Part B Insider (Multispecialty) Coding Alert
Fraud & Abuse:
Register Possible AKS, CMP Changes in New Proposal
See new safe harbors to promote value-based care. The feds are on a mission to reduce adm... Read more
Register Possible AKS, CMP Changes in New Proposal
See new safe harbors to promote value-based care. The feds are on a mission to reduce adm... Read more
Stark Law Update:
Know What's on the Table with Stark
Get the facts on what ‘commercially reasonable' means. If you've been waiting anxiously... Read more
Know What's on the Table with Stark
Get the facts on what ‘commercially reasonable' means. If you've been waiting anxiously... Read more
E/M Coding:
Tackle Prolonged Service Issues With 3 Tips
Hint: Check guidelines for add-on codes. Now and again, you may need to spend more time w... Read more
Tackle Prolonged Service Issues With 3 Tips
Hint: Check guidelines for add-on codes. Now and again, you may need to spend more time w... Read more
Clip and Save:
Be Aware of These 18 PHI Identifiers
Remember, IP addresses constitute PHI. With data breaches on the rise, it's become even m... Read more
Be Aware of These 18 PHI Identifiers
Remember, IP addresses constitute PHI. With data breaches on the rise, it's become even m... Read more
Part B Coding Coach:
Review Possible Additional Services With This Q-and-A
Know how to code secondary issues in fracture encounters. There's no denying that fractur... Read more
Review Possible Additional Services With This Q-and-A
Know how to code secondary issues in fracture encounters. There's no denying that fractur... Read more
Physician Notes:
AIC Thresholds Go Up in 2020
Reminder: CMS updates the AIC threshold amounts annually. If you're filing an Administrat... Read more
AIC Thresholds Go Up in 2020
Reminder: CMS updates the AIC threshold amounts annually. If you're filing an Administrat... Read more
Reader Question:
Find Out About Medicare's Colonoscopy Criteria
Question: What documentation do we have to provide for a Medicare patient to justify a scr... Read more
Find Out About Medicare's Colonoscopy Criteria
Question: What documentation do we have to provide for a Medicare patient to justify a scr... Read more
Compliance:
New Rule Stops Fraud Before Enrollment
Tip: Check into your partners' business dealings to avoid problems. The feds continue to ... Read more
New Rule Stops Fraud Before Enrollment
Tip: Check into your partners' business dealings to avoid problems. The feds continue to ... Read more
E/M Coding:
Know the Top E/M Revisions in CPT® 2020
Hint: Reporting online E/M, monitoring will be different next year. The 2020 CPT® c... Read more
Know the Top E/M Revisions in CPT® 2020
Hint: Reporting online E/M, monitoring will be different next year. The 2020 CPT® c... Read more
Medicare Mythbusters:
MAC Debunks 8 Common Medicare Myths
Tip: There's more to Medicare than just Part B. If you think that Medicare Advantage is j... Read more
MAC Debunks 8 Common Medicare Myths
Tip: There's more to Medicare than just Part B. If you think that Medicare Advantage is j... Read more
Part B Coding Coach:
When Can Bronchoscopies and Thoracotomies Be Billed Together? Find Out
See how modifier 59 factors into these billing scenarios. Most pulmonology coders wouldn'... Read more
When Can Bronchoscopies and Thoracotomies Be Billed Together? Find Out
See how modifier 59 factors into these billing scenarios. Most pulmonology coders wouldn'... Read more
Physician Notes:
Start Using Patients' MBIs Before the Transition Ends
Tip: Use MBIs on referrals, too. If you're not using your patients' Medicare Beneficiary ... Read more
Start Using Patients' MBIs Before the Transition Ends
Tip: Use MBIs on referrals, too. If you're not using your patients' Medicare Beneficiary ... Read more
Evaluation & Management:
Feds Nix E/M Blended Payment Proposals
Hint: Expect the 2020 rule to fix other E/M issues, too. Recent evidence suggests that yo... Read more
Feds Nix E/M Blended Payment Proposals
Hint: Expect the 2020 rule to fix other E/M issues, too. Recent evidence suggests that yo... Read more
Review 5 Fee Schedule Key Points
CMS keeps pushing its policy rollback revolution. Though the E/M updates are a hot topic,... Read more
CMS keeps pushing its policy rollback revolution. Though the E/M updates are a hot topic,... Read more
Part B Policy:
Check Out 4 Care Management Proposals in the 2020 MPFS
Hint: CMS aims to change CM with overhauls and a new option. If care management services ... Read more
Check Out 4 Care Management Proposals in the 2020 MPFS
Hint: CMS aims to change CM with overhauls and a new option. If care management services ... Read more
