 Medicare Ph... Read more
Compliance:
How To Set Up a Useful Code-of-Conduct Policy
There’s more to the Affordable Care Act (ACA) than making health insurance accessi... Read more
How To Set Up a Useful Code-of-Conduct Policy
There’s more to the Affordable Care Act (ACA) than making health insurance accessi... Read more
Risk Management:
Don't Become an OIG Target
Identify practice risk areas. Increasing scrutiny by the HHS Office of the Inspector G... Read more
Don't Become an OIG Target
Identify practice risk areas. Increasing scrutiny by the HHS Office of the Inspector G... Read more
Industry Notes
OCR Did Not Comply With HIPAA Requirements, Says OIG One governmental agency — t... Read more
OCR Did Not Comply With HIPAA Requirements, Says OIG One governmental agency — t... Read more
Reader Question:
Not All Follow-Ups Are Created Equal
Question: We recently finished our first internal audit and found a potential issue: One... Read more
Not All Follow-Ups Are Created Equal
Question: We recently finished our first internal audit and found a potential issue: One... Read more
Reader Question:
Modifier 25 Trumps 59
Question: Our payer is denying a claim involving an E/M and a fine needle aspiration (FN... Read more
Modifier 25 Trumps 59
Question: Our payer is denying a claim involving an E/M and a fine needle aspiration (FN... Read more
Reader Question:
Need ASC Coverage Resources? Look Here
Question: I might be transferring to our hospital’s ASC location and want to learn... Read more
Need ASC Coverage Resources? Look Here
Question: I might be transferring to our hospital’s ASC location and want to learn... Read more
Reader Question:
Check for Interruption Before Reporting 99058
Question: A mother called and reported her baby was having trouble breathing. A nurse re... Read more
Check for Interruption Before Reporting 99058
Question: A mother called and reported her baby was having trouble breathing. A nurse re... Read more
Emergency Medicine Billing:
Get Paid for Emergency Services You Provide to Patients in Custody
Set up a reasonable system for remuneration related to ED care. In the Centers for Med... Read more
Get Paid for Emergency Services You Provide to Patients in Custody
Set up a reasonable system for remuneration related to ED care. In the Centers for Med... Read more
Pulmonary Coding:
Win Deserved Dollars With These 5 Tips for Inhaler Teaching
Tip: Use a judicious mix of modifiers if you have the documentation to back your claim. ... Read more
Win Deserved Dollars With These 5 Tips for Inhaler Teaching
Tip: Use a judicious mix of modifiers if you have the documentation to back your claim. ... Read more
Billing:
CMS Evaluating Chiropractors' Ability to Provide And Collect for E/M Services
Agency estimates that chiropractors will see a two-percent increase in pay for total all... Read more
CMS Evaluating Chiropractors' Ability to Provide And Collect for E/M Services
Agency estimates that chiropractors will see a two-percent increase in pay for total all... Read more
Industry Notes
Mark Your Calendars: CMS Sets March 3-March 7 As ICD-10 Testing Week If you worry abou... Read more
Mark Your Calendars: CMS Sets March 3-March 7 As ICD-10 Testing Week If you worry abou... Read more
Reader Question:
Standby Time Isn't Applicable to Medicare
Question: A surgeon has requested that our anesthesiologist be on stand-by for a procedu... Read more
Standby Time Isn't Applicable to Medicare
Question: A surgeon has requested that our anesthesiologist be on stand-by for a procedu... Read more
Compliance:
Look For Clues In Documentation To Correctly Identify E/M Code
Heed what RACs have to say about errors. Knowing the nitty-gritty of E/M coding rules ... Read more
Look For Clues In Documentation To Correctly Identify E/M Code
Heed what RACs have to say about errors. Knowing the nitty-gritty of E/M coding rules ... Read more
Medicare Drug Screen:
Don't Expect Medicare To Pay For 80100, 80101, or 80104
Tip: Look to HCPCS codes to get reimbursement. If you’re reporting drug screenin... Read more
Don't Expect Medicare To Pay For 80100, 80101, or 80104
Tip: Look to HCPCS codes to get reimbursement. If you’re reporting drug screenin... Read more
CPT® 2014:
Strengthen Your Bottom Line With These New and Revised PQRS Measures
Transfer of care has a new definition to check how sick the patient was at the time of t... Read more
Strengthen Your Bottom Line With These New and Revised PQRS Measures
Transfer of care has a new definition to check how sick the patient was at the time of t... Read more
Home Health Survey & Certification:
Avoid New Alternative Sanctions With This Tip From CMS
Weigh the pros and cons before opting for third party accreditation. Wouldn’t it... Read more
Avoid New Alternative Sanctions With This Tip From CMS
Weigh the pros and cons before opting for third party accreditation. Wouldn’t it... Read more
Home Health Prospective Payment System:
Medicare Delays Final Payment Rule
But rebasing cuts are still on track for Jan. 1. You’ll have to wait a few more ... Read more
Medicare Delays Final Payment Rule
But rebasing cuts are still on track for Jan. 1. You’ll have to wait a few more ... Read more
Industry Notes
This MAC Is Rejecting Claims Via EDI If you’ve recently started using the electr... Read more
This MAC Is Rejecting Claims Via EDI If you’ve recently started using the electr... Read more
Reader Question:
Comprehensive History Is Not a Given
Question: Our physician admitted someone as an initial inpatient, but couldn’t get... Read more
Comprehensive History Is Not a Given
Question: Our physician admitted someone as an initial inpatient, but couldn’t get... Read more
Reader Question:
Count Days Carefully When It Comes To Global
Question: A patient saw our physician because of an abscess, and returned for a follow-u... Read more
Count Days Carefully When It Comes To Global
Question: A patient saw our physician because of an abscess, and returned for a follow-u... Read more
Reader Question:
Can A V Code Be A Primary Diagnosis?
