Thursday, September 4, 2014
Clarification on Modifier 59
Medicare policy limits the use of modifier 59. Medicare’s long-standing policy is that modifier 59 should be reported only when procedures are performed on different anatomic sites or different patient sessions on the same day. The modifier should not be used as means to simply bypass an edit nor is it used simply because the two CPT code descriptors are different. It should only be appended to identify clearly independent services that represent significant departures from the usual situations described by a CCI edit. The medical record must support the distinct nature of the services. It is not necessary to have different diagnosis codes for the two procedures, but that is often the case. Care should be taken to ensure that the most accurate ICD code is being provided for each service.
Challenging Times Ahead
Challenging Times
Ahead
Issues that will affect Reimbursement to Florida Providers:
·
Ongoing Efforts to replace sustainable growth rate [SGR]
and reform Medicare Reimbursement
·
Changes to
Medicaid Reimbursment
·
90- Day Grace Period
If those were not enough , physicians
have to prepare for the ICD-10
transition and complete the conversions to EMR.
Information provided to physicians, coders are supplied through multiple
sources.
However, AccuChecker is the Complete Tool for Medical Reimbursement.
·
ICD-10
·
HEDIS
·
PQRS
·
Coding [ Procedures / CCI / LCD/ NMP]
All the data your need to submit a clean claim and secure an accurate
reimbursement
Feel Free to Glance our site : www.accuchecker.com
ACK BASIC: http://www.accuchecker.com/AckBasic.aspx
ACK CLASSIC: http://www.accuchecker.com/AckClassic.aspx
Call for your FREE Trial or Webinar
: 305-227-2383 or 1-877-938-9311
Coding Made Simple
Coding Made Simple
FSY
2015 is around the corner, and with the New Year comes changes.
The
new year will bring in new regulations , HEDIS 2015 , PQRS 2015, the
implementation of ICD-10, and other changes:
Beginning next year, primary care physicians and others
could begin billing separately for chronic care management (CCM) services if
the Physician Fee Schedule (PFS) proposed by the Centers for Medicare and
Medicaid Services (CMS) is adopted
Telehealth services CMS proposes to cover under Medicare
include:
·
annual wellness
visits,
·
psychoanalysis,
·
psychotherapy, and
·
prolonged
evaluation and management services
Regarding the Sunshine Act, CMS is proposing, among other
changes, to begin requiring disclosure of payments drug and medical device
manufacturers make to speakers at certain continuing medical education (CME)
events. CME events previously had been exempted from Sunshine Act reporting
requirements. Eliminating the exemption “will create a more consistent
reporting requirement, and will also be more consistent for consumers who will
ultimately have access to the reported data,” according to CMS.
CPT 2015 Anticipated Code Changes
In 2015, many CPT code changes will take effect. For example:
A number of new radiology and radiation
oncology codes will be created in 2015. A total of 22 of the 35 new codes are
the result of bundling requests from the AMA’s Relativity Assessment Workgroup
(RAW). The purpose of the RAW is to identify potentially misvalued services.
The current screens used by the RAW are: codes frequently performed together,
fastest growing, CMS/Other time source and services previously flagged as new
technology
How does one prepare for these changes
? AccuChecker
AccuChecker is The Complete Tool for
today’s Medical Reimbursement
Providers
want accurate reimbursement.
Payers
want efficient claims processing.
The time to prepare is NOW!
Call for
Free Trial or Webinar 305-227-2383 or
1-877-938-9311
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Wednesday, September 3, 2014
Billing Services
Billing Services
What is a Billing Service
The medical billing process is an interaction between a health care
provider and the insurance company (payer). The entirety of this interaction is
known as the billing cycle
sometimes referred to as Revenue Cycle Management. This can take anywhere from
several days to several months to complete, and require several interactions
before a resolution is reached. The relationship between a health care provider
and insurance company is that of a vendor to a subcontractor. Health care
providers are contracted with insurance companies to provide health care
services. The interaction begins with the office visit: a physician or their
staff will typically create or update the patient's medical record.
Billing Services
are required to be familiar with all the current regulations / guidelines :
·
HEDIS
·
PQRS
·
Meaningful Use
·
Quality Measures
·
ICD-10
AccuChecker
OnLine CLASSIC is an Internet database subscription service that allows you to
have the resources at your fingertips.
The Complete Tool For Medical
Reimbursement
The AccuChecker OnLine
CLASSIC is a comprehensive database with:
·
Procedures –
CPT, Category II and HCPCS codes.
·
Diagnoses codes
(ICD-9-CM, ICD-10-CM and ICD-10-PCS).
·
Converter of
