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Part B Insider (Multispecialty) Coding Alert

Evaluation & Management:
Feds Nix E/M Blended Payment Proposals
Hint: Expect the 2020 rule to fix other E/M issues, too. Recent evidence suggests that yo... Read more
Review 5 Fee Schedule Key Points
CMS keeps pushing its policy rollback revolution. Though the E/M updates are a hot topic,... Read more
Part B Policy:
Check Out 4 Care Management Proposals in the 2020 MPFS
Hint: CMS aims to change CM with overhauls and a new option. If care management services ... Read more
Reader Question:
Tackle Tick Bites with These Tips
Question: When a patient has a tick bite and the clinician orders a test for suspected Lym... Read more
Reader Question:
Check MAC Advice on Refills and MDM
Question: Can you count a routine prescription refill as a moderate level of risk when det... Read more
Part B Coding Coach:
Cardiology: 3 Tips Boost Your EP Coding Skills
Tip: 5 components are necessary to report a comprehensive EP study. If you find intracard... Read more
Physician Notes:
Plan for MFA Prompts for Part B Provider Online Enrollment
Check with your MAC for implementation woes. Hackers continue to target healthcare with m... Read more
Reimbursement:
Find Out Your Chances of a MIPS Audit
Tip: Keep your files on hand for at least six years. If you're busy submitting Merit-Base... Read more
CPT® 2021:
Look for 3-Part E/M Guidelines in the Future
Summary details plan to bring more order to E/Ms. CPT® plans to split evaluation and man... Read more
Compliance:
Understand How Fraud and Abuse Are Different
Hint: ‘Gang visits' aren't what you think. You may think that CMS is easing up on compl... Read more
RAC Audits:
Auditors Home in on Modifiers for Discontinued Procedures
Find out what RACs are reviewing. Occasionally, you're forced to discontinue a procedure ... Read more
Part B Coding Coach:
Address 99285 Concerns With 3 Tips
Tip: Ensure your documentation backs up the higher-level E/M code. Whether you bill 99285... Read more
Physician Notes:
Remind Your BAs and Vendors About New MBIs
Tip: Fix your claims problems now. Statistics shows that providers are doing a great job ... Read more
ICD-10-CM Coding:
Check Out New Heatstroke, Poisoning Code Options Available Oct. 1
The 2020 diagnosis code list includes nearly 400 changes. CMS is expanding your coding op... Read more
Enforcement:
OIG Targets False Claims in New Report
Don't underestimate the importance of proving medical necessity. If you're waiting for th... Read more
HIPAA:
Master 4 Contracts for Security and Privacy
Tip: Factor cybersecurity into your BAAs. HIPAA compliance planning and training can help... Read more
Part B Coding Coach:
Know These Dos and Don’ts of Special Services
Plus: Three coding tips that help you go beyond the guidelines. There are six after-hours... Read more
Physician Notes:
Late Signature Issues Are on the Rise
Tip: Submit attestation instead of adding signature after the fact. One Medicare Administ... Read more
E/M Coding:
See What’s Ahead for E/M in 2021
Hint: 99201 exits the coding stage. If you thought the Medicare Physician Fee Schedule (M... Read more
Compliance:
Review 4 Tips to Ace ABN Quandaries
Tip: Follow Medicare's rules to avoid ABN issues. Now and again, your practice may perfor... Read more
Part B Coding Coach:
Sidestep Miscoding Woes with Radial/Ulnar Fx Fixes
Tip: Patient could suffer from an open or closed fracture. Documentation is key in health... Read more
Physician Note:
CMS Offers New Guidance on Co-Location Requirements
Sharing public areas, services, and staff with other healthcare entities is complicated. N... Read more
Physician Note:
Safe Harbors’ Proposed Rule Slated for Possible July Release
The feds are set to release the long-promised revisions to safe harbors under the Anti-Kic... Read more
Physician Note:
MAC Warns Physicians About Home Health Referrals
When referring Medicare beneficiaries for home health care, it's all in the details. In a ... Read more
Reader Question:
See the Q6 Guidance on NPPs’ Services
Question: We'd like to report a nurse practitioner's (NP) services to Medicare with a locu... Read more
HIPAA:
CMP Reductions Signal New Direction for HIPAA Enforcement
Hint: Assess and manage risks or pay the price. In 2018, the feds set records with their ... Read more
Compliance:
Know the Facts on MIPS Audits
Hint: Keep detailed notes and dates for back-up. Part B providers have a lot on their pla... Read more
Implement 5 Documentation Tips to Tackle MIPS Audits Head-On
Your Merit-Based Incentive Payment System (MIPS) attestations may be airtight, but... Read more
Part B Coding Coach:
Breathe Easy with This Seasonal Allergy Coding Advice
Hint: Allergic rhinitis codes are nothing to sneeze at. What do sniffles, watery eyes, an... Read more
Physician Note:
Soaring Measles Outbreak Remains an Issue in 23 States
Measles — once considered eliminated in the United States — is back with a vengeance a... Read more
Physician Note:
Feds Extend Comment Period on Interoperability Proposals
Do you need more time to peruse the interoperability rule that CMS released in February? T... Read more