Question: Our ED recently treated two patients that sustained injuries when their car ve... Read more
Can A V Code Be A Primary Diagnosis?
Question: Our ED recently treated two patients that sustained injuries when their car ve... Read more
Appeals:
Expect A Positive Outcome When Appealing A Denial
More than half of redeterminations favor Part B practices. A recent audit report from... Read more
Expect A Positive Outcome When Appealing A Denial
More than half of redeterminations favor Part B practices. A recent audit report from... Read more
Reimbursement:
This Mistake Could Cost Your Practice $10,000 A Year
Watch out for these hard-to-detect nuances when billing new patient visits. Make sure ... Read more
This Mistake Could Cost Your Practice $10,000 A Year
Watch out for these hard-to-detect nuances when billing new patient visits. Make sure ... Read more
Coding Spotlight:
4 Tips Help You To Know When To Report +99140 Emergency
Payer interpretation is key to whether or not you get reimbursed. When you submit +991... Read more
4 Tips Help You To Know When To Report +99140 Emergency
Payer interpretation is key to whether or not you get reimbursed. When you submit +991... Read more
Home Health Billing:
Gear Up For Listing Changes From July 1, 2014
Heed what CMS has to say about documentation needs on your HHPPS claim. The Centers fo... Read more
Gear Up For Listing Changes From July 1, 2014
Heed what CMS has to say about documentation needs on your HHPPS claim. The Centers fo... Read more
Industry Note
CMS Improves Upon PECOS Enrollment System Now that the government shutdown is behind u... Read more
CMS Improves Upon PECOS Enrollment System Now that the government shutdown is behind u... Read more
Reader Question:
Check With Payer Before Adding SA
Question: When the NP provides unsupervised services, I bill the codes under the nurse p... Read more
Check With Payer Before Adding SA
Question: When the NP provides unsupervised services, I bill the codes under the nurse p... Read more
Reader Question:
How Can We Screen New Staffers?
Question: We had a staff member who we caught taking some prescription samples for her... Read more
How Can We Screen New Staffers?
Question: We had a staff member who we caught taking some prescription samples for her... Read more
Reader Question:
Surgeon Needn't Wait for Path Report--But It Helps
Question: Is there a hard-and-fast billing rule that requires us to wait for the patholo... Read more
Surgeon Needn't Wait for Path Report--But It Helps
Question: Is there a hard-and-fast billing rule that requires us to wait for the patholo... Read more
Fact Finder:
Keep Your Claims Running Smoothly
Don’t confuse rumors with facts — check them first. If you take every nugg... Read more
Keep Your Claims Running Smoothly
Don’t confuse rumors with facts — check them first. If you take every nugg... Read more
Collection Corner:
Get the Money Every Time and Leave Patients Smiling
There’s no reason to dread collection calls. It’s possible to make collect... Read more
Get the Money Every Time and Leave Patients Smiling
There’s no reason to dread collection calls. It’s possible to make collect... Read more
Worker's Compensation:
Prevent Reimbursement Delays With 3 Tips
Streamlining processes and doing some research on the ground will help reduce hiccups. ... Read more
Prevent Reimbursement Delays With 3 Tips
Streamlining processes and doing some research on the ground will help reduce hiccups. ... Read more
Home Health Compliance`:
CMS Urged to Enforce Face-to-Face Regs Less Stringently
Confusing and overlapping requirements exceed intent of the law, say commenters. Comme... Read more
CMS Urged to Enforce Face-to-Face Regs Less Stringently
Confusing and overlapping requirements exceed intent of the law, say commenters. Comme... Read more
Industry Notes
Medicare Keeps Rolling During Government Shutdown Your MACs will continue processing p... Read more
Medicare Keeps Rolling During Government Shutdown Your MACs will continue processing p... Read more
Incident-to Billing:
Weigh the Pros and Cons Before Adding an NPP
Tip: Remember incident-to billing is under close scrutiny for audit and OIG enforcement.... Read more
Weigh the Pros and Cons Before Adding an NPP
Tip: Remember incident-to billing is under close scrutiny for audit and OIG enforcement.... Read more
CERT:
Is Your MAC Likely to Come Looking for Money You Still Owe?
Good news: CERT results reveal practices actually made fewer errors in 2012 than in 2011... Read more
Is Your MAC Likely to Come Looking for Money You Still Owe?
Good news: CERT results reveal practices actually made fewer errors in 2012 than in 2011... Read more
Which Specialties Are Billing Improperly?
