Archive for 'Provider News'

Billing Errors: This MAC’s Audit Finds That Some Practices Could Be Collecting More

Posted on 08. Jul, 2015 by .


Downcoding errors mean that these providers are selling themselves short.

When you hear that a MAC reviewed a practice’s documentation and found errors, you probably assume that the payer uncovered dozens of upcoded charges. But in some cases, the opposite may be also true. That’s the case with a recent CERT audit summary reported by Part B MAC WPS Medicare, which found a variety of errors including several cases where the practices could have billed higher E/M codes.

Downcoding Is Alive and Well

WPS Medicare recently released its Fourth Quarter 2014 CERT Error Summary, which reveals the documentation, coding and billing errors that the contractor uncovered during its most recent audit. Most of the errors were related to insufficient documentation, including situations where the physician signature or order was missing from a claim, as well as missing progress notes and dates of service. (more…)

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Privacy: HIPAA Audits on the Way-After This Quick Station Break

Posted on 24. Jun, 2015 by .


Expect more comprehensive audits instead of desk reviews.

The HHS Office for Civil Rights has announced that it is yet again delaying Phase 2 of the HIPAA audits — with no definitive date set for the audits to actually begin. When the audits do start, however, they’ll be much more intense than previously planned. Here’s what you need to know to prepare.

Why the delay? “Phase 2 of the HIPAA audits was initially slated to begin in the fall of 2014 and was subsequently moved to late 2014 or early 2015,” noted Charlotte, N.C.-based attorney Chara O’Neale in a blog post for law firm Parker Poe. “Currently, no timeline has been provided as to when the next round of audits will officially begin.” (more…)

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Don’t Relax Your HIPAA Standards

Posted on 12. Jun, 2015 by .


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, 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. (more…)

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

Posted on 27. May, 2015 by .


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 who’s currently enrolled as a cardiologist to make that change to interventional cardiology,” he said.  (more…)

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

Posted on 14. May, 2015 by .


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. (more…)

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Physician Notes: Keep Working Toward Meaningful Use Thanks to Extension

Posted on 23. Apr, 2015 by .


If you were busily trying to prepare your meaningful use attestation for the 2014 reporting period, CMS has offered you a bit of breathing room. The deadline for attestation is now March 20, giving you three more weeks of prep time than you had before to attest to meaningful use. In addition, CMS is extending the EHR reporting option for PQRS to March 20 as well.

As long as you comply with the electronic health record (EHR) reporting option rules by 11:59 pm EST on March 20, turboessays you’ll be in the clear for meaningful use compliance. (more…)

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Part B Payments: CMS Launches Plan to Reform Medicare Payment Model

Posted on 08. Apr, 2015 by .


You could be tying half of your pay to quality within three years.

Although Medicare’s fee-for-service payment model has most likely been the norm as long as your practice has been accepting Part B payments that could change in the not-too-distant future.

On Jan. 26, HHS Secretary Sylvia M. Burwell announced a new plan that will allow CMS to reimburse providers based on quality of care, rather than the number of procedures and services they provide.

“HHS has set a goal of tying 30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and tying 50 percent of payments to these models by the end of 2018,” CMS reps said in a statement. (more…)

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Physician Notes: Ever Feel Like Auditors Are on A Witch Hunt? CMS Responds

Posted on 30. Mar, 2015 by .


If you get frustrated over auditors’ reviews of your claims, you aren’t alone. A caller to CMS’s Jan. 7 Open Door Forum questioned whether CMS is just performing fishing expeditions, finding practices guilty until proven innocent—and one CMS official explained why.

“Observation management codes, if they’re less than eight hours, they don’t count,” the caller said. Auditors, however, have no idea about whether submitted observation care codes reflect services performed for less than eight hours or not until they receive the practices’ paperwork. (more…)

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Physician Notes: CMS: Submit Requested Documentation Within 45 Days, or Face Denials

Posted on 25. Feb, 2015 by .


Plus: CMS releases 2015 therapy cap amounts

If your payer is performing a pre-payment audit of your claims, the MAC will typically ask you for additional documentation. In the past, some MACs would say you had 30 days to submit the documentation, while other insurers might not have given you a timeframe. CMS has cleared the air on this topic, confirming that you have 45 days to respond to an Additional Documentation Request (ADR), CMS says in MLN Matters article (more…)

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E/M Coding: Can you Spot the Problem With This E/M Code Assignment?

Posted on 12. Feb, 2015 by .


A thorough read is all it takes to identify the most glaring issue.

Sometimes, we’re so quick to review a physician’s documentation that we can gloss over important facts within the records, which can lead to assigning the wrong code. Read through the following documentation example and see if you can identify the problems with the physician’s code assignment.

Date of service: Dec. 8, 2014

Chief complaint: The patient presents today to assess the status of his left shoulder abscess, on which we performed an I&D on Dec. 1.

HPI: This 77-year-old male is improving with no further problems and there are no stitches that need to be removed. He is back to his normal activities of daily living and his urination and bowel movements are normal. He is not using pain medication and he reports that the incision is healing well. (more…)

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