Part B Insider (Multispecialty) Coding Alert
Part B Payment:
CMS Shakes Up E/M Payments Starting in 2021
Don't panic — level 5 codes maintain their higher payouts. For Part B providers, E/M vi... Read more
CMS Shakes Up E/M Payments Starting in 2021
Don't panic — level 5 codes maintain their higher payouts. For Part B providers, E/M vi... Read more
Evaluation and Management:
Prep Now for These 2019 E/M Policy Changes
CMS staggers E/M updates from 2019 through 2021, relates MPFS. If you guessed the feds wo... Read more
Prep Now for These 2019 E/M Policy Changes
CMS staggers E/M updates from 2019 through 2021, relates MPFS. If you guessed the feds wo... Read more
Compliance:
CMS Updates PIM With LCD Guideline Revisions
Medicare guidance suggests MACs nix codes from LCDs in the future. As the agency steamrol... Read more
CMS Updates PIM With LCD Guideline Revisions
Medicare guidance suggests MACs nix codes from LCDs in the future. As the agency steamrol... Read more
Part B Coding Coach:
Get the Scoop on How to Code All Types of Colorectal Screenings
From FOBT to screening barium enemas, know how to report these services. Gastroenterologi... Read more
Get the Scoop on How to Code All Types of Colorectal Screenings
From FOBT to screening barium enemas, know how to report these services. Gastroenterologi... Read more
Physician Notes:
Feds Create Another Medicare Fraud Strike Force Team to Fight Opioid Crisis
Plus: Input this new flu vaccine into your code checklist. Over summer, the Department of... Read more
Feds Create Another Medicare Fraud Strike Force Team to Fight Opioid Crisis
Plus: Input this new flu vaccine into your code checklist. Over summer, the Department of... Read more
Modifiers:
Get the Facts on Modifier 24
A comprehensive understanding of global surgical packages is imperative. Now and again, a... Read more
Get the Facts on Modifier 24
A comprehensive understanding of global surgical packages is imperative. Now and again, a... Read more
Documentation:
Prevent Part B Denials with this Signature Primer
Tip: Know the ins-and-outs on incident-to signature rules. CPT® and ICD-10 codes are ess... Read more
Prevent Part B Denials with this Signature Primer
Tip: Know the ins-and-outs on incident-to signature rules. CPT® and ICD-10 codes are ess... Read more
Part B Coding Coach:
Deploy NCCI Know-How for Surgical Coding Conundrums
Tip: Review modifier 59 rules, too. If surgical coding is not something you do every day,... Read more
Deploy NCCI Know-How for Surgical Coding Conundrums
Tip: Review modifier 59 rules, too. If surgical coding is not something you do every day,... Read more
Physician Notes:
Look for MBIs on Remittance Advice Going Forward, CMS Says
Plus: MAC reminds practices to forward CERT documentation now. New Medicare Beneficiary I... Read more
Look for MBIs on Remittance Advice Going Forward, CMS Says
Plus: MAC reminds practices to forward CERT documentation now. New Medicare Beneficiary I... Read more
Reader Question:
Review These NPP Guidelines for Coding Virtual Visits
Question: What's the best way to document email exchanges between a patient's guardian and... Read more
Review These NPP Guidelines for Coding Virtual Visits
Question: What's the best way to document email exchanges between a patient's guardian and... Read more
Disaster Coding:
Ensure Part B Pay After a Catastrophe
You can append modifier CR for more than just natural disasters. When a hurricane bears d... Read more
Ensure Part B Pay After a Catastrophe