The government’s CERT report not only identifies the types of errors that practice... Read more
The government’s CERT report not only identifies the types of errors that practice... Read more
Reimbursement:
Expect to Recoup Money You Lost to Two Troublesome Edits
CMS has good news for you on various fronts. The Centers for Medicare & Medicaid S... Read more
Expect to Recoup Money You Lost to Two Troublesome Edits
CMS has good news for you on various fronts. The Centers for Medicare & Medicaid S... Read more
Shared Visits:
Avoid Becoming a CERT Statistic and Paybacks
Use the tips given below to find out when NPP, physician can combine forces. You have ... Read more
Avoid Becoming a CERT Statistic and Paybacks
Use the tips given below to find out when NPP, physician can combine forces. You have ... Read more
Industry Notes
CMS to Update LCDs With ICD-10 Codes by April 10 If your practice has been clamoring t... Read more
CMS to Update LCDs With ICD-10 Codes by April 10 If your practice has been clamoring t... Read more
Reader Question:
Don't Try to Report Prescription Writing Only
Question: Is there a code specific to writing a prescription? Answer: CPT® in... Read more
Don't Try to Report Prescription Writing Only
Question: Is there a code specific to writing a prescription? Answer: CPT® in... Read more
Reimbursement:
Overcome Close Scrutiny of Incident-to Billing With These 3 Tips
You could be costing your practice 15 percent of every NPP E/M service. You can avoid... Read more
Overcome Close Scrutiny of Incident-to Billing With These 3 Tips
You could be costing your practice 15 percent of every NPP E/M service. You can avoid... Read more
ICD-10 Conversion:
Stop Wishing And Start Preparing For ICD-10 Implementation Date
Tip: ICD-10 codes’ more detailed information will simplify claims in the long run.... Read more
Stop Wishing And Start Preparing For ICD-10 Implementation Date
Tip: ICD-10 codes’ more detailed information will simplify claims in the long run.... Read more
Recovery Audit Contractors:
OIG Asks CMS To Take Immediate Action On Potential Fraud
RACs identify improper payments totaling over a billion dollars. The Centers for Medi... Read more
OIG Asks CMS To Take Immediate Action On Potential Fraud
RACs identify improper payments totaling over a billion dollars. The Centers for Medi... Read more
CMS-1500 Forms:
CMS-1500 Makes Filing Claims Easier
Bonus: Form helps identify ordering, referring and supervising providers. Here’s... Read more
CMS-1500 Makes Filing Claims Easier
Bonus: Form helps identify ordering, referring and supervising providers. Here’s... Read more
Part B Revenue Booster:
Differentiate Co-Surgery From Assistant Surgery or Risk Thousands
Hint: Be vigilant when reading the op notes. Complex procedures sometimes require a se... Read more
Differentiate Co-Surgery From Assistant Surgery or Risk Thousands
Hint: Be vigilant when reading the op notes. Complex procedures sometimes require a se... Read more
Industry Notes
CMS Reminds Practices How to Avoid 1.5% PQRS Pay Cut in 2015 Voluntary incentive progr... Read more
CMS Reminds Practices How to Avoid 1.5% PQRS Pay Cut in 2015 Voluntary incentive progr... Read more
Compliance:
Bust These 5 Common Compliance Myths
Tip: Make a good faith effort to comply with the spirit of the law. Don’t get wa... Read more
Bust These 5 Common Compliance Myths
Tip: Make a good faith effort to comply with the spirit of the law. Don’t get wa... Read more
Reimbursement:
Maximize Your Income: Know When to Bill Same-Day E/M Encounters
Reduce wasted time and resources with these expert tips. You know that if two physicia... Read more
Maximize Your Income: Know When to Bill Same-Day E/M Encounters
Reduce wasted time and resources with these expert tips. You know that if two physicia... Read more
Revenue Booster:
Ensure Your Practice Recoups Deserved Pay With a Well-Oiled Billing and Collections Program
Use these seven tips to stay on top of your reimbursement challenges. You need clear-c... Read more
Ensure Your Practice Recoups Deserved Pay With a Well-Oiled Billing and Collections Program
Use these seven tips to stay on top of your reimbursement challenges. You need clear-c... Read more
2014 Medicare Fee Schedule:
Take Advantage Of Comment Period To Dodge The '1-2-3 Punch' Coming Down The Pike
Independent labs and radiology centers expected to take double digit losses. The Cente... Read more
Take Advantage Of Comment Period To Dodge The '1-2-3 Punch' Coming Down The Pike
Independent labs and radiology centers expected to take double digit losses. The Cente... Read more
Medicare Fee Schedule 2014:
Good News For EDs: More Cash Could Be Headed Your Way
The proposed rule makes for the highest increase of any specialty. With the 2014 Medic... Read more
Good News For EDs: More Cash Could Be Headed Your Way
The proposed rule makes for the highest increase of any specialty. With the 2014 Medic... Read more
Reimbursement:
Report TCM Codes Correctly To Keep Income Flowing
Note these differences between Medicare and CPT® for coding transitional care manage... Read more
Report TCM Codes Correctly To Keep Income Flowing
Note these differences between Medicare and CPT® for coding transitional care manage... Read more
Clip and Save:
Ensure Payers Correctly Apply Every Refund That You Send
Use this sample letter to provide all of the information your payer needs. When you se... Read more
Ensure Payers Correctly Apply Every Refund That You Send
Use this sample letter to provide all of the information your payer needs. When you se... Read more
Industry Notes
CMS ‘Regrets Inconvenience’ of Erroneously Requesting Overpayments Your ph... Read more
CMS ‘Regrets Inconvenience’ of Erroneously Requesting Overpayments Your ph... Read more
Reader Question:
Include Phone Work in Next E/M Code
Question: From his office, an oncologist reviews lab test results and, by telephone, ord... Read more
Include Phone Work in Next E/M Code
Question: From his office, an oncologist reviews lab test results and, by telephone, ord... Read more
Reader Question:
Your Physician Has Various Ways to Document
Question: My ob-gyn reported an established patient office visit code 99214, but t... Read more
Your Physician Has Various Ways to Document
Question: My ob-gyn reported an established patient office visit code 99214, but t... Read more
Reader Question:
Note That Immunization by MA Doesn't Usually Qualify for E/M
Question: This is the first year we are considering providing FluMist without a physicia... Read more
Note That Immunization by MA Doesn't Usually Qualify for E/M
Question: This is the first year we are considering providing FluMist without a physicia... Read more