Part B Coding Coach:
Cardiology: 3 Tips Boost Your EP Coding Skills
Tip: 5 components are necessary to report a comprehensive EP study. If you find intracard... Read more
Cardiology: 3 Tips Boost Your EP Coding Skills
Tip: 5 components are necessary to report a comprehensive EP study. If you find intracard... Read more
Physician Notes:
Plan for MFA Prompts for Part B Provider Online Enrollment
Check with your MAC for implementation woes. Hackers continue to target healthcare with m... Read more
Plan for MFA Prompts for Part B Provider Online Enrollment
Check with your MAC for implementation woes. Hackers continue to target healthcare with m... Read more
Reader Question:
Tackle Tick Bites with These Tips
Question: When a patient has a tick bite and the clinician orders a test for suspected Lym... Read more
Tackle Tick Bites with These Tips
Question: When a patient has a tick bite and the clinician orders a test for suspected Lym... Read more
Reader Question:
Check MAC Advice on Refills and MDM
Question: Can you count a routine prescription refill as a moderate level of risk when det... Read more
Check MAC Advice on Refills and MDM
Question: Can you count a routine prescription refill as a moderate level of risk when det... Read more
Reimbursement:
Find Out Your Chances of a MIPS Audit
Tip: Keep your files on hand for at least six years. If you're busy submitting Merit-Base... Read more
Find Out Your Chances of a MIPS Audit
Tip: Keep your files on hand for at least six years. If you're busy submitting Merit-Base... Read more
CPT® 2021:
Look for 3-Part E/M Guidelines in the Future
Summary details plan to bring more order to E/Ms. CPT® plans to split evaluation and man... Read more
Look for 3-Part E/M Guidelines in the Future
Summary details plan to bring more order to E/Ms. CPT® plans to split evaluation and man... Read more
Compliance:
Understand How Fraud and Abuse Are Different
Hint: ‘Gang visits' aren't what you think. You may think that CMS is easing up on compl... Read more
Understand How Fraud and Abuse Are Different
Hint: ‘Gang visits' aren't what you think. You may think that CMS is easing up on compl... Read more
RAC Audits:
Auditors Home in on Modifiers for Discontinued Procedures
Find out what RACs are reviewing. Occasionally, you're forced to discontinue a procedure ... Read more
Auditors Home in on Modifiers for Discontinued Procedures
Find out what RACs are reviewing. Occasionally, you're forced to discontinue a procedure ... Read more
Part B Coding Coach:
Address 99285 Concerns With 3 Tips
Tip: Ensure your documentation backs up the higher-level E/M code. Whether you bill 99285... Read more
Address 99285 Concerns With 3 Tips
Tip: Ensure your documentation backs up the higher-level E/M code. Whether you bill 99285... Read more
Physician Notes:
Remind Your BAs and Vendors About New MBIs
Tip: Fix your claims problems now. Statistics shows that providers are doing a great job ... Read more
Remind Your BAs and Vendors About New MBIs
Tip: Fix your claims problems now. Statistics shows that providers are doing a great job ... Read more
ICD-10-CM Coding:
Check Out New Heatstroke, Poisoning Code Options Available Oct. 1
The 2020 diagnosis code list includes nearly 400 changes. CMS is expanding your coding op... Read more
Check Out New Heatstroke, Poisoning Code Options Available Oct. 1
The 2020 diagnosis code list includes nearly 400 changes. CMS is expanding your coding op... Read more
Enforcement:
OIG Targets False Claims in New Report
Don't underestimate the importance of proving medical necessity. If you're waiting for th... Read more
OIG Targets False Claims in New Report
Don't underestimate the importance of proving medical necessity. If you're waiting for th... Read more
HIPAA:
Master 4 Contracts for Security and Privacy
Tip: Factor cybersecurity into your BAAs. HIPAA compliance planning and training can help... Read more
Master 4 Contracts for Security and Privacy
Tip: Factor cybersecurity into your BAAs. HIPAA compliance planning and training can help... Read more
Part B Coding Coach:
Know These Dos and Don'ts of Special Services
Plus: Three coding tips that help you go beyond the guidelines. There are six after-hours... Read more
Know These Dos and Don'ts of Special Services
Plus: Three coding tips that help you go beyond the guidelines. There are six after-hours... Read more
Physician Notes:
Late Signature Issues Are on the Rise
Tip: Submit attestation instead of adding signature after the fact. One Medicare Administ... Read more
Late Signature Issues Are on the Rise
