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Don’t Relax Your HIPAA Standards

Posted on 12. Jun, 2015 by .

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Audit delay doesn’t mean you can forget about privacy.

Ignore the HHS Office for Civil Rights’ upcoming HIPAA audits at your peril, experts warn.

Disregarding Phase 2 audits is no longer an option, Jared Festner, HIPAA specialist for Irvine, Calif.-based Medical Information Technology Group said in a statement. “If you think for one minute your [organization] won’t be under the microscope for everything from device encryption, essaywritingservices.com.au to making sure that every policy and procedure is completely filled out and updated on a yearly basis, you’ll be kicking yourself once you receive fines of up to $1.5 million per offense.”

The delay in Phase 2 OCR audits doesn’t mean that you can relax your efforts to make sure you’re in compliance with all HIPAA regulations, said Charlotte, N.C.-based attorney Chara O’Neale in a blog post for law firm Parker Poe.

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Physician Fee Schedule: Follow Changing Payment Trail for Your Lab

Posted on 12. Jun, 2015 by .

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The RVUs aren’t all you need to observe.

As it turns out, things weren’t settled when CMS published the Medicare Physician Fee Schedule Final Rule in November last year.

Now you’ll need to pay attention to changes in payment and claims processing if you don’t want to face confusion as you bill for your lab services in 2015.

Do this: Just read the following updates, and you’ll have everything you need to understand your Medicare pay — for now.

Your Claims Should Be Moving Again

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ICD-10: Associations Fear ICD-10 Transfer Might Trigger Massive Denials

Posted on 27. May, 2015 by .

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End-to-end testing reveals potential problems.

If you have questions about the ICD-10 transition, you’re not alone. Specialty societies, including the American Medical Association (AMA), are waiting for answers, too.

The AMA was among 100 medical groups that wrote to the Centers for Medicare & Medicaid Services (CMS) on March 4 seeking responses to ICD-10 issues that they believe have not been appropriately addressed. Although the groups didn’t go so far as to request a delay to the Oct. 1 implementation date, they did express strong concerns about the transition in the 7-page letter to Acting CMS Administrator Andrew Slavitt.

Chief among the issues were the results of CMS’s end-to-end testing periods, which revealed claim acceptance rates in the 76 to 89 percent range.

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Reader Question: Appeal for Payment if LCD Support Spirometry Diagnosis

Posted on 27. May, 2015 by .

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Question:My records indicate that spirometry is a coverable CMS expense, but we cannot get Medicare to reimburse for it. The denials state that COPD/pulmonary dysfunction and chronic bronchitis are not coverable. My CMS sheet states that is exactly what the test is covered for. What should we do? 

Colorado Subscriber

Answer:

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Billing: 5 Tips You Need to Know for Clean 2015 Claims

Posted on 27. May, 2015 by .

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This MAC illuminates several of the most challenging coding issues.

Your MAC has been processing claims based on the “new” 2015 rules for a few weeks now, but your head may still be spinning over the changes. Sit back and get the scoop on proper claims submissions thanks to the following five tips provided by NGS Medicare’s Nathan L. Kennedy, Jr., CPC, CHC, CPPM, CPC-I during the MAC’s Jan. 27 online conference, “J6 January Quarterly Release Webinar.”

1. Update Your Interventional Cardiology Specialty Code. “CMS established a new specialty code for interventional cardiology, and that specialty code is C3,” Kennedy said. “In the past, interventional cardiology was not an acceptable Medicare specialty and you had to go with cardiology, but now you can submit an application for that specialty if the specialist is new best essay writers uk, or you can request a change for someone…

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Compliance: Do You Know How to Avoid These 5 Types of Medicaid Fraud?

Posted on 27. May, 2015 by .

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Medicaid auditors could be reviewing your files—make sure you aren’t violating any of these common issues.

If you’re worrying about whether your state Medicaid provider might head your way for an audit, keep in mind that you only have to stress if you’re doing something you shouldn’t be—and one way to find out if that’s the case is to check in on the most common types of Medicaid fraud.

Fortunately, the Arkansas Medicaid Fraud Control Unit recently published five examples of common Medicaid fraud types essayswriters.biz. Read on for the list, as well as examples to help you steer clear of these issues.

1. Billing for Services Not Rendered: This type of fraud occurs when “a provider bills for treatments or procedures which are not actually performed,” the Arkansas Medicaid Fraud Control Unit says on its website.

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ICD-10: CMS Accepts 81 Percent of ICD-10 Test Claims

Posted on 14. May, 2015 by .

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Biggest denial reason had nothing to do with diagnosis coding.

It appears that ICD-10 really will be implemented this year, with a recent Congressional hearing confirming that the government doesn’t plan to push back the new diagnosis coding system any further than it already has been—and with those plans full steam ahead, CMS revealed that its recent end-to-end testing period returned positive results.

The agency processed 14,929 test claims during the Jan. 26 to Feb. 3 testing period, from 661 participating providers. An overwhelming majority of claims—81 percent—were accepted through the system, and the remaining claims were rejected for three main reasons custom-papers-online.com, as follows, according to the most recent statistics released by CMS:

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Reader Question: Don’t Bill 99051 as Stand-Alone Code

Posted on 14. May, 2015 by .

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Question: I have three questions about using 99051:

1. Should we use 99051 in addition to the E/M code for that service (scheduled hours)?
2. What is the definition of “basic service?”
3. Would you provide references for using this code?

Oklahoma Subscriber

Answer: 

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Physician Notes: Unnecessary Services Lead to $5.3 Million Repayment for NY Doctor

Posted on 14. May, 2015 by .

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When coding and billing experts continually remind practices to “put medical necessity first,” they aren’t just blowing smoke. Without a medically necessary reason to perform your services, you could be facing jail time.

A New York physician is learning that lesson the hard way this week after pleading guilty to billing Medicare for $14.2 million in claims for medically unnecessary treatments, the Department of Justice reported on March 6.

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Reimbursement: Final Fee Schedule Confirms Phasing Out of Global Periods

Posted on 14. May, 2015 by .

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Ophthalmology practices, prepare for a 2 percent cut to Medicare payments.

When CMS announced on Halloween that it had published the 2015 Physician Fee Schedule Final rule, many practices were a bit spooked to review it — but fortunately, the finalized version of the document doesn’t differ too wildly from the proposal that the agency published earlier this year. Read on to discover several of the most impactful items from the 1,185-page document.

No Negative Conversion Factor — Yet

When it comes to the conversion factor, the fee schedule had some good news buyessaysonlinecheap.net. Because the Protecting Access to Medicare Act won’t allow any cuts in the conversion factor through March 31, 2015, CMS has finalized the conversion factor of $35.8013 through that date. Starting April 1,

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