You can append modifier CR for more than just natural disasters. When a hurricane bears d... Read more
Part B Payment:
CMS Throws ACOs for a Loop with MSSP Proposed Rule
If you plan to ramp up your income by joining an Accountable Care Organization (ACO) in 20... Read more
CMS Throws ACOs for a Loop with MSSP Proposed Rule
If you plan to ramp up your income by joining an Accountable Care Organization (ACO) in 20... Read more
Telehealth:
Expect Expansions to Continue into 2019, MPFS Proposals Suggest
Plus: See more options for physicians as care goes online. The reduction of physicians' a... Read more
Expect Expansions to Continue into 2019, MPFS Proposals Suggest
Plus: See more options for physicians as care goes online. The reduction of physicians' a... Read more
Part B Coding Coach:
ICD-10 Coding: Distinguish CTS to Guarantee Pay for Future Treatments
Tip: CTS diagnosis is often required before payers will approve therapeutic measures. Cod... Read more
ICD-10 Coding: Distinguish CTS to Guarantee Pay for Future Treatments
Tip: CTS diagnosis is often required before payers will approve therapeutic measures. Cod... Read more
Physician Notes:
Know This MIPS Exception Deadline
Tip: Submit your hardship applications ASAP. If your practice was impacted by disaster th... Read more
Know This MIPS Exception Deadline
Tip: Submit your hardship applications ASAP. If your practice was impacted by disaster th... Read more
Reader Question:
Conquer CCI Edits with Exclusive, Unlikely Expertise
Question: The Correct Coding Initiative (CCI) baffles me; I have a lot of trouble with the... Read more
Conquer CCI Edits with Exclusive, Unlikely Expertise
Question: The Correct Coding Initiative (CCI) baffles me; I have a lot of trouble with the... Read more
Policy:
CMS Delivers Some Shockers in CY 2019 MPFS Proposed Rule
Get ready for more shortcuts and rollbacks — but, at a cost. The feds continue slashing... Read more
CMS Delivers Some Shockers in CY 2019 MPFS Proposed Rule
Get ready for more shortcuts and rollbacks — but, at a cost. The feds continue slashing... Read more
Evaluation and Management:
Specialty May Determine Pay Gains with CY 2019 MPFS Proposal
Hint: Suggested E/M documentation changes could balance shortcomings. If a hefty portion ... Read more
Specialty May Determine Pay Gains with CY 2019 MPFS Proposal
Hint: Suggested E/M documentation changes could balance shortcomings. If a hefty portion ... Read more
Part B Reimbursement:
Manage MIPS with Changes in the MPFS Proposals
Expect eased requirements in next year's plans. If you just got the hang of the Merit-Bas... Read more
Manage MIPS with Changes in the MPFS Proposals
Expect eased requirements in next year's plans. If you just got the hang of the Merit-Bas... Read more
Part B Coding Coach:
Master MRI Coding with Advice from the Experts
Anatomy and guidance questions factor into correct coding. Physicians sometimes perform a... Read more
Master MRI Coding with Advice from the Experts
Anatomy and guidance questions factor into correct coding. Physicians sometimes perform a... Read more
Physician Notes:
PECOS Security Is Important, Too
Plus: Devise HIPAA compliance protocols for device disposals. HIPAA requires that practic... Read more
PECOS Security Is Important, Too
Plus: Devise HIPAA compliance protocols for device disposals. HIPAA requires that practic... Read more
Reader Question:
Is Your Practice Appeal Policy Up To Date?
Question: We were a solo practice for about 15 years, and the founding physician's wife wa... Read more
Is Your Practice Appeal Policy Up To Date?
