Reader Question: Keep CMS Rules in Mind When Coding Based on Time (January 2012)
Question: If the physician documents: “Time spent in the evaluation of the patient with mostly medical decision making time (two thirds) is 75 min,” can I bill our Part B MAC using the E/M code based on time alone?Answer: No, you cannot code based on time with just the documentation you have mentioned. Here’s why: You should only code an E/M service based on time alone if at least 50 percent of the visit was [...]
Medicare Errors: Providers Underbilled More Than $1 Billion to Medicare in 2010 (December 2011)
CERT results reveal $34.3 billion in improper Medicare payments–$1.1 billion of which was underpaid.If your practice’s collections rate was off by 10.5 percent, you’d be in big trouble, right? Well, that’s the 2010 Medicare Fee-for-Service improper payment rate, and your MAC may come looking for money you still owe to them.CMS’s new Comprehensive Error Rate Testing (CERT) results, which were released in November, show that practices actually made fewer errors in 2010 than in the [...]
Services became payable within the last two months, so you can begin billing MACs for them.Eager to begin seeing Medicare patients for the newly-sanctioned alcohol misuse visits, cardiovascular screens, and depression screenings? Now you can collect for these services with some freshly-issued ‘G’ codes that MACs began accepting recently.Background: Primary care providers can now collect for an annual alcohol misuse screening at no cost to the patient. If the screening turns up positive for alcohol [...]
Privacy: HIPAA Audits Are Heating Up–Is Your Practice Prepared? (December 2011)
Contact experienced outside counsel immediately, our experts advise.Establishing HIPAA protocols isn’t a one-time job. Make sure your privacy and security practices are up-to-date to account for new information management applications and systems or state laws (i.e., the Massachusetts privacy regulations), or you could come up short under audit, warns Kenneth Rashbaum, Esq. of Rashbaum Associates in New York. HIPAA Audits Announced“The American Recovery and Reinvestment Act of 2009, in Section 13411 of the HITECH Act, [...]
Pull Together Your HIPAA Audit Plan With These Pointers (December 2011)
It’s never too late to start getting into compliance.Assemble a team: “Covered entities should be assembling a team to review all privacy and security policies, procedures and practices, and should update and revise them as needed,” Kenneth Rashbaum, Esq. of Rashbaum Associates in New York tells Eli. The team should be comprised of IT, health information management (known as medical records in some institutions), in-house counsel, the chief information security officer and/or an outside technology [...]
Physician Note: CMS Releases Updated, Aggressive 5010 Timeline (December 2011)
Plus: Congress has yet to pass 2012 payment fix.CMS offered an early holiday gift to medical practices with the Nov. 17 announcement that it would not initiate enforcement action regarding 5010 until March 31, 2012. But even at the time, the agency did tell practices that they need to be able to prove that they’re making a “good faith effort” to transition to the new data set. Now CMS puts its money where its mouth [...]
As 2011 comes to a close, it’s clear that Congress plans to take the looming Medicare pay cuts right down to the wire.Part B practices are facing a 27 percent cut to Medicare rates effective Jan. 1 unless Congress steps in and reverses that cut, which it has done in prior years. However, with the calendar almost about to turn to 2012, the government has not yet taken action.“Once again, Congress failed to stop the [...]
Reader Question: Forget About Collecting for ‘S’ Codes From Medicare (December 2011)
Question: We’ve had increasing problems billing and being paid for the medications we use for trigger point and nerve block injections. We bill J1094 for Dexamethasone 4 mg, S0020 for Marcaine 0.5 percent and J2010 for Lidocaine 2 percent. We never get paid for the Marcaine and rarely get paid for the Dexamethasone. What should I change when we resubmit? Answer: Physicians typically use Marcaine as an anesthetic for the procedure. If you look in [...]
Reader Question: Get to Know Pecking Order for CPT® Codes (December 2011)
Question: I know that as a general rule the highest RVU has a higher billed amount and that when you bill you should always put the highest amount first. But when it comes to bilateral surgeries is it true that you would sometimes be prudent to put another procedure first because a bilateral code that was done bilateral/unilateral would still be paid at a reduced allowable? Texas SubscriberAnswer: Yes, you should sometimes put another procedure [...]
Reader Question: 1 Exam Bullet May Require 3 Vitals (December 2011)
Question: Can you please explain how taking the vital signs contributes to determining the E/M service’s physical exam?New Hampshire SubscriberAnswer: Checking any three of seven vital signs will count as one bullet in the physical exam, based on the current (1997) documentation guidelines for E/M services, which you can find at (www.cms.gov/MLNEdWebGuide/25_EMDOC.asp). Here’s how it works: Under the 1997 documentation guidelines for E/M services, performing (and documenting) any three of the following seven vital signs will [...]