Reader Question:
Assign a Physician, Not PA, for Initial NF Visits
Question: I am receiving denial C0-170 (Payment is denied when performed/billed by this ... Read more
Assign a Physician, Not PA, for Initial NF Visits
Question: I am receiving denial C0-170 (Payment is denied when performed/billed by this ... Read more
Reimbursement:
2014 Fee Schedule Proposals Look Bleak
Good news: CMS proposes innovative approach for patients with chronic conditions. As a... Read more
2014 Fee Schedule Proposals Look Bleak
Good news: CMS proposes innovative approach for patients with chronic conditions. As a... Read more
Home Health Reimbursement:
170 Revenue-Generating Diagnosis Codes Pruned
Watch how your plan of care is defined. Including diagnosis codes in the case mix poin... Read more
170 Revenue-Generating Diagnosis Codes Pruned
Watch how your plan of care is defined. Including diagnosis codes in the case mix poin... Read more
Compliance:
Make Sure Your Compliance Plan Meets ACA Requirements
Your Medicare, Medicaid and CHIP program participation could be at stake. CMS may be t... Read more
Make Sure Your Compliance Plan Meets ACA Requirements
Your Medicare, Medicaid and CHIP program participation could be at stake. CMS may be t... Read more
See What the ACA Says About Compliance Programs
Review the following directive from the Affordable Care Act creating the requirement for... Read more
Review the following directive from the Affordable Care Act creating the requirement for... Read more
Billing:
Stay Out Of Hot Water -- Develop Overpayment Policies
Check with your payer before returning overpayments. If you hope to remain compliant, ... Read more
Stay Out Of Hot Water -- Develop Overpayment Policies
Check with your payer before returning overpayments. If you hope to remain compliant, ... Read more
Industry Notes
Discrimination Costs Doc Federal Funding The HHS Office for Civil Rights (OCR) lodged ... Read more
Discrimination Costs Doc Federal Funding The HHS Office for Civil Rights (OCR) lodged ... Read more
Stark:
Know And Translate Stark Law To Your Providers
Ask yourself three basic questions to gauge whether you‘re in violation. It&rsqu... Read more
Know And Translate Stark Law To Your Providers
Ask yourself three basic questions to gauge whether you‘re in violation. It&rsqu... Read more
Recovery Audit Contractors:
Correct These Issues To Stay Out Of The RACs' Field Of Vision
Brush up on these five high-error areas. If you have recently heard from recovery aud... Read more
Correct These Issues To Stay Out Of The RACs' Field Of Vision
Brush up on these five high-error areas. If you have recently heard from recovery aud... Read more
Clip And Save:
Use This E/M Modifier Cheat Sheet to Bill Correctly Every Time
If you’re often mixing up your E/M modifiers, then clip this article and post it n... Read more
Use This E/M Modifier Cheat Sheet to Bill Correctly Every Time
If you’re often mixing up your E/M modifiers, then clip this article and post it n... Read more
How to Use Modifiers 76 and 77 to Your Advantage
If you’re one of the practices that the RACs identified as improperly billing dupl... Read more
If you’re one of the practices that the RACs identified as improperly billing dupl... Read more
Industry Notes
CPT® Announces New Vaccine Codes for CPT® 2014 You probably haven’t even... Read more
CPT® Announces New Vaccine Codes for CPT® 2014 You probably haven’t even... Read more
Reader Question:
Avoid Skirting the System to Save Patients Money
Question: We have a patient who wants us to directly bill her allowable charges for a pr... Read more
Avoid Skirting the System to Save Patients Money
Question: We have a patient who wants us to directly bill her allowable charges for a pr... Read more
Reader Question:
CMS Will Immediately Deny Outdated Codes
Question: A 65-year-old patient who just enrolled in Medicare came to our office for his... Read more
CMS Will Immediately Deny Outdated Codes
Question: A 65-year-old patient who just enrolled in Medicare came to our office for his... Read more
Reader Question:
Don't Automatically Combine ER and Office Visits
Question: If a patient was seen for an office visit (99214) first and then later on the ... Read more
Don't Automatically Combine ER and Office Visits
Question: If a patient was seen for an office visit (99214) first and then later on the ... Read more
PECOS:
Get The Skinny On Enrollment Specifications To Avoid Giving Away Services
Enjoy these advantages to submitting your Medicare credentialing application electronica... Read more
Get The Skinny On Enrollment Specifications To Avoid Giving Away Services
Enjoy these advantages to submitting your Medicare credentialing application electronica... Read more
Compliance:
Check Documentation Before Deciding Which Set of E/M Guidelines To Use
Tip: Specialty and specific details captured in the record hold the key to choosing the ... Read more
Check Documentation Before Deciding Which Set of E/M Guidelines To Use
Tip: Specialty and specific details captured in the record hold the key to choosing the ... Read more
Reimbursement:
Boost Your Bottom Line By Billing Services In Addition To Preventive Care
Appropriate modifier use could help break bundling of services. Normally you’ll ... Read more
Boost Your Bottom Line By Billing Services In Addition To Preventive Care
Appropriate modifier use could help break bundling of services. Normally you’ll ... Read more
Reimbursement:
MAC Overpays Hospitals For Post-Acute Transfers
Glitchy edit missed DRG prorates. Edits designed to catch transfers from hospitals to ... Read more
MAC Overpays Hospitals For Post-Acute Transfers
Glitchy edit missed DRG prorates. Edits designed to catch transfers from hospitals to ... Read more
Home Health Regulations:
Avoid These F2F Pitfalls
Does your docs’ F2F documentation include an explanation of clinical findings? M... Read more
Avoid These F2F Pitfalls
Does your docs’ F2F documentation include an explanation of clinical findings? M... Read more
Industry Notes
CMS Knows You’re Confused About POS Rules When the Centers for Medicare & Me... Read more
CMS Knows You’re Confused About POS Rules When the Centers for Medicare & Me... Read more
Medicare Funding:
CMS Slows Spending To Avoid Bankruptcy Plunge
Changes implemented by the Affordable Care Act (ACA) allowed Medicare Part A to stay fun... Read more
CMS Slows Spending To Avoid Bankruptcy Plunge
Changes implemented by the Affordable Care Act (ACA) allowed Medicare Part A to stay fun... Read more
Reimbursement:
Are These 2 Misconceptions Costing You Critical Care Pay?