Question: We were a solo practice for about 15 years, and the founding physician's wife wa... Read more
Medicare Card Transition:
Ensure Your Patients Are Getting Their MBIs in the Mail
The first wave of the Medicare card transition is complete. With the Medicare card change... Read more
Ensure Your Patients Are Getting Their MBIs in the Mail
The first wave of the Medicare card transition is complete. With the Medicare card change... Read more
E/M Coding:
Strong Notes Back Up Critical Care Claims
Watch the clock for correct critical care coding. Part B clinicians sometimes treat patie... Read more
Strong Notes Back Up Critical Care Claims
Watch the clock for correct critical care coding. Part B clinicians sometimes treat patie... Read more
Part B Statistics:
Review Critical Care Service Benchmarks to See Where You Fall
Over 10,000 Part B providers received CBRs to help clean up their claims. As with many cl... Read more
Review Critical Care Service Benchmarks to See Where You Fall
Over 10,000 Part B providers received CBRs to help clean up their claims. As with many cl... Read more
Measure Your Critical Care Numbers Against Your Peers
Critical care sits atop the MACs' Targeted Probe and Educate to-do lists. If you're worri... Read more
Critical care sits atop the MACs' Targeted Probe and Educate to-do lists. If you're worri... Read more
Part B Coding Coach:
Review Post-Procedural Infection Code Options Set to Debut Oct. 1
The 2019 diagnosis codes include over 300 additions. With 320 new diagnosis codes ready f... Read more
Review Post-Procedural Infection Code Options Set to Debut Oct. 1
The 2019 diagnosis codes include over 300 additions. With 320 new diagnosis codes ready f... Read more
Physician Notes:
MA Claims Are on the OIG's Watch List
Are you seeing an uptick in your Medicare Advantage (MA) denials? This might be the reason... Read more
MA Claims Are on the OIG's Watch List
Are you seeing an uptick in your Medicare Advantage (MA) denials? This might be the reason... Read more
Physician Notes:
CMS Issues RFI on Stark Law Rollbacks
The feds are at it again — this time it's over revising the Stark Law. CMS published a ... Read more
CMS Issues RFI on Stark Law Rollbacks
The feds are at it again — this time it's over revising the Stark Law. CMS published a ... Read more
Physician Notes:
Calculate 2019 Part B Pay from Updated MIPS Data
If you're curious about what your Medicare pay will amount to in 2019, CMS has updated eli... Read more
Calculate 2019 Part B Pay from Updated MIPS Data
If you're curious about what your Medicare pay will amount to in 2019, CMS has updated eli... Read more
Compliance:
Part B Lab Tests Remain a Fixture on the OIG Hit List
Plus: Medicare pay cuts for lab work may lead to reduced testing. Clinical tests are a ne... Read more
Part B Lab Tests Remain a Fixture on the OIG Hit List
Plus: Medicare pay cuts for lab work may lead to reduced testing. Clinical tests are a ne... Read more
Fraud & Abuse:
Keep Lab Referrals and Claims on Point, Recent Enforcement Suggests
Extreme judgments may be a precursor of things to come. Time and again, fraudsters try to... Read more
Keep Lab Referrals and Claims on Point, Recent Enforcement Suggests
Extreme judgments may be a precursor of things to come. Time and again, fraudsters try to... Read more
Enforcement:
Master the 3 Big Fraud Laws to Avoid the OIG Spotlight
Tip: With Stark, it doesn't matter if the violation was accidental. Referral abuse is a m... Read more
Master the 3 Big Fraud Laws to Avoid the OIG Spotlight
Tip: With Stark, it doesn't matter if the violation was accidental. Referral abuse is a m... Read more
Part B Coding Coach:
Differentiate Conization or Biopsy with this LEEP Advice
Hint: Endocervix removal or lack thereof determines codes. Documentation is key to clean ... Read more
Differentiate Conization or Biopsy with this LEEP Advice
Hint: Endocervix removal or lack thereof determines codes. Documentation is key to clean ... Read more
Physician Notes:
CDC Releases Final FY 2019 ICD-10-CM Updates
Medicare Part B providers will have lots of new options in their coding wheelhouse startin... Read more
CDC Releases Final FY 2019 ICD-10-CM Updates