Tip: Submit attestation instead of adding signature after the fact. One Medicare Administ... Read more
E/M Coding:
See What's Ahead for E/M in 2021
Hint: 99201 exits the coding stage. If you thought the Medicare Physician Fee Schedule (M... Read more
See What's Ahead for E/M in 2021
Hint: 99201 exits the coding stage. If you thought the Medicare Physician Fee Schedule (M... Read more
Compliance:
Review 4 Tips to Ace ABN Quandaries
Tip: Follow Medicare's rules to avoid ABN issues. Now and again, your practice may perfor... Read more
Review 4 Tips to Ace ABN Quandaries
Tip: Follow Medicare's rules to avoid ABN issues. Now and again, your practice may perfor... Read more
Part B Coding Coach:
Sidestep Miscoding Woes with Radial/Ulnar Fx Fixes
Tip: Patient could suffer from an open or closed fracture. Documentation is key in health... Read more
Sidestep Miscoding Woes with Radial/Ulnar Fx Fixes
Tip: Patient could suffer from an open or closed fracture. Documentation is key in health... Read more
Physician Note:
CMS Offers New Guidance on Co-Location Requirements
Sharing public areas, services, and staff with other healthcare entities is complicated. N... Read more
CMS Offers New Guidance on Co-Location Requirements
Sharing public areas, services, and staff with other healthcare entities is complicated. N... Read more
Physician Note:
Safe Harbors' Proposed Rule Slated for Possible July Release
The feds are set to release the long-promised revisions to safe harbors under the Anti-Kic... Read more
Safe Harbors' Proposed Rule Slated for Possible July Release
The feds are set to release the long-promised revisions to safe harbors under the Anti-Kic... Read more
Physician Note:
MAC Warns Physicians About Home Health Referrals
When referring Medicare beneficiaries for home health care, it's all in the details. In a ... Read more
MAC Warns Physicians About Home Health Referrals
When referring Medicare beneficiaries for home health care, it's all in the details. In a ... Read more
Reader Question:
See the Q6 Guidance on NPPs' Services
Question: We'd like to report a nurse practitioner's (NP) services to Medicare with a locu... Read more
See the Q6 Guidance on NPPs' Services
Question: We'd like to report a nurse practitioner's (NP) services to Medicare with a locu... Read more
HIPAA:
CMP Reductions Signal New Direction for HIPAA Enforcement
Hint: Assess and manage risks or pay the price. In 2018, the feds set records with their ... Read more
CMP Reductions Signal New Direction for HIPAA Enforcement
Hint: Assess and manage risks or pay the price. In 2018, the feds set records with their ... Read more
Compliance:
Know the Facts on MIPS Audits
Hint: Keep detailed notes and dates for back-up. Part B providers have a lot on their pla... Read more
Know the Facts on MIPS Audits
Hint: Keep detailed notes and dates for back-up. Part B providers have a lot on their pla... Read more
Implement 5 Documentation Tips to Tackle MIPS Audits Head-On
Your Merit-Based Incentive Payment System (MIPS) attestations may be airtight, but... Read more
Your Merit-Based Incentive Payment System (MIPS) attestations may be airtight, but... Read more
Part B Coding Coach:
Breathe Easy with This Seasonal Allergy Coding Advice
Hint: Allergic rhinitis codes are nothing to sneeze at. What do sniffles, watery eyes, an... Read more
Breathe Easy with This Seasonal Allergy Coding Advice
Hint: Allergic rhinitis codes are nothing to sneeze at. What do sniffles, watery eyes, an... Read more
Physician Note:
Soaring Measles Outbreak Remains an Issue in 23 States
Measles — once considered eliminated in the United States — is back with a vengeance a... Read more
Soaring Measles Outbreak Remains an Issue in 23 States
Measles — once considered eliminated in the United States — is back with a vengeance a... Read more
Physician Note:
Feds Extend Comment Period on Interoperability Proposals
Do you need more time to peruse the interoperability rule that CMS released in February? T... Read more
Feds Extend Comment Period on Interoperability Proposals
Do you need more time to peruse the interoperability rule that CMS released in February? T... Read more
Physician Note:
CMS Gets in on the Podcast Craze
If you haven't heard, CMS is now offering policy highlights, thoughts, and ideas via podca... Read more
CMS Gets in on the Podcast Craze
If you haven't heard, CMS is now offering policy highlights, thoughts, and ideas via podca... Read more
Reader Question:
Who Can Record a ROS? Find Out
Question: There is a debate in our office about who can record an ROS. Can you help us? C... Read more