Crucial: You must meet vital time and documentation requirements. Regardless of the se... Read more
Are These 2 Misconceptions Costing You Critical Care Pay?
Crucial: You must meet vital time and documentation requirements. Regardless of the se... Read more
CMS Regulations:
Get The Scoop on These Hot Issues
Changes and clarifications should make life easier for you. The government tightened u... Read more
Get The Scoop on These Hot Issues
Changes and clarifications should make life easier for you. The government tightened u... Read more
Claim Denials:
Brace for Intensified Scrutiny of 'G' Modifiers
Without standardized procedures, Medicare has overpaid almost $744 million in 2011 alone... Read more
Brace for Intensified Scrutiny of 'G' Modifiers
Without standardized procedures, Medicare has overpaid almost $744 million in 2011 alone... Read more
Collections:
Get Paid for Home Visits: Apply These Coding Tips
Medical necessity is key to reimbursement. If your physician makes a house call, you d... Read more
Get Paid for Home Visits: Apply These Coding Tips
Medical necessity is key to reimbursement. If your physician makes a house call, you d... Read more
Industry Notes
58 Percent of PECOS Records Are Inaccurate, OIG Says You diligently transferred your M... Read more
58 Percent of PECOS Records Are Inaccurate, OIG Says You diligently transferred your M... Read more
Reader Question:
Preexisting vs. New Matters During Global Periods
Question: If I see a patient after his radical prostatectomy within the global period, a... Read more
Preexisting vs. New Matters During Global Periods
Question: If I see a patient after his radical prostatectomy within the global period, a... Read more
Reader Question:
Showing Two Percent Cut on Invoice Is Your Choice
Question: Now that the Medicare remittance is clearly tracking CO-223 for sequestration ... Read more
Showing Two Percent Cut on Invoice Is Your Choice
Question: Now that the Medicare remittance is clearly tracking CO-223 for sequestration ... Read more
ICD-10:
Contact Your State Worker's Compensation Insurer For Details On ICD-10 Transition
Oct. 1, 2014 deadline is firm CMS says. It’s time for you to get your ICD-10 tra... Read more
Contact Your State Worker's Compensation Insurer For Details On ICD-10 Transition
Oct. 1, 2014 deadline is firm CMS says. It’s time for you to get your ICD-10 tra... Read more
Reimbursement:
Appeal Medicare Advantage 2 Percent Slashes
Double-check your contract to determine whether your Medicare Advantage payer is allowed... Read more
Appeal Medicare Advantage 2 Percent Slashes
Double-check your contract to determine whether your Medicare Advantage payer is allowed... Read more
Hospital Outpatient Procedure Payments:
Update Your Systems To Reflect OPPS And ASC Changes
Good news for providers. Expect to modify your reporting of some services thanks to re... Read more
Update Your Systems To Reflect OPPS And ASC Changes
Good news for providers. Expect to modify your reporting of some services thanks to re... Read more
Billing:
Nail Down PA Reimbursement In Four Expert-Tested Steps
Coding the assist shouldn’t be as tough as coding the procedure itself. Watch ho... Read more
Nail Down PA Reimbursement In Four Expert-Tested Steps
Coding the assist shouldn’t be as tough as coding the procedure itself. Watch ho... Read more
Billing Strategies:
Prevent Income From Plummeting
Make a big difference to your practice’s bottom line with smart relationship manag... Read more
Prevent Income From Plummeting
Make a big difference to your practice’s bottom line with smart relationship manag... Read more
Industry Notes:
You May Need to Resubmit AWV, IPPE Claims, CMS Says
Rural health clinics may have been shortchanged since January. Have your preventive vi... Read more
You May Need to Resubmit AWV, IPPE Claims, CMS Says
Rural health clinics may have been shortchanged since January. Have your preventive vi... Read more
Reader Question:
Capture Payment For Biopsy Result Discussion
Question: A patient came in for the biopsy report after a 90-day global procedure. The d... Read more
Capture Payment For Biopsy Result Discussion
Question: A patient came in for the biopsy report after a 90-day global procedure. The d... Read more
Compliance:
Make Distinguishing Between New vs. Established Patient a Breeze
Tip: Keep track of timelines. Evaluation and management of a patient differs depending... Read more
Make Distinguishing Between New vs. Established Patient a Breeze
Tip: Keep track of timelines. Evaluation and management of a patient differs depending... Read more
Compliance:
Brush Up On Signature Guidelines
Tread carefully to guard against the wrong use of signatures. Signature requirements f... Read more
Brush Up On Signature Guidelines
Tread carefully to guard against the wrong use of signatures. Signature requirements f... Read more
Reimbursement:
Don't Fall For These ABN Myths
Eliminate all scope of error with guidance from CMS. When Medicare excludes certain se... Read more
Don't Fall For These ABN Myths
Eliminate all scope of error with guidance from CMS. When Medicare excludes certain se... Read more
Reimbursement:
Boost Pay With These Savvy Tips
Preventive wellness visit coupled with significant other problem can qualify for two cod... Read more
Boost Pay With These Savvy Tips
Preventive wellness visit coupled with significant other problem can qualify for two cod... Read more
Industry Notes
Auditors Accuse CIGNA of Overbilling Medicare by $28 Million If you think medical prac... Read more
