Part B Insider (Multispecialty) Coding Alert
CERT Program Not Consistent, OIG Says
If the Comprehensive Error Rate Testing auditor didn't do a good job of following up with you about its documentation requests, then you're not alone.
CERT contractor AdvanceMed didn't always follow up via phone in many cases if you failed to send in medical records after the first request, complains the HHS Office of Inspector General. But AdvanceMed did a better job of completing quality assurance reviews properly than it did the last time the OIG looked at it.
The Centers for Medicare & Medicaid Services could be doing a better job of making sure that the CERT program is consistent, the OIG adds in its report on the program (A-03-05-00006). The OIG recommended that CMS centralize the management of the CERT program and make sure the sampling periods for CERT audits are the same every time.
Part B Insider (Multispecialty) Coding Alert
- CCI EDITS:
5700 Drug Administration Edits Are Heading Your Way
Make sure your documentation justifies separate services
Brace yourself for a new [...] - CCI EDITS:
You Can't Use A Modifier To Unbundle Radiology Codes With E/M Visits
New nursing home, domiciliary care codes hit with hundreds of edits
Radiologists will find life especially [...] - CAPITOL HILL WATCH:
Heads Up--Budget Discussions May Continue Into 2006
And a pay freeze, not a pay hike, may be the best you can hope [...] - CERT Program Not Consistent, OIG Says
If the Comprehensive Error Rate Testing auditor didn't do a good job of following up [...] - MODIFIERS:
Prepare For Audits Of Modifiers 25 And 59
Pitfall: A quarter of modifier 59 claims didn't have enough documentation
The HHS Office of Inspector [...] - E/M SERVICES:
You May See More Reimbursement For The E/M Coding You're Already Doing
MedPAC considers a 2.7 percent increase in your payments for 2006 and 2007
- RADIOLOGY:
Avoid These PET/CT Coding Pitfalls
Find out 3 important documentation must-haves
You can expect claims denials if [...] - OPHTHALMOLOGY:
Opt For Accurate OPT Coding With This Advice
Lesions' appearance will affect your claim alternatives
Medicare recently changed the conditions [...] - GYNECOLOGY:
You Be the Coder--Attain Vaginal Suspension Coding Victory With This Advice
Question: I have documentation that the ob-gyn performed a vaginal vault suspension at the same [...] - CARDIOLOGY:
Reader Question--Don't Have A Heart Attack Over Bundled Angioplasty Codes
Question: The recent National Correct Coding Initiative edits for angioplasty coding have me confused. How [...] - Got something to say? Look who's talking...
The PBI Discussion Group is your resource for connecting with coding and billing [...] - INTERNAL MEDICINE:
Lessen ABPM Coding Pressure With These Ideas
Key: ICD-9 code 796.2 can get you $67
The code you report for ambulatory [...] - NEUROSURGERY:
Uncover How 2 Non-Covered Services Can Pay Off
Hint: ABN/modifier combo will guarantee payment--and protect you
When it comes to reimbursement for non-covered procedures, [...] - ORTHOPEDIC:
Make Sure You're Up To Speed On How To Report 29873
Bad news: Expect less payment than what you're used to
As of July 5, 2005, [...] - Part B Coding Coach:
Brace Yourself For 2006 Injection And Flu Shot Coding With 4 Need-to-Know Tips
Warning: You may be over-reporting 99211 and sending up a red flag to Medicare
A long-standing [...] - 3 Steps Pinpoint the Right Flu Shot Code
Selecting the right codes for a flu shot visit is as easy as 1-2-3. Follow [...] - PHYSICIAN NOTES:
Physicians 'Skeptical' Or 'Hostile' About Quality-Reward Systems
Not much money, lots of extra work, in pay for performance
There's "lots of buzz," but [...]
