Specialists’ Non-Physicián Practitioners Can Collect Primary Care Incentive Bonuses

Posted on 20. May, 2011 by in Coding Challenge, Hot Coding Topics.

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Question: Our cardiology practice employs a non-physicián practitioner (NPP) who performs a lot of E/M services for our patients, and that NPP received a bonus payment as part of the Primary Care Incentive Payment Program, which surprised us. We wanted to double-check this — is a non-physicián practitioner working for a specialist eligible to collect primary care incentive bonuses that are being distributed as a result of the Affordable Care Act rule?

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Follow 3 Tips to Improve Your A/R Process and Boost Your Collections

Posted on 10. May, 2011 by in Provider News.

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Avoid the ‘code it, bill it, and forget it’ mentality — don’t be afraid to follow up on your claims.

The economic downturn coupled with looming healthcare changes means that your practice — and all others — are under more pressure than ever to collect every penny you deserve.  You can refine your accounts receivable (A/R) process quickly and easily to bring in the money without a lot of extra effort.

A/R defined: “Accounts receivable (A/R) is the money that is owed to the practice,” explains Elin Baklid-Kunz, MBA, CPC, CCS, a director of physician services in Daytona, Fla., during The Coding Institute’s audioconference “Top A/R Tactics: Fight Back Against Lower Payments and Increased Government Scrutiny.”

Follow these three best practices to set your practice on an improved A/R track and avoid thousands in lost reimbursement.

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Put Your ePrescribing Knowhow Into Meaningful Use

Posted on 10. May, 2011 by in Hot Coding Topics.

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Get your system moving before June 30th or you’ll pay the price.

If you do not have an electronic prescribing (ePrescribing or eScribing) system yet in place, or have not integrated one into your electronic medical record (EMR) system, you better get a move on it. You only have until June 30, 2011 to submit at least ten claims to Medicare demonstrating that you are a successful eScriber for 2011. Otherwise, you are at risk of not only losing the bonus in 2011 but according to the rulemaking for 2011, also facing penalties assessed, reducing your Medicare fee schedule by 1 percent in 2012.

With limited time, it is smart to consider a stand-alone internet based system which you can implement relatively easy. You could get this system up and running right away, at a low cost,

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Remember Diagnosis to Support 62311 Post-Op

Posted on 09. May, 2011 by in Coding Challenge, Hot Coding Topics.

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Question:
Our state’s Medicaid carrier denies our claims when we submit 62311 with modifier 59 for postoperative pain management. They say the 62311 is bundled with the anesthesia procedure code. How should we handle this?  -Ohio Subscriber

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Coding 96372 With 90471

Posted on 05. May, 2011 by in Hot Coding Topics.

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Question:

During an office visit, our nurse administered a B12 injection and a flu shot to an established patient. Can we code for both injections in addition to the office visit? (Illinois Subscriber)

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New Year, New Insurance = New Verification

Posted on 05. May, 2011 by in Hot Coding Topics.

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Question:

How should I file a claim on a patient who has new coverage but has not received an insurance identification card yet? (South Carolina Subscriber)

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Does One-Hour E/M Warrant Add-on Prolonged Service Code?

Posted on 05. May, 2011 by in Hot Coding Topics.

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Question:

Our physician provided a one hour E/M service, most of which was spent on counseling, so we reported 99215 and one unit of +99354 (Prolonged physician service in the office or other outpatient setting requiring direct [face-to-face] patient contact beyond the usual service; first hour). An outside auditor came to our practice and said we should not have reported 99354, and told us to write our payer and give back the reimbursement we received for this extra charge. Is this accurate?

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5 Tips Lead You to G0438, G0439 Coding Success

Posted on 05. May, 2011 by in Hot Coding Topics.

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Boost your bottom line by reporting new annual wellness visits correctly.  If you want your annual visit claims to be picture perfect in 2011, then follow these five tips to avoid future denials and keep your physician’s claim on the fast track to success.

Background: The Affordable Care Act (ACA) extended preventive coverage to more than 88 million patients covered by health insurance, and Medicare has codified that benefit in the form of an annual wellness visit. Medicare valued the new annual wellness codes based on a level 4, problem-oriented new and established E/M service.

The two new codes are:

G0438 — Annual wellness visit; includes a personalized prevention plan of service (PPPS), first visit

G0439 — Annual wellness visit; includes a personalized prevention plan of service (PPPS), subsequent visit.

Tip 1: Apply G0438 to Second Year of Coverage

Be wary of applying these codes to new Medicare patients coming…

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Simplify Your Endometrial Cancer Claims In Just Three Steps

Posted on 28. Apr, 2011 by in Hot Coding Topics.

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If your ob-gyn converts a laparoscopic to an open procedure, your coding for endometrial cancer surgeries can drastically transform. Follow these three steps to ward against denials.

Review This Op Note

Preoperative diagnosis: Adenocarcinoma of the endometrium.

Postoperative diagnosis: Same as above, but greater than 50 percent myometrial invasion, pathology pending.

Operation performed: Laparoscopic assisted transvaginal hysterectomy (LAVH) with bilateral salpingo-oophorectomy, laparotomy with pelvic and periaortic node dissection, partial omentectomy, pelvic washings.

Procedure: Exam of the pelvic organs revealed an 8-week-size uterus. The right and left ovaries appear to be within normal limits. The ob-gyn found no evidence of excrescences or signs of metastatic disease in the lower pelvis along the bowel or serosa, nor did he discover evidence of metastatic disease in the upper abdomen, liver and dome of the diaphragm. He then performed a dissection.

He removed the uterus vaginally with the assistance of the laparoscope,

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Does 99360 Merit Medicare Pay?

Posted on 24. Apr, 2011 by in Coding Challenge, Hot Coding Topics.

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Question: My doctors stand by for the cardiologists during a pacemaker placement in case they need to place epicardial leads. They want to report their time, and I have found 99360 for this. Do they need to dictate something in order for me to charge for this?

Answer: CMS and many other payers don’t pay for 99360 (Physician standby service, requiring prolonged physician attendance [face-to face] without direct patient contact, each 30 minutes [e.g., operative standby, standby for frozen section, for cesarean/high risk delivery, for monitoring EEG]), so the physician may not be able to charge for standby time.

If a third party payer does reimburse for 99360, then be sure the physician has documented the standby service with something such as: I was requested by

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