Auditors Accuse CIGNA of Overbilling Medicare by $28 Million If you think medical prac... Read more
Reimbursement:
Offset Sequestration Cuts With 5 Expert Tips
Keep cash flowing. The two percent across-the-board Medicare pay cuts that kicked in o... Read more
Offset Sequestration Cuts With 5 Expert Tips
Keep cash flowing. The two percent across-the-board Medicare pay cuts that kicked in o... Read more
PECOS Enforcement:
Get the Update on the PECOS Delay
HHAs: Head off costly appeals by monitoring RAPs. Home health agencies have a moment t... Read more
Get the Update on the PECOS Delay
HHAs: Head off costly appeals by monitoring RAPs. Home health agencies have a moment t... Read more
Home Health Agencies:
Take a Closer Look at Your Agency's PECOS Readiness
Be sure you’re on top of these costly edits before they hit. When Home Health &a... Read more
Take a Closer Look at Your Agency's PECOS Readiness
Be sure you’re on top of these costly edits before they hit. When Home Health &a... Read more
Denials Management:
Don't Let MUEs Sabotage Your Claims
Use these 4 tips to appeal denials successfully Medically unlikely edits (MUE) are des... Read more
Don't Let MUEs Sabotage Your Claims
Use these 4 tips to appeal denials successfully Medically unlikely edits (MUE) are des... Read more
Industry Notes
Dx Coding Rules Change: Don’t Get Caught Asleep at the Wheel As most coders are... Read more
Dx Coding Rules Change: Don’t Get Caught Asleep at the Wheel As most coders are... Read more
Reader Question:
Don't Change Inpatient POS for Radiology
Question:One of my coworkers heard that some Medicare rules have changed regarding wheth... Read more
Don't Change Inpatient POS for Radiology
Question:One of my coworkers heard that some Medicare rules have changed regarding wheth... Read more
Reimbursement:
Primary Care: Catch The Medicaid Pay Boost Wave
Find out how to self-attest to start collecting cash. If you’re a primary care p... Read more
Primary Care: Catch The Medicaid Pay Boost Wave
Find out how to self-attest to start collecting cash. If you’re a primary care p... Read more
Practice Management:
Intercept Big Time Losses With Effective Denial Management
Eliminate the cause of your denials by systematically addressing them. Your practice c... Read more
Intercept Big Time Losses With Effective Denial Management
Eliminate the cause of your denials by systematically addressing them. Your practice c... Read more
Divide and Conquer Carriers to Solve Your Denial Woes
3 expert tips help you eliminate the root causes of your rejections. Denial management... Read more
3 expert tips help you eliminate the root causes of your rejections. Denial management... Read more
Use This 5-Step Checklist to Simplify Your Secondary Claim Issues
Start with all insurance cards, not just Medicare. If your practice’s internal a... Read more
Start with all insurance cards, not just Medicare. If your practice’s internal a... Read more
Billing:
Collect What You Deserve With This 4 Step Approach
Deal with unexpected denials by first checking the regs. You can’t afford to wri... Read more
Collect What You Deserve With This 4 Step Approach
Deal with unexpected denials by first checking the regs. You can’t afford to wri... Read more
Patient Care:
Ensure You're Handling Test Results Properly
Timeliness holds the key to both correct interventions and patient satisfaction. Too m... Read more
Ensure You're Handling Test Results Properly
Timeliness holds the key to both correct interventions and patient satisfaction. Too m... Read more
Industry Notes
Missouri Doctor Faces Sentence for Chronic Upcoding A Missouri physician and her husba... Read more
Missouri Doctor Faces Sentence for Chronic Upcoding A Missouri physician and her husba... Read more
Reader Question:
How Can We Bill Extended Time?
Question: One of our asthmatic patients was in the hospital for over a week with pneumon... Read more
How Can We Bill Extended Time?
Question: One of our asthmatic patients was in the hospital for over a week with pneumon... Read more
Reimbursement:
Adopt These 3 Billing Strategies for Nursing Facility Patients
Don’t sacrifice fees — follow these key steps. If you’re not up to s... Read more
Adopt These 3 Billing Strategies for Nursing Facility Patients
Don’t sacrifice fees — follow these key steps. If you’re not up to s... Read more
Clip and Save:
Create a Nursing Facility Payment Contract With this Sample Tool
Even if your provider doesn’t see many NF patients, be proactive and have a contra... Read more
Create a Nursing Facility Payment Contract With this Sample Tool
Even if your provider doesn’t see many NF patients, be proactive and have a contra... Read more
Keep These CMS and MAC Critical Care Documentation Guidelines Handy
Ensure you’re following the rules by reviewing these 11 citations and quotes from ... Read more
Ensure you’re following the rules by reviewing these 11 citations and quotes from ... Read more
Reimbursement:
Good News: Expect More Pay for These 10 Procedures
CMS has made some changes with retroactive effect to Jan. 1, 2013. Now you can collect... Read more
Good News: Expect More Pay for These 10 Procedures
CMS has made some changes with retroactive effect to Jan. 1, 2013. Now you can collect... Read more
Practice Management:
Is Your Phone System Annoying Patients?
Use these tips to improve telephone menus and voice mail — and keep patients happy... Read more
Is Your Phone System Annoying Patients?
