Archive for 'Provider News'

Physician Notes: ‘No Show’ Physician Faces 5 Years in Prison Over $13 Million Scheme

Posted on 28. Jan, 2015 by .


A Brooklyn, NY healthcare clinic was raking in cash over the past several years, despite the fact that investigators say its medical director wasn’t even on site to perform the services being billed to Medicare and Medicaid. (more…)

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Physician Notes: CMS Clears up the Most Common ICD-10 Myths

Posted on 14. Jan, 2015 by .


Plus: MACs to increase minimum dollar amounts for appeals in 2015

You’ve heard there won’t be an ICD-10 book that you can keep on your desk because the abundance of codes would make a book too thick—but is that tale true? Actually, no—it’s one of many ICD-10 myths that CMS hopes to dispel with its latest publication, called ICD-10-CM/PCS Myths and Facts. (more…)

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Part B Records: Auditors ‘Vexed’ by Providers’ Lack of Documentation

Posted on 18. Dec, 2014 by .


Want your audit to be over quickly? Hand over the records.

If you’ve ever wondered what gives auditors the biggest headache, you might be surprised at the answer. Although your first instinct might be that auditors find messy records or illegible documentation, the reality is that they frequently deal with providers who can’t produce any documentation at all.

Find What the Auditor Is Missing (more…)

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Part B Documentation: New MAC Tip Reminds Practices What the Nurse Can–and Cannot—Document

Posted on 10. Dec, 2014 by .


Hint: Documenting HPI is the job of the doctor or NPP.

Your nurse might be quite adept at recording your documentation—but if she documents too much, your notes might not be applicable to your coding choices. That’s the word from a new E/M Tip that Part B MAC Palmetto GBA issued last week, reminding doctors what ancillary staff members can document in your Medicare records.

“Ancillay staff may only document the Review of Systems (ROS), Past, Family, and Social History (PFSH) and Vital Signs,” the latest tip, published Sept. 23, indicates.

As for the history of present illness, leave that to the physician or NPP, Palmetto says. “Only the physician or NPP that is conducting the E/M service can perform the history of present illness (HPI). This is considered physician work and not relegated to ancillary staff. The exam and medical decision making are also considered physician work and not relegated to ancillary staff.”

Exception: (more…)

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Part B Coverage: Medicare Launches New Code for Hepatitis C Screening

Posted on 26. Nov, 2014 by .


CMS now provides coverage for these tests in certain populations.

After several months of wrangling, CMS has confirmed that it will pay for hepatitis C virus screenings administered to Medicare patients who meet specific criteria. The agency also debuted a new HCPCS code to describe the preventive test and offered diagnosis coding tips, all thanks to Transmittal 174, issued on Sept. 5.

The specifics: Effective for dates of service June 2, 2014 and afterward, CMS will pay for hepatitis C screenings if patients meet either of the following two requirements: (more…)

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Part B Errors: Documentation for Obesity Counseling Sorely Lacking, CMS Says

Posted on 12. Nov, 2014 by .


Don’t forget the ‘Five A’ strategy in your documentation.

When CMS established code G0447 in 2011, Part B practices were thrilled to have a way to report obesity counseling. However, in the three years that have passed since the code debuted, several issues have cropped up that plague these claims—and you should know what they are if you want to collect for your services.

Background: You can report G0447 (Face-to-face behavioral counseling for obesity, 15 minutes) if your patient has a body mass index (BMI) of 30 kg/m2 or higher and you perform obesity counseling. Medicare will reimburse you for one visit per week for the first month and one visit every other week between months two and six. In addition, if the patient loses 6.6 pounds during the first six months, he is eligible for an additional visit every month for months seven through 12.

Focus on Physician Records (more…)

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Patient Privacy: Portable Device Theft Gets Spotlight in HITECH Reports

Posted on 22. Oct, 2014 by .


HHS collected millions in HIPAA penalties in recent years.

HIPAA breaches caused by laptop thefts are on the rise, new HHS reports show. Are you doing all you can to avoid risk in this area?

Two recent reports to Congress from the HHS Office for Civil Rights, mandated by the Health Information Technology for Economic and Clinical Health (HITECH) Act, cover calendar years 2011 and 2012.

A breach notification report provides an overview of the breach notification requirements, while a report on the HIPAA rules summarizes complaints HHS has received of alleged violations of HITECH and the HIPAA Privacy and Security Rules, according to OCR.

During 2011 and 2012, (more…)

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Take 3 Steps to Avoid Punishing HIPAA Penalties

Posted on 08. Oct, 2014 by .


Look for compliance clues in two new government reports.

Recent HIPAA reports mandated by the HITECH act may seem like jumbles of depressing statistics, but you can actually learn quite a bit from them.

Here are three key lessons you can glean from these reports:

1. Ratchet up your theft-prevention efforts. Theft didn’t merely rank number one on the list of breach causes, it blew all other causes out of the water. Theft accounted for half of the breaches in both years (50 percent in 2011 and 53 percent in 2012), according to a blog post from health law attorney Leah Roffman with Cooley. (more…)

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Part B Mythbuster: Lack of Symptoms May Not Sink Your E/M Claims

Posted on 24. Sep, 2014 by .


No pain? You may still gain.

Myth: You can’t bill an evaluation and management claim unless the patient has pain or some similar complaint.

Reality: Sometimes you’ll find that test results are what prompt a patient visit, not pain or even a complaint. A patient may come to a specialist or other physician because he or she has abnormal test results.

Challenge: It can be a challenge to obtain four out of eight elements of the history of present illness (HPI) when the patient comes in with severe anemia, for example. The patient may say something like, “My doctor told me to come here because my blood count is low.” Often times these patients have no complaints whatsoever. And sometimes patients will simply say, “my doctor sent me here but I don’t know why!’”

The patient’s medical decision-making is complex, but the doctor can’t obtain a level-four visit without full HPI documentation. If the visit doesn’t last over half an hour, you can’t bill as critical care. And if the patient’s history only has three elements, the coder must downcode the case to a level three visit.

The solution: (more…)

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Find Positive Answers for ‘All Others Negative’

Posted on 10. Sep, 2014 by .


Here’s how to handle ROS black holes – and avoid scrutiny

There’s no question that when the physician checks the “all others negative” box for ROS elements, you can be left with less information than you’d like. Here’s the skinny on when you need more specific data and when you can let your doctor slide.

Require the Basics

If the physician doesn’t supply more information than checking the “all others negative” box, keep your eyes peeled: the systems the physician considers for the review of systems (ROS) elements can be hidden in the history of present illness (HPI) elements.

There are no numerical requirements for how many systems the physician must document in conjunction with the “all others negative” statement, and it is up to the doctor to decide how many systems are pertinent to the complaint.

The documentation guidelines simply say “positive or pertinent negative responses.” (more…)

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