Medicare Part B providers will have lots of new options in their coding wheelhouse startin... Read more
Physician Notes:
Don't Miss the CMS Web Interface Sign-Up Deadline for MIPS 2018
If your Medicare Part B practice or virtual group submitted your 2017 Merit-Based Incentiv... Read more
Don't Miss the CMS Web Interface Sign-Up Deadline for MIPS 2018
If your Medicare Part B practice or virtual group submitted your 2017 Merit-Based Incentiv... Read more
Reader Question:
Keep Bug Bite Coding in Check this Summer
Question: How do I code for multiple mosquito bites on a patient? Is there one code I can ... Read more
Keep Bug Bite Coding in Check this Summer
Question: How do I code for multiple mosquito bites on a patient? Is there one code I can ... Read more
Reader Question:
Use CMS-855O Form for Unlicensed Residents ASAP
CMS wants to streamline provider enrollment for unlicensed residents in another effort to ... Read more
Use CMS-855O Form for Unlicensed Residents ASAP
CMS wants to streamline provider enrollment for unlicensed residents in another effort to ... Read more
Part B Policy:
CMS Rebrands ACI as 'Promoting Interoperability'
Practices will face penalties for not sharing data with patients, CMS says. If you feel o... Read more
CMS Rebrands ACI as 'Promoting Interoperability'
Practices will face penalties for not sharing data with patients, CMS says. If you feel o... Read more
E/M Mythbuster:
Scrap These 4 Prolonged Service Coding Myths
Hint: Read and review published guidelines to code correctly. Sometimes visits last longe... Read more
Scrap These 4 Prolonged Service Coding Myths
Hint: Read and review published guidelines to code correctly. Sometimes visits last longe... Read more
Compliance:
Get the Facts on the 4 Top Ways Medicare Audits Claims
Failure to comply with CERT auditors can lead to more scrutiny. With so many avenues to s... Read more
Get the Facts on the 4 Top Ways Medicare Audits Claims
Failure to comply with CERT auditors can lead to more scrutiny. With so many avenues to s... Read more
Part B Coding Coach:
Boost Your Shoulder Arthroscopy Savvy with These Coding Alternatives
Tip: Clarify whether the procedure is diagnostic or surgical to avoid confusion. Orthoped... Read more
Boost Your Shoulder Arthroscopy Savvy with These Coding Alternatives
Tip: Clarify whether the procedure is diagnostic or surgical to avoid confusion. Orthoped... Read more
Physician Notes:
Expect Fines and Possibly Prison for Criminal HIPAA Violations, DOJ Says
Plus: Review your GDPR smarts before the May 25 release date. Most HIPAA breaches concern... Read more
Expect Fines and Possibly Prison for Criminal HIPAA Violations, DOJ Says
Plus: Review your GDPR smarts before the May 25 release date. Most HIPAA breaches concern... Read more
Reader Question:
Anthem Decides to Keep Modifier 25 Policy Status Quo
Question: Last year, we heard Anthem would start cutting its modifier 25 payment by 50 per... Read more
Anthem Decides to Keep Modifier 25 Policy Status Quo
Question: Last year, we heard Anthem would start cutting its modifier 25 payment by 50 per... Read more
Part B Policy:
Bipartisan Budget Act Slims Some MIPS Requirements
Cost category percentages could remain status quo, BBA suggests As the dust settles on Pe... Read more
Bipartisan Budget Act Slims Some MIPS Requirements
Cost category percentages could remain status quo, BBA suggests As the dust settles on Pe... Read more
E/M Coding:
CMS Continues to Focus on E/M Problem Areas
Incomplete documentation remains a top issue. Part B providers depend heavily on their ev... Read more
CMS Continues to Focus on E/M Problem Areas
Incomplete documentation remains a top issue. Part B providers depend heavily on their ev... Read more
Part B Payment:
Know These MSP Facts to Ensure Medicare Reimbursement
Hint: Look at patient's age and employment to pinpoint primary payer. Many different thin... Read more
Know These MSP Facts to Ensure Medicare Reimbursement
Hint: Look at patient's age and employment to pinpoint primary payer. Many different thin... Read more
Part B Coding Coach:
ICD-10: See How 'Medical Necessity' Factors into GI Surgery Pay
Tip: Pinpoint coding to correspond with symptoms and final diagnoses. With a plethora of ... Read more
