Archive for 'Provider News'

Part B Payment: CMS Proposes Eliminating Mammogram G Codes

Posted on 27. Aug, 2014 by .


Plus: You could see moderate sedation changes in January.

The potential updates to Medicare’s global period rules (see the Insider Vol. 15 no. 25) are just the tip of the iceberg when it comes to the Proposed Medicare Physician Fee Schedule that CMS published last week. There are also specific coding changes that the agency has proposed which could impact the way you code your services, CMS reps said during a July 11 CMS Open Door Forum regarding the 2015 proposed fee schedule.

The following highlights reveal some possibilities that could be in the pipeline for your Medicare payments. (more…)

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E/M Coding: This Payer Clarifies ‘New Problem’ From MDM Perspective

Posted on 13. Aug, 2014 by .


You can get extra points under ‘management options’ for new problems…if you know what they are.

When it comes to choosing the overall level of service for an evaluation and management encounter, such as an office visit, most coders will tell you that determining the medical decision making (MDM) complexity is the most complicated and difficult piece of the puzzle. Not only is the MDM a head-scratcher, but even the individual elements under it can be tough to navigate.

Such is the case when addressing a new problem, which can snag you more points than an established one. But many practices struggle to define what makes a new problem “new.” Fortunately, one MAC stepped in to clarify this issue last week.

Background: To determine the level of MDM, you should assign points to each of the three MDM components that your doctor performs. (more…)

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Patient Privacy: Your Associate’s Mistakes Shouldn’t Cost You Money

Posted on 23. Jul, 2014 by .


Look out: Private lawsuits can be just as costly as federal HIPAA fines.

You might think you’re in the clear as long as you have a good grip on HIPAA requirements in your organization, but that may not always be the reality. A recent court case shows you could be held responsible for a business associate’s HIPAA violation.

Background: Led by former patient Shana Springer, Stanford Hospital & Clinics and two of its vendors faced a class action lawsuit for alleged privacy breaches of patients’ protected health information (PHI), violating California’s state privacy laws. The plaintiffs sought $20 million in damages, but the defendants recently settled the case for $4.1 million.

Multi-Specialty Collection Services (MSCS) was Stanford’s business associate (BA) and was named in the lawsuit, and then another BA contracting with MSCS, Corcino & Associates, was added to the complaint. The lawsuit alleged that Stanford and its BAs were responsible for disclosing the PHI of 20,000 emergency room patients. The BA had posted an Excel file online containing the PHI.

Because the BAs were at fault for the unpermitted disclosure, they will pay the majority of the settlement — about $3.3 million, reported attorney Elana Zana in a blog post for the Seattle-based law firm Ogden Murphy Wallace. But Stanford is still stuck paying out a whopping $500,000 toward a “vendor education fund” under the settlement agreement, as well as $250,000 in settlement administrative costs.

Why ‘No Fault’ Doesn’t Protect You (more…)

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Part B Mythbuster: Can You Report Critical Care Time Outside the ICU?

Posted on 09. Jul, 2014 by .


The answer to this commonly-held belief may surprise you.

Your physician performs CPR for a non-responsive patient in the observation care unit of the hospital, where he attends to the patient for 30 minutes, and the patient is later moved to the ICU, where your physician sees her for another 75 minutes evaluating her need for a mechanical ventilator, feeding tube and accompanying sedation while she stabilizes. Your physician bills for 70 minutes of critical care services, right? Wrong.

Myth: Although many physicians believe they can only report critical care services for patients who are in the hospital’s intensive care or critical care unit, that longstanding belief is a myth.

Reality: (more…)

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Part B Mythbuster: Don’t Avoid 99221 Series Just Because You Didn’t Perform Admission

Posted on 25. Jun, 2014 by .


The admit rules changed with the introduction of modifier AI.

If your coding education took place prior to 2010, you might still be under the impression that only one physician can charge Medicare for initial hospital care—but if you fall under the spell of this common myth, you could be losing money.

Myth: Your physician admits a patient to the hospital and another specialist performs initial hospital care later that day. The other specialist submits his claim first, which means that only he will get paid for the admission—and your doctor won’t, right?

Not so fast.

Reality: (more…)

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Patient Status: 3 Steps Show You When Facility’s Overnight Patient Qualifies for Outpatient Coding

Posted on 11. Jun, 2014 by .


Not every outpatient passes through the freestanding or ASC facility.

A patient staying overnight in the hospital can still be considered an “outpatient,” but the charge capture differs considerably from an inpatient. Factors such as using the same beds as inpatients can make coding and billing quite challenging for a patient undergoing observation care. Read on for three steps to consider before submitting codes such as G0379 (Direct admission of patient for hospital observation care) for a patient.

Step 1: (more…)

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HIPAA Case Study: Could You Be Left Paying the Bill for a BA’s Mistakes?

Posted on 27. May, 2014 by .


Safeguard your practice with a thorough look at your BA’s privacy practices.

You might think you’re in the clear as long as you have a good grip on HIPAA requirements in your office. Not so fast: A recent court case shows you could be held responsible for a business associate’s (BA’s) HIPAA violation. (more…)

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Patient Privacy: Just One Laptop Theft Causes $1.7 Million HIPAA Settlement

Posted on 13. May, 2014 by .


Reminder: If you know your systems are at risk, fix them immediately.

It’s just one laptop—but the repercussions of it being stolen reverberated far and wide for one company.

When a physical therapy facility had a laptop stolen, the company filed a breach report, prompting the Office of Civil Rights (OCR) to open a compliance review. What the OCR found led to a startling settlement. (more…)

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Physician Notes: New CMS-1500 Requires Letters, Not Numbers, for Dx Pointer

Posted on 23. Apr, 2014 by .


Plus: HIPAA gets its random audit program into gear.

Although CMS’s latest iteration of the CMS-1500 form (version 02/12) doesn’t include drastic changes, it does feature one adjustment that appears to be tripping up coders across the country, according to a news blast from Part B MAC National Government Services. And since you can only use the previous CMS-1500 form through the end of March, now is the time to adjust to the new form’s rules.

SuperCoder’s CMS 1500 Scrubber for Real-Time and Batch Processing
Power yourself with these two scrubbers that clean claims for more than 50 top denial triggers and suggests compliance-boosting fixes. Click here to know more


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Time-Based Coding: Time Is on Your Side When Coding Pediatric Notes

Posted on 08. Apr, 2014 by .


Let these three answers guide your time-based E/M coding quandaries.

Pediatricians are masters at listening to worried parents, scared children, or other concerned caregivers. Those minutes spent talking to parents can be lengthy, but it isn’t wasted time since it assists you in diagnosing the patient and helps the patient understand his condition and how to get better. You can collect for that valuable time by utilizing time-based E/M coding to your advantage. Consider the answers to these commonly-asked questions to help you collect the appropriate payments for your evaluation and management visits.

‘Shall’ Doesn’t Mean ‘May’

Question 1: How do we know if we should code using time as the determining factor versus using history, exam, and medical decision-making? Our pediatrician sees a lot of kids with special needs and ostensibly we could be coding mostly 99215s if we coded them all based on time, but we aren’t sure when we should. (more…)

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