Who Can Record a ROS? Find Out
Question: There is a debate in our office about who can record an ROS. Can you help us? C... Read more
Reader Question:
Know When It's Ok to Write Off a Patient's Bill
Question: We have had a few patients who don't pay their bills, even if we offer discounts... Read more
Know When It's Ok to Write Off a Patient's Bill
Question: We have had a few patients who don't pay their bills, even if we offer discounts... Read more
Appeals:
Know the 5 Levels of the Medicare Appeals Process
Hint: Reopen first, before you try for an appeal. If you find the Medicare appeals proces... Read more
Know the 5 Levels of the Medicare Appeals Process
Hint: Reopen first, before you try for an appeal. If you find the Medicare appeals proces... Read more
E/M Coding:
Use CBR Insight to Back Up Your Claims
Tip: Turnaround E/M blunders with benchmarking numbers. If you feel like Medicare claims ... Read more
Use CBR Insight to Back Up Your Claims
Tip: Turnaround E/M blunders with benchmarking numbers. If you feel like Medicare claims ... Read more
Part B Coding Coach:
Don't Let Unlisted Procedures Impact Your Paycheck
Home in on these five details for coding success. Unlisted procedures might seem like the... Read more
Don't Let Unlisted Procedures Impact Your Paycheck
Home in on these five details for coding success. Unlisted procedures might seem like the... Read more
Physician Notes:
CMS Gets In on the HIPAA-Audit Game
Plus: MAC Satisfaction Indicator survey is up and running for 2019. If you weren't keen o... Read more
CMS Gets In on the HIPAA-Audit Game
Plus: MAC Satisfaction Indicator survey is up and running for 2019. If you weren't keen o... Read more
Reader Question:
Master Prolonged Service Coding to Avoid Denials
Question: We have a new gastroenterologist who seems very fond of adding prolonged se... Read more
Master Prolonged Service Coding to Avoid Denials
Question: We have a new gastroenterologist who seems very fond of adding prolonged se... Read more
Compliance:
Boost 3-Year Rule Knowledge with This Primer
Tip: Review CPT® guidelines for best results. Choosing the right E/M code is daunting, b... Read more
Boost 3-Year Rule Knowledge with This Primer
Tip: Review CPT® guidelines for best results. Choosing the right E/M code is daunting, b... Read more
Interoperability:
Data-Sharing Issues Prompt Coordinated Proposals
CoPs may be revised to accommodate the health IT proposals. CMS has been on a health IT r... Read more
Data-Sharing Issues Prompt Coordinated Proposals
CoPs may be revised to accommodate the health IT proposals. CMS has been on a health IT r... Read more
Clip & Save:
Review 5 Provider-Audit Hot Spots
Hint: E/M coding is a perennial Medicare claims audit favorite. Medicare Part B coders sh... Read more
Review 5 Provider-Audit Hot Spots
Hint: E/M coding is a perennial Medicare claims audit favorite. Medicare Part B coders sh... Read more
Part B Coding Coach:
Master Sepsis Coding with This Primer
Hint: Key facts can assist with sepsis coding regulations. With annual ICD-10 changes, co... Read more
Master Sepsis Coding with This Primer
Hint: Key facts can assist with sepsis coding regulations. With annual ICD-10 changes, co... Read more
Physician Note:
Submit Your MIPS 2018 Data Before It's Too Late
If you haven't submitted your Merit-Based Incentive Payment System (MIPS) data for... Read more
Submit Your MIPS 2018 Data Before It's Too Late
If you haven't submitted your Merit-Based Incentive Payment System (MIPS) data for... Read more
Physician Note:
CMS Offers New Option for Online ADR Letter Exchange
CMS's burden-reduction rodeo continues with new ways to share documentation requests. You... Read more
CMS Offers New Option for Online ADR Letter Exchange
CMS's burden-reduction rodeo continues with new ways to share documentation requests. You... Read more
Reader Question:
Counter Consultation Catastrophes with Office and Inpatient Mastery
Question: What is the difference between an office consultation and an inpatient consultat... Read more
Counter Consultation Catastrophes with Office and Inpatient Mastery
Question: What is the difference between an office consultation and an inpatient consultat... Read more
Targeted Probe and Educate:
Subsequent Care Coding Remains a Popular TPE Focus Area
Hint: Incorrect coding tops the denial reasons for these codes. Billing subsequent hospit... Read more
Subsequent Care Coding Remains a Popular TPE Focus Area
Hint: Incorrect coding tops the denial reasons for these codes. Billing subsequent hospit... Read more
E/M Coding:
Keep Claims Clean with These 3 Tips
