Modifier 59 Is Over-Used and Abused, MAC Says

Failure to adopt the X[ESPU] modifiers may be putting your practice at risk for Medicare fraud. Modifier 59 Distinct procedural service continues to be the most-used modifier among Medicare Part B providers, according to Novitas, and it is sending up … For more, read here: AAPC Blog Related Posts:Using Modifier 95 for Telehealth Makes Cents

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Medicare Telehealth Coding as of April 30

Healthcare providers are granted even more latitude for use of telehealth services during the COVID-19 public health emergency. On a Friday, at month-end, the Centers for Medicare & Medicaid Services (CMS) kindly dropped another bomb on us: more t… For more, read here: AAPC Blog Related Posts:CMS Goes After Medicare Advantage OverpaymentsOIG Uncovers Medicare Overpayments for Chronic Care…New Medicare Cards Initiate Phishing ScamUsing Modifier 95 for Telehealth Makes CentsOIG to Audit Risk Adjustment CodingPrevent Medicare Claims Denials in 2020

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Using Modifier 95 for Telehealth Makes Cents

Capture full payment for remote visits during the PHE for COVID-19. An interim final rule published in the April 6, 2020, Federal Register explains how to bill telehealth services during the COVID-19 public health emergency (PHE). The final rule goes … For more, read here: AAPC Blog Related Posts:Modifier 59 Is Over-Used and Abused, MAC SaysMedicare Telehealth Coding as of April 30

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Check Your FESS Claims for Improper Payment Adjustments

MACs may be applying the multiple endoscopy rule incorrectly. In the 2020 Medicare Physician Fee Schedule (MPFS) Final Rule, the Centers for Medicare & Medicaid Services (CMS) finalized the proposal to apply the special rule for multiple endosco… For more, read here: AAPC Blog Related Posts:CMS Proposes Payment Changes to Endoscopic Sinus CodesPrevent Medicare Claims Denials in 2020

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New Medicare Cards Initiate Phishing Scam

Medicare patients are receiving calls from telephone solicitors who are phishing for private identification information for nefarious purposes. The ruse is facilitated by the issuance of new Medicare cards. Here’s How the Scam Goes Down The callers c… For more, read here: AAPC Blog Related Posts:Medicare Telehealth Coding as of April 30OIG Uncovers Medicare Overpayments for Chronic Care…Prevent Medicare Claims Denials in 2020CMS Goes After Medicare Advantage Overpayments

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New Patient E/M Denials: Mystery Solved

New patient evaluation and management (E/M) claims are being denied when the patient was previously seen by a specialty physician assistant or specialty nurse practitioner on staff. This is happening when another provider of a different specialty in t… For more, read here: AAPC Blog Related Posts:Prevent Medicare Claims Denials in 2020MDM – New Problem to Examiner or Patient?

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Multiple Endoscopy Rule Examples

In my last blog “Special Rules Apply to Endoscopic Sinus Surgeries,” I discussed the change to the Multiple Endoscopy Rule for multiple surgeries when performed within the family of endoscopic sinus codes. How Does the Multiple Endoscopy Rule Affect … For more, read here: AAPC Blog Related Posts:2021 Physician Fee Schedule Final Rule – Prolonged Services

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Prevent Medicare Claims Denials in 2020

Medicare has been issuing beneficiaries new member cards with Medicare Beneficiary Identifiers (MBI) in place of Social Security Numbers (SSNs) for more than two years. 2019 was a phase-in period when Medicare would accept either a beneficiary’s Socia… For more, read here: AAPC Blog Related Posts:New Medicare Cards Initiate Phishing ScamCheck Your FESS Claims for Improper Payment AdjustmentsCMS Goes After Medicare Advantage OverpaymentsOIG Uncovers Medicare Overpayments for Chronic Care…New Patient E/M Denials: Mystery SolvedMedicare Telehealth Coding as of April 30

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MDM – New Problem to Examiner or Patient?

When calculating an evaluation and management (E/M) level or auditing an E/M service, every Medicare Administrative Contractor (MAC) has always had the points assigned for a new problem under the Number of Diagnoses or Treatment Options based on a new… For more, read here: AAPC Blog Related Posts:New Patient E/M Denials: Mystery Solved

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CMS Proposes Payment Changes to Endoscopic Sinus Codes

The Centers for Medicare & Medicaid Services (CMS) is proposing major payment changes to sinus endoscopy services. The 2020 Physician Fee Schedule (PFS) proposed rule includes the following excerpt: We are proposing to apply the special rule for m… For more, read here: AAPC Blog Related Posts:Special Rules Apply to Endoscopic Sinus SurgeriesCheck Your FESS Claims for Improper Payment Adjustments

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