Physician Note:
CMS Gets in on the Podcast Craze
If you haven't heard, CMS is now offering policy highlights, thoughts, and ideas via podca... Read more
Reader Question:
Who Can Record a ROS? Find Out
Question: There is a debate in our office about who can record an ROS. Can you help us? C... Read more
Reader Question:
Know When It’s Ok to Write Off a Patient’s Bill
Question: We have had a few patients who don't pay their bills, even if we offer discounts... Read more
Appeals:
Know the 5 Levels of the Medicare Appeals Process
Hint: Reopen first, before you try for an appeal. If you find the Medicare appeals proces... Read more
E/M Coding:
Use CBR Insight to Back Up Your Claims
Tip: Turnaround E/M blunders with benchmarking numbers. If you feel like Medicare claims ... Read more
Part B Coding Coach:
Don’t Let Unlisted Procedures Impact Your Paycheck
Home in on these five details for coding success. Unlisted procedures might seem like the... Read more
Physician Notes:
CMS Gets In on the HIPAA-Audit Game
Plus: MAC Satisfaction Indicator survey is up and running for 2019. If you weren't keen o... Read more
Reader Question:
Master Prolonged Service Coding to Avoid Denials
Question: We have a new gastroenterologist who seems very fond of adding prolonged se... Read more
Compliance:
Boost 3-Year Rule Knowledge with This Primer
Tip: Review CPT® guidelines for best results. Choosing the right E/M code is daunting, b... Read more
Interoperability:
Data-Sharing Issues Prompt Coordinated Proposals
CoPs may be revised to accommodate the health IT proposals. CMS has been on a health IT r... Read more
Clip & Save:
Review 5 Provider-Audit Hot Spots
Hint: E/M coding is a perennial Medicare claims audit favorite. Medicare Part B coders sh... Read more
Part B Coding Coach:
Master Sepsis Coding with This Primer
Hint: Key facts can assist with sepsis coding regulations. With annual ICD-10 changes, co... Read more
Physician Note:
Submit Your MIPS 2018 Data Before It’s Too Late
If you haven't submitted your Merit-Based Incentive Payment System (MIPS) data for... Read more
Physician Note:
CMS Offers New Option for Online ADR Letter Exchange
CMS's burden-reduction rodeo continues with new ways to share documentation requests. You... Read more
Reader Question:
Counter Consultation Catastrophes with Office and Inpatient Mastery
Question: What is the difference between an office consultation and an inpatient consultat... Read more
Targeted Probe and Educate:
Subsequent Care Coding Remains a Popular TPE Focus Area
Hint: Incorrect coding tops the denial reasons for these codes. Billing subsequent hospit... Read more
E/M Coding:
Keep Claims Clean with These 3 Tips
Know what ‘interval' means. Coding for subsequent hospital care isn't easy, and many co... Read more
Compliance:
Calculate Your Audit Odds with Expert Advice
Tip: Gauge your stats with Medicare utilization data. With audits on the rise, CMS remain... Read more
Part B Coding Coach:
Review These New PTP Edit Pairs
CCI 2019 adds biopsy, care management, and psych test codes to the list. With 45,727 addi... Read more
Physician Notes:
CMS Offers New Medicare Enrollment App For Physicians and NPPs
Hint: CMS promises an easier process with new form. If you thought the old Medicare Enrol... Read more
Enforcement:
Modifier 59 Case Highlights Risks of Unbundling
Organization receives $12.5 million settlement for modifier 59 abuses. Now that you've ma... Read more
Compliance:
Consider This Expert Advice for Modifier 59 Mastery
Ensure your documentation supports modifier 59 usage. Before you append modifier 59 (Dist... Read more
Reimbursement:
E/M Services Factor Heavily in Improper Payment Numbers
Mistakes are still in the billions, but the error rate is declining. If E/M services are ... Read more
E/M Coding:
Quell E/M History Quandaries with PFSH Basics
Tip: Review Medicare guidance for in-depth knowledge. Clear and concise documentation of ... Read more
Part B Coding Coach:
Master Oculoplastic Coding with 3 FAQs
Hint: Not all plastic surgeries are considered cosmetic. Recouping payment for surgeries ... Read more
Physician Notes:
Heed Updated MAC Advice on MBIs
Caution: Don't report HICNs and MBIs on same claim. Now that CMS has finished up its new ... Read more
Part B Payment:
CMS Overhauls QPP's Promoting Interoperability ... Again
Plus: 2015 Edition CEHRT is now a reality for 2019. If your head is spinning from all the... Read more
Recovery Audit Contractors:
RACs Zero in on Modifier 57 Usage
Study CPT® guidance for a better understanding of this tricky modifier. Not only do modi... Read more
Avoid Modifier 57 Snafus with Global Surgery Know-How
Peruse the 10-day versus 90-day global package details. A review of global surgery distin... Read more
Appeals:
Thoroughly Investigate Your Denials with These Expert Tips
Hint: Back up your claims with solid evidence. Maybe you've always wanted to do some priv... Read more
Part B Coding Coach:
Master Common Winter Woes with This Coding Chart
Boost your documentation with tips from the experts. During the season of giving, some of... Read more