Know what ‘interval' means. Coding for subsequent hospital care isn't easy, and many co... Read more
Keep Claims Clean with These 3 Tips
Know what ‘interval' means. Coding for subsequent hospital care isn't easy, and many co... Read more
Compliance:
Calculate Your Audit Odds with Expert Advice
Tip: Gauge your stats with Medicare utilization data. With audits on the rise, CMS remain... Read more
Calculate Your Audit Odds with Expert Advice
Tip: Gauge your stats with Medicare utilization data. With audits on the rise, CMS remain... Read more
Part B Coding Coach:
Review These New PTP Edit Pairs
CCI 2019 adds biopsy, care management, and psych test codes to the list. With 45,727 addi... Read more
Review These New PTP Edit Pairs
CCI 2019 adds biopsy, care management, and psych test codes to the list. With 45,727 addi... Read more
Physician Notes:
CMS Offers New Medicare Enrollment App For Physicians and NPPs
Hint: CMS promises an easier process with new form. If you thought the old Medicare Enrol... Read more
CMS Offers New Medicare Enrollment App For Physicians and NPPs
Hint: CMS promises an easier process with new form. If you thought the old Medicare Enrol... Read more
Enforcement:
Modifier 59 Case Highlights Risks of Unbundling
Organization receives $12.5 million settlement for modifier 59 abuses. Now that you've ma... Read more
Modifier 59 Case Highlights Risks of Unbundling
Organization receives $12.5 million settlement for modifier 59 abuses. Now that you've ma... Read more
Compliance:
Consider This Expert Advice for Modifier 59 Mastery
Ensure your documentation supports modifier 59 usage. Before you append modifier 59 (Dist... Read more
Consider This Expert Advice for Modifier 59 Mastery
Ensure your documentation supports modifier 59 usage. Before you append modifier 59 (Dist... Read more
Reimbursement:
E/M Services Factor Heavily in Improper Payment Numbers
Mistakes are still in the billions, but the error rate is declining. If E/M services are ... Read more
E/M Services Factor Heavily in Improper Payment Numbers
Mistakes are still in the billions, but the error rate is declining. If E/M services are ... Read more
E/M Coding:
Quell E/M History Quandaries with PFSH Basics
Tip: Review Medicare guidance for in-depth knowledge. Clear and concise documentation of ... Read more
Quell E/M History Quandaries with PFSH Basics
Tip: Review Medicare guidance for in-depth knowledge. Clear and concise documentation of ... Read more
Part B Coding Coach:
Master Oculoplastic Coding with 3 FAQs
Hint: Not all plastic surgeries are considered cosmetic. Recouping payment for surgeries ... Read more
Master Oculoplastic Coding with 3 FAQs
Hint: Not all plastic surgeries are considered cosmetic. Recouping payment for surgeries ... Read more
Physician Notes:
Heed Updated MAC Advice on MBIs
Caution: Don't report HICNs and MBIs on same claim. Now that CMS has finished up its new ... Read more
Heed Updated MAC Advice on MBIs
Caution: Don't report HICNs and MBIs on same claim. Now that CMS has finished up its new ... Read more
Part B Payment:
CMS Overhauls QPP's Promoting Interoperability ... Again
Plus: 2015 Edition CEHRT is now a reality for 2019. If your head is spinning from all the... Read more
CMS Overhauls QPP's Promoting Interoperability ... Again
Plus: 2015 Edition CEHRT is now a reality for 2019. If your head is spinning from all the... Read more
Recovery Audit Contractors:
RACs Zero in on Modifier 57 Usage
Study CPT® guidance for a better understanding of this tricky modifier. Not only do modi... Read more
RACs Zero in on Modifier 57 Usage
Study CPT® guidance for a better understanding of this tricky modifier. Not only do modi... Read more
Avoid Modifier 57 Snafus with Global Surgery Know-How
Peruse the 10-day versus 90-day global package details. A review of global surgery distin... Read more
Peruse the 10-day versus 90-day global package details. A review of global surgery distin... Read more
Appeals:
Thoroughly Investigate Your Denials with These Expert Tips
Hint: Back up your claims with solid evidence. Maybe you've always wanted to do some priv... Read more
Thoroughly Investigate Your Denials with These Expert Tips
Hint: Back up your claims with solid evidence. Maybe you've always wanted to do some priv... Read more
Part B Coding Coach:
Master Common Winter Woes with This Coding Chart
Boost your documentation with tips from the experts. During the season of giving, some of... Read more
Master Common Winter Woes with This Coding Chart
Boost your documentation with tips from the experts. During the season of giving, some of... Read more