ICD-10: See How 'Medical Necessity' Factors into GI Surgery Pay
Tip: Pinpoint coding to correspond with symptoms and final diagnoses. With a plethora of ... Read more
Physician Notes:
OIG Offers New Gadgets for Compliance Inquiry
Plus: Find out how to access your 2018 MIPS participation status here. Accessing federal ... Read more
OIG Offers New Gadgets for Compliance Inquiry
Plus: Find out how to access your 2018 MIPS participation status here. Accessing federal ... Read more
Enforcement:
Note the Major CMP Increases Under the Bipartisan Budget Act
Hint: Maximum criminal penalties quadrupled from $25k to $100k. Before you submit your Pa... Read more
Note the Major CMP Increases Under the Bipartisan Budget Act
Hint: Maximum criminal penalties quadrupled from $25k to $100k. Before you submit your Pa... Read more
Compliance:
Master the Medicare Card and Number Transition with This Advice
S, L, O, I, B, and Z will never be part of the new MBI, CMS notes. As March comes to a cl... Read more
Master the Medicare Card and Number Transition with This Advice
S, L, O, I, B, and Z will never be part of the new MBI, CMS notes. As March comes to a cl... Read more
Review These MBI Extras for Transition Success
Know the HICN rules for during and after the transition deadlines. Nothing in Medicare is... Read more
Know the HICN rules for during and after the transition deadlines. Nothing in Medicare is... Read more
Documentation:
Revise Your Medical Student E/M Documentation Policies, CMS Says
CMS's deregulation train eases reporting restrictions for student clinicians. Administrat... Read more
Revise Your Medical Student E/M Documentation Policies, CMS Says
CMS's deregulation train eases reporting restrictions for student clinicians. Administrat... Read more
Policy:
More Health IT Changes Are on the Way for Part B Providers
CMS charges ahead with patient-first promises. Medicare administrative cutbacks have been... Read more
More Health IT Changes Are on the Way for Part B Providers
CMS charges ahead with patient-first promises. Medicare administrative cutbacks have been... Read more
Part B Coding Coach:
Prepare for School, Sports, and Occupational Exams with These Codes
Tip: Encourage patients to schedule physicals at annual wellness visits. End-of-year phys... Read more
Prepare for School, Sports, and Occupational Exams with These Codes
Tip: Encourage patients to schedule physicals at annual wellness visits. End-of-year phys... Read more
Physician Notes:
Use Social Media for Emergency Updates with Care
Does social media benefit your ED team? ASPR-TRACIE wants to hear about it. New guidance ... Read more
Use Social Media for Emergency Updates with Care
Does social media benefit your ED team? ASPR-TRACIE wants to hear about it. New guidance ... Read more
Targeted Probe And Educate:
Use These 5 Tips to Master Part B Claims Reviews
Be on top of your MAC's TPE guidance as the program evolves in 2018. CMS's Targeted Probe... Read more
Use These 5 Tips to Master Part B Claims Reviews
Be on top of your MAC's TPE guidance as the program evolves in 2018. CMS's Targeted Probe... Read more
Compliance:
What's On the RAC Hot List? E/M Codes Billed With Procedures
Review guidance on modifiers 24, 25, and 57 before you submit your claims. The popularity... Read more
What's On the RAC Hot List? E/M Codes Billed With Procedures
Review guidance on modifiers 24, 25, and 57 before you submit your claims. The popularity... Read more
Part B Reimbursement:
Deadline Alert: Submit Your 2017 QPP Measures with New CMS Tool
Hint: It's crunch time - get your 4 percent bump before it's too late. Due to overwhelmin... Read more
Deadline Alert: Submit Your 2017 QPP Measures with New CMS Tool
Hint: It's crunch time - get your 4 percent bump before it's too late. Due to overwhelmin... Read more
Part B Coding Coach:
Know the Differences for Complex Repair, Adjacent Tissue Transfer Coding
Tip: Look beyond the CPT® rules to avoid denials. CPT® code guidance is great, but you'... Read more
Know the Differences for Complex Repair, Adjacent Tissue Transfer Coding
Tip: Look beyond the CPT® rules to avoid denials. CPT® code guidance is great, but you'... Read more
