CDI Tips for Diagnostic Endoscopies
CPT® guidelines offer clues for what payers and auditors are looking for in op notes. When reading notes or auditing documentation associated with the performance of diagnostic endoscopies performed by otolaryngologists (e.g., 31231, 31575, 31525, … For more,...
2021 Physician Fee Schedule Final Rule – Prolonged Services
by Barbara J Cobuzzi The 2021 Physician Fee Schedule Final Rule was published by CMS on Tuesday December 1, 2020. (https://www.cms.gov/files/document/12120-pfs-final-rule.pdf) There were not many surprises since we had the Proposed Rule to review during the late...
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,...
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...
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,...
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,...
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,...
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,...
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,...
Special Rules Apply to Endoscopic Sinus Surgeries
The multiple surgery calculation for nasal endoscopy codes is changed when multiple nasal endoscopies are performed in the same session on the same day. For Calendar Year 2020, instead of paying the multiple surgeries at 50 percent, surgeons will be … For more,...
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,...
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...
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,...
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,...
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,...
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,...
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,...
OIG Expects to Recover $5.9B in Healthcare Fraud
The Office of Inspector General (OIG) expects a banner year in recoveries stemming from fraud investigations and audits. According to the OIG semiannual report, released Dec. 2, the U.S. Department of Health and Human services (HHS) stands to recoup a… For more,...
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,...
OIG to Audit Risk Adjustment Coding
Consistent with previous reporting, the Office of Inspector General (OIG) has added to its 2020 Work Plan a targeted audit of Medicare Advantage (MA) programs for risk adjustment diagnosis codes. This is not the first time federal agency has targeted … For more,...