Use these tips to improve telephone menus and voice mail — and keep patients happy... Read more
Industry Notes
CMS Allows TCM Code Reporting for Both New and Established Patients You’ve got q... Read more
CMS Allows TCM Code Reporting for Both New and Established Patients You’ve got q... Read more
Enrollment:
Get Your Ordering/Referring NPI In Place Or Lose Pay
May 1 is the deadline you have to watch out for according to CMS. The last thing you w... Read more
Get Your Ordering/Referring NPI In Place Or Lose Pay
May 1 is the deadline you have to watch out for according to CMS. The last thing you w... Read more
Home Health Reimbursement:
Use 6 Strategies To Avert PECOS Edit Losses
You could pay a steep price if your provider information is incorrect. Now is the time... Read more
Use 6 Strategies To Avert PECOS Edit Losses
You could pay a steep price if your provider information is incorrect. Now is the time... Read more
Legislation:
Expect Medicare Shortfall From Congressional Stalemate
Medicare providers will bear some of the brunt of the sequester cuts. You have till A... Read more
Expect Medicare Shortfall From Congressional Stalemate
Medicare providers will bear some of the brunt of the sequester cuts. You have till A... Read more
Hospital Corner:
Oversee And Manage The Revenue Cycle With These 5 Steps
Ethically optimizing reimbursement and lowering compliance risks is every facility&rsquo... Read more
Oversee And Manage The Revenue Cycle With These 5 Steps
Ethically optimizing reimbursement and lowering compliance risks is every facility&rsquo... Read more
Compliance:
Waste Not, Want Not Where Drugs Are Concerned, Says OIG
Target: Multi-use drugs. Medical practices were given a slap on the wrist by the Offic... Read more
Waste Not, Want Not Where Drugs Are Concerned, Says OIG
Target: Multi-use drugs. Medical practices were given a slap on the wrist by the Offic... Read more
Industry Notes:
Industry Notes:
Government Trying to Recoup More Medicaid Dollars If you think Medicare is the only go... Read more
Industry Notes:
Government Trying to Recoup More Medicaid Dollars If you think Medicare is the only go... Read more
Compliance:
Record-Breaking Recovery From Fraudulent Medicare Billers
Even though the government recovered a whopping $4.2 billion, expect the noose to get ti... Read more
Record-Breaking Recovery From Fraudulent Medicare Billers
Even though the government recovered a whopping $4.2 billion, expect the noose to get ti... Read more
MAC Spotlight:
Wait For Clarity On TCM Rules To Emerge
Some MACs seem to be in the dark regarding whether subsequent E/M visits are separately ... Read more
Wait For Clarity On TCM Rules To Emerge
Some MACs seem to be in the dark regarding whether subsequent E/M visits are separately ... Read more
Coding Strategies:
Take These Steps to Ensure Your Time Documentation Makes the Grade
Auditors will not be impressed if you rely on the physician’s memory; only sound d... Read more
Take These Steps to Ensure Your Time Documentation Makes the Grade
Auditors will not be impressed if you rely on the physician’s memory; only sound d... Read more
Home Health:
Comply With Correction Time Frames To Avoid Harsher Punishment
Watch out for administrative hand holding by CMS disguised as “alternative sanctio... Read more
Comply With Correction Time Frames To Avoid Harsher Punishment
Watch out for administrative hand holding by CMS disguised as “alternative sanctio... Read more
Industry Notes:
Industry Notes:
Physician Who Alters Medical Record Is Charged With Obstruction of Justice Ever wonder... Read more
Industry Notes:
Physician Who Alters Medical Record Is Charged With Obstruction of Justice Ever wonder... Read more
Reader Question:
Report Payers That Don't Accept New Codes
Question: We already have payers that are rejecting the new CPT® codes. They are not... Read more
Report Payers That Don't Accept New Codes
Question: We already have payers that are rejecting the new CPT® codes. They are not... Read more
Reader Question:
Check Eligibility Dates As Part of Verification
Question: How should I file a claim on a patient who has new coverage but has not receiv... Read more
Check Eligibility Dates As Part of Verification
Question: How should I file a claim on a patient who has new coverage but has not receiv... Read more
Appeal Strategies:
Appeal Modifier 25 Denials Effectively
Avoid missing out on deserved reimbursement with these four steps. If you feel that re... Read more
Appeal Modifier 25 Denials Effectively
Avoid missing out on deserved reimbursement with these four steps. If you feel that re... Read more
Refunds:
You Might Have To Return Money 5 Years Later
Legislation removes one more obstacle for Medicare to recoup overpayments. Medicare ha... Read more
You Might Have To Return Money 5 Years Later
Legislation removes one more obstacle for Medicare to recoup overpayments. Medicare ha... Read more
Inpatient Coding:
You Can Recoup Pay for Death Pronouncements
Key: Enter correct date and place of service. There’s no need to write off your ... Read more
You Can Recoup Pay for Death Pronouncements
Key: Enter correct date and place of service. There’s no need to write off your ... Read more
RAC Audits:
Brace For Intensified Scrutiny
Check out what’s on the radar screen of auditors. The recovery audit contractors... Read more
Brace For Intensified Scrutiny
Check out what’s on the radar screen of auditors. The recovery audit contractors... Read more
Front Office Strategies:
Streamline Your Patient Check-Ins
3 Step plan helps you collect all of the essential information you’ll need to proc... Read more
Streamline Your Patient Check-Ins
3 Step plan helps you collect all of the essential information you’ll need to proc... Read more
Compliance:
Get Ready to Repay CMS for Treating Illegal Immigrants
Millions at stake for payment of non-covered services. If you have been paid erroneous... Read more
Get Ready to Repay CMS for Treating Illegal Immigrants
Millions at stake for payment of non-covered services. If you have been paid erroneous... Read more
Industry Notes:
Industry Notes:
Congress to Consider Repeal of Medicare Payments Advisory Board Just what physicians n... Read more
Industry Notes:
Congress to Consider Repeal of Medicare Payments Advisory Board Just what physicians n... Read more
Practice Management:
Use These 8 Tactics to Add the Right Coder to Your Staff
