Don’t risk HIPAA violations when you’re trying to get help with your Medicare claims. You shouldn’t submit any protected health information (PHI) for beneficiaries when contacting your MAC via e-mail, reminds contractor National Government Services in a new post on its website.NGS can’t accept e-mail inquiries that include beneficiary- or claim-specific information due to PHI Internet security policy requirements, it says. When sending a request, make sure it does not include Medicare numbers, Social Security [...]
Reader Question: ‘None’ May Not Be Good Enough Answer When Recording Family History (January 2012)
Question: Our physician often records the word “none” under the “family history” section of his E/M notes for a privately-insured patient. To me, that isn’t comprehensive enough for me to count as being completed, but the physician disagrees. In my opinion, it would only count if the doctor recorded something more along the lines of “none that relate to the present illness/injury.” Can you advise? Delaware SubscriberAnswer: The answer comes down to the auditing rules [...]
Part B Payment: Congress Votes to Boost Conversion Factor Through February 29. (January 2012)
At nearly the last minute, lawmakers ensure that you won’t lose 27 percent.Although the government appeared poised to take a big bite out of your next Part B payments, you have another two months before you need to worry about losing pay. That’s because the 27 percent Medicare pay cuts that practices have feared since last fall were once again kicked to the curb by Congress, resulting in a Medicare Physician Fee Schedule conversion factor [...]
New edition of bundling edits targets 2012 CPT® codes.You may just be digging in to your 2012 CPT® book, but the Correct Coding Initiative (CCI) has already taken aim at some of the new codes by bundling them into existing codes effective Jan. 1.The CCI released version 18.0 at the end of 2012, revealing 15,530 new active pairs and 6,197 code pair deletions, said Frank D. Cohen, MPA, MBB, senior analyst with The Frank Cohen [...]
Plus: Find out the details behind one confusing MUE edit.Stumped by why a medically unlikely edit would have a limit of zero units? CMS has your answer, with new policies that help you determine why certain edits exist.Although we mostly think about lists of coding bundles when we discuss the Correct Coding Initiative (CCI), there is another side to national bundling rules–the National Correct Coding Initiative Policy Manual. And thanks to a Jan. 2012 update, [...]
Compliance: Find Out What the Stark ‘Physician Self-Referral Law’ Actually Covers (January 2012)
Need an exception? They only apply in specific scenarios.If anything in the healthcare industry keeps physicians on their toes, it’s the Stark Law. This group of strict regulations that prohibit physician self-referrals has been through several thorough sets of updates, and even then, not all the loose ends have been tied up.For those that need a refresher: For Medicare cases (and potentially other payers on the state level), Stark prohibits physicians from making a referral [...]
Part B Coding Coach: Fine Tune Your Fibroid Claims By Studying These Removal Methods (January 2012)
Check out this minimally invasive, nonsurgical option. To accurately report uterine fibroid removals, you must know what method the ob-gyn used to take care of the growth. Learning more about each method of fibroid treatment, you will be prepared for whatever your ob-gyn chooses to perform. Method 1: Count Hysterectomy As Most Common Procedure First, if the ob-gyn removes the uterus entirely, he performed a hysterectomy. This is the most common option, but only when [...]
Confused by Fibroids Vs. Polyps? Here’s How to Make the Distinction (January 2012)
You may have to wait for the pathology report.Fibroids and polyps are similar because they’re both growths, but one occurs in the endometrial lining while the other occurs in the muscle. Can you guess which one is which? Here’s the answer.Polyps are small growths on the surface of the uterine wall that are easy for the ob-gyn to remove. In other words, they are an overgrowth of the endometrial lining. They’re intracavitary lesions.Fibroids (or myomas) [...]
Physician Note: CMS Outlines New ICD-10 Codes for 2012 (January 2012)
Plus: Some RAC programs have been put on the back burner for now.You may not be familiar with the ICD-10 code set yet, but it continues to grow anyway. CMS recently posted the 2012 ICD-10 code update, which not only shows which codes were added, deleted, and revised this year, but also offers information on the new diagnosis coding system, which will be mandatory for all providers as of Oct. 1, 2013.For example: In 2011, [...]
Sometimes common sense does seem to prevail at the policy-making level.CMS has agreed to delay two contentious demonstration projects – the Prepayment Review and Prior Authorization for Power Mobility Devices (PMD) demonstration and the Recovery Audit Prepayment Review demonstration. CMS received many comments and suggestions regarding these demos, so it needs the time to “carefully consider” the comments, the agency says in an e-mail message to providers.The agency didn’t give a timeline for the delays. However, [...]
