Compliance: Focus on Your Compliance Plan Now Or Pay Later   (July 2010)

Enhanced fraud-fighting atmosphere makes your plan more important than ever.
If the feds show up on your doorstep or auditors take a magnifying glass to your claims, would they find you’re following the rules? Showing authorities that you’re complying with rules and regulations is just one important function of a compliance plan for your organization. “It’s absolutely time – past time – to work on a compliance plan,” urges attorney Liz Pearson with Pearson & Bernard in Edgewood, [...]

Part B Coding Coach: 3 Steps Erase Coding Mishaps From Your Myomectomy Claims   (July 2010)

Find out how the weight of myomas means more than the number of them.
Deciding which myomectomy code you’ll report depends on three factors: the approach the ob-gyn uses, the number of the myomas, and their weight. Three steps show you how to translate this information into the correct CPT code every time.
Watch out: If your ob-gyn performs a hysterectomy, you won’t report the myomectomy separately. First, Define Myomas and Their Types When your ob-gyn [...]

Modifiers: Learn the Tricks to Untangling Differences in Modifiers 58, 78, and 79   (July 2010)

Don’t miss out on extra pay when global period resets.
Just because you routinely append modifiers to your claims doesn’t mean you’re filing correctly and getting the most appropriate pay. Brush up on your modifier know-how with these tips for three of the trickiest choices: modifiers 58, 78, and 79.
Selecting between these modifiers can be carrier-specific in some situations, says Jacqui Jones, office manager for Benjamin F. Balme, MD, PC in Klamath Falls, Ore. Remember All [...]

PQRI: CMS Proposes Making PQRI Reporting Easier in 2011   (July 2010)

Plus: CMS reveals common errors from previous PQRI quarters.
Collecting your PQRI bonus could get quite a bit easier next year.
That’s the word from a July 20 CMS-sponsored PQRI national provider call, where Medicare analysts indicated that CMS is proposing to revise the claims-based reporting criteria so that you’ll have to report at least three PQRI measures (or 1 to 2 measures if fewer than 3 apply) for at least 50 percent of applicable Part B [...]

Reader Question: Counting Nerve Conduction Test Per Limb Will Result in Denials   (July 2010)

Question: I coded my physician’s diagnostic testing recently that included nerve conduction studies, an EMG, plus H-reflex testing. The doctor’s final diagnosis was S1 radiculopathy (723.4). I billed all of the appropriate codes, plus an E/M code with modifier 25 in the following sequence:99213-2595903-LT x 295903-RT x 295904-LT95904-RT95934-LT95934-RT95861.
The patient’s MAC denied a lot of the diagnostic studies. Why didn’t we get paid for the full services provided?
Answer: When your physician performs a nerve conduction study [...]

Physician Notes: DOJ Arrests 94 People in One Day for Medicare Fraud Totaling Over $250 Million in Alleged False Billing   (July 2010)

Plus: OIG Estimates $137 Million In KX Overpayments For DME
When the Medicare Fraud Strike Force has a big day, it has a very big day.
On July 16, the Dept. of Justice-Health and Human Services Medicare Fraud Strike Force charged 94 people for allegedly participating in different schemes to bill over $250 million in false claims to Medicare carriers.
The defendants span across five different states (Florida, Louisiana, New York, Michigan, and Texas), and were involved in [...]

In other news…   (July 2010)

When the HHS Office of Inspector General audited a sample of 2006 DME claims with the KX modifier, it found $127 million in estimated overpayments. Now it’s looking at 2007 claims, and the results are equally grim.
Background: Certain durable medical equipment items require a KX modifier for Medicare claims. The modifier indicates that the item in question has extra documentation requirements and that the supplier has the required documentation on file.
The problem is that [...]

Electronic Health Records: CMS Nails Down EHR ‘Meaningful Use’ Requirements   (July 2010)

You could benefit from incentive bonuses by next year.
Your practice could be edging ever closer to a potential $44,000 EHR bonus, thanks to new clarification from CMS.
Eligible professionals who want to demonstrate “meaningful use” of an electronic health record (EHR) – and therefore exhibit eligibility to qualify for potential $44,000 perphysician EHR incentives from Medicare that will be issued to those who qualify over a five-year period – have been eager to find out what type of [...]

Compliance: Physician-Owned Business Settles Stark and Anti-Kickback Allegations for Over $7 Million   (July 2010)

Plus: Stark under-arrangement law changes may alter how you can do business.
Trading cash payments for patient referrals might temporarily make a company financially flush – but eventually, it will cause nothing but problems. Why? Because under the Federal anti-kickback and Stark laws, such referrals are illegal.
Earlier this month, a group of physician-owned urology centers that provided hospitals with lithotripsy and laser services/equipment entered into a Civil Monetary Penalty settlement agreement with the OIG, resulting in a [...]

Recovery Audit Contractors: RACs ID Insufficient Documentation As Weakness Among Practices   (July 2010)

Stay on top of RAC requests so you’re able to meet all request deadlines.
Recovery audit contractors (RACs) can retroactively deny your claims for a number of reasons – but one that can easily be remedied is lack of medical documentation on your practice’s part.
If a RAC requests your medical documentation and you don’t send it – or you submit incomplete or illegible records – your payments can be denied. Plus, money that your MAC already sent to you [...]