Bring in the reimbursement your practice deserves by hiring the right coder. A solid c... Read more
Use These 8 Tactics to Add the Right Coder to Your Staff
Bring in the reimbursement your practice deserves by hiring the right coder. A solid c... Read more
Revenue Booster:
Make Your History Documentation Word Perfect
Tip: Avoid repeating yourself. Losing money on your E/M visits? History documentation ... Read more
Make Your History Documentation Word Perfect
Tip: Avoid repeating yourself. Losing money on your E/M visits? History documentation ... Read more
Revenue Booster:
Body System or Site? Be Sure You Clarify
Escape scrutiny — and ensure proper payment — with specific body part descri... Read more
Body System or Site? Be Sure You Clarify
Escape scrutiny — and ensure proper payment — with specific body part descri... Read more
Risk Management:
Tighten Up Background Checks And Avoid Audit Scrutiny
Stricter requirements put HHAs under scrutiny. Home Health Agencies are in the limelig... Read more
Tighten Up Background Checks And Avoid Audit Scrutiny
Stricter requirements put HHAs under scrutiny. Home Health Agencies are in the limelig... Read more
Staffing:
Develop A 'Targeted Screen' For Better Legal Standing
Protect your HHA from discrimination claims under the new EEOC guidance. If an employe... Read more
Develop A 'Targeted Screen' For Better Legal Standing
Protect your HHA from discrimination claims under the new EEOC guidance. If an employe... Read more
Industry Notes
New codes for emerging technologies are always welcome by physician practices, but when ... Read more
New codes for emerging technologies are always welcome by physician practices, but when ... Read more
2013 Payment:
Medicare Pay Cut Reversal Gives Practices a Welcome Boost
Congress does the last reel escape act again. If you were wondering how you’d sc... Read more
Medicare Pay Cut Reversal Gives Practices a Welcome Boost
Congress does the last reel escape act again. If you were wondering how you’d sc... Read more
Compliance:
Incorrect Reporting Could Be One Of Your Costliest Mistakes
The three-day payment window applies if the hospital wholly owns or operates the practic... Read more
Incorrect Reporting Could Be One Of Your Costliest Mistakes
The three-day payment window applies if the hospital wholly owns or operates the practic... Read more
IPPS 2013:
HAC Could Impact Your Reimbursement
Be careful to document all "present on admission" conditions for each patient.... Read more
HAC Could Impact Your Reimbursement
Be careful to document all "present on admission" conditions for each patient.... Read more
Compliance:
Tighten Up Documentation, Correct Modifier Use Or Else, Says OIG
Many OIG suggestions ignored according to a report. When the OIG released its Compendi... Read more
Tighten Up Documentation, Correct Modifier Use Or Else, Says OIG
Many OIG suggestions ignored according to a report. When the OIG released its Compendi... Read more
SNF Compliance:
Find Out If Your Facility's MDS Process Needs Revamping Before Surveyors Do
Tip: Validation reports hold the key to RAI compliance. While reviewing validation rep... Read more
Find Out If Your Facility's MDS Process Needs Revamping Before Surveyors Do
Tip: Validation reports hold the key to RAI compliance. While reviewing validation rep... Read more
Industry Notes:
Prepare for Quality Measure Contract Discussions
Contracts between hospitals and insurers cover virtually every facet of care, so be awar... Read more
Prepare for Quality Measure Contract Discussions
Contracts between hospitals and insurers cover virtually every facet of care, so be awar... Read more
Reader Question:
Take This 'No Man's Land' Coding Advice
Question: A mother brought her daughter for a well child check-up, although she didn&rsq... Read more
Take This 'No Man's Land' Coding Advice
Question: A mother brought her daughter for a well child check-up, although she didn&rsq... Read more
Reader Question:
Check Individual Payer Consultation Rules
Question: If my doctor sees a patient in the office for something like diabetes, then th... Read more
Check Individual Payer Consultation Rules
Question: If my doctor sees a patient in the office for something like diabetes, then th... Read more
Reader Question:
'Case Management' Can Be Coded Various Ways
Question: Does CPT® include any procedure codes for case management, phone calls to ... Read more
'Case Management' Can Be Coded Various Ways
Question: Does CPT® include any procedure codes for case management, phone calls to ... Read more
Revenue Booster:
Are Your Overlooking These 5 Opportunities To Collect Reimbursement?
Tip: Don’t delay follow up if you want to keep reimbursement flowing. Leaving no... Read more
Are Your Overlooking These 5 Opportunities To Collect Reimbursement?
Tip: Don’t delay follow up if you want to keep reimbursement flowing. Leaving no... Read more
Payer Preferences:
You Could Be Missing Out On Legitimate Post-Op Revenue
Don’t automatically skip billing for post-surgical infection care. If you’... Read more
You Could Be Missing Out On Legitimate Post-Op Revenue
Don’t automatically skip billing for post-surgical infection care. If you’... Read more
Compliance:
Win A ZPIC Appeal With These Expert Pointers
Make documentation back up your claims. Present your arguments cogently to your Zone P... Read more
Win A ZPIC Appeal With These Expert Pointers
Make documentation back up your claims. Present your arguments cogently to your Zone P... Read more
Audits:
Audit Strategies Boost Your ZPIC Audit Preparedness -- And Confidence
Apply these tips and be ready when auditors come knocking. Audits and compliance issue... Read more
Audit Strategies Boost Your ZPIC Audit Preparedness -- And Confidence
Apply these tips and be ready when auditors come knocking. Audits and compliance issue... Read more
Compliance:
ED Coders: Expect Close Scrutiny on E/M Claims
EHRs being made the culprit of E/M code abuse. The sharp rise in upcoding of evaluatio... Read more
ED Coders: Expect Close Scrutiny on E/M Claims
EHRs being made the culprit of E/M code abuse. The sharp rise in upcoding of evaluatio... Read more
Industry Notes:
Industry Notes:
Use ‘Single Line Strike’ to Amend Medical Record, CMS Says Most practices ... Read more
Industry Notes:
Use ‘Single Line Strike’ to Amend Medical Record, CMS Says Most practices ... Read more