Physician Notes:
Fraud and Upcoding Net MD 13 Years in Prison, Millions in Returns
The feds are on the lookout for outlier activity. Some believe they can buck the system t... Read more
Fraud and Upcoding Net MD 13 Years in Prison, Millions in Returns
The feds are on the lookout for outlier activity. Some believe they can buck the system t... Read more
Medicare Errors:
New Data Highlights Part B Providers' Issues with E/M Claims
Downcoded claims account for a billion in missed opportunities. Put correct coding first ... Read more
New Data Highlights Part B Providers' Issues with E/M Claims
Downcoded claims account for a billion in missed opportunities. Put correct coding first ... Read more
CMS Spotlights Insufficient Data Issue in CERT Release
Tip: Stay on top of your recertifications, guidance suggests. This year's CERT supplement... Read more
Tip: Stay on top of your recertifications, guidance suggests. This year's CERT supplement... Read more
Take a Look at The Top Medicare Claims Problems
CMS continues to see big claims issues for home health and lab services. Part B providers... Read more
CMS continues to see big claims issues for home health and lab services. Part B providers... Read more
Compliance:
Be Aware of New Federal Guidance on Provider Texting
Do not text physician orders, CMS cautions. Due to its ease of use and quick turnaround, ... Read more
Be Aware of New Federal Guidance on Provider Texting
Do not text physician orders, CMS cautions. Due to its ease of use and quick turnaround, ... Read more
MACRA:
Avoid a 4% Penalty — Report MIPS 2017 Data Before March 31
Remember you only need report 90 days of data for 2017 to sidestep penalties. Performance... Read more
Avoid a 4% Penalty — Report MIPS 2017 Data Before March 31
Remember you only need report 90 days of data for 2017 to sidestep penalties. Performance... Read more
Part B Coding Coach:
Pinpoint the Best UTI Code Choice with This Overview
Tip: Review the different names used to identify urinary tract infections. With options g... Read more
Pinpoint the Best UTI Code Choice with This Overview
Tip: Review the different names used to identify urinary tract infections. With options g... Read more
Physician Notes:
Get Ready for Medicare's New Opus: "Patients Over Paperwork"
CMS promised in the fall to cut down administrative burden for providers in its initiative... Read more
Get Ready for Medicare's New Opus: "Patients Over Paperwork"
CMS promised in the fall to cut down administrative burden for providers in its initiative... Read more
Enforcement:
OIG Utilizes Providers' Data in Biggest Fraud Takedown Ever
EHR vendor's shoddy software causes false claims - and a $155 million fine. Data drives h... Read more
OIG Utilizes Providers' Data in Biggest Fraud Takedown Ever
EHR vendor's shoddy software causes false claims - and a $155 million fine. Data drives h... Read more
Compliance:
Conquer These 10 Claims Catastrophes With Expert Advice
Tip: Don't let your font choice impact your Part B claims. Clean claims are easy if you k... Read more
Conquer These 10 Claims Catastrophes With Expert Advice
Tip: Don't let your font choice impact your Part B claims. Clean claims are easy if you k... Read more
Part B Payment:
CMS Eases Up on QPP Requirements in 2018
Hint: You can still use your 2014 CEHRT, feds say. As Part B clinicians ramp up for Perfo... Read more
CMS Eases Up on QPP Requirements in 2018
Hint: You can still use your 2014 CEHRT, feds say. As Part B clinicians ramp up for Perfo... Read more
Part B Coding Coach:
CPT® 2018: Test Your Cardiology Coding Smarts with These Tough Questions
Remember: Don't count on 34825 and +34826 in 2018. With Jan. 1 around the bend, it's time... Read more
CPT® 2018: Test Your Cardiology Coding Smarts with These Tough Questions
Remember: Don't count on 34825 and +34826 in 2018. With Jan. 1 around the bend, it's time... Read more
Physician Notes:
MAC Sees Rise in Appeals Mistakes
CMS paperwork can be confusing, but one Medicare Administrative Contractor is reporting an... Read more
MAC Sees Rise in Appeals Mistakes
CMS paperwork can be confusing, but one Medicare Administrative Contractor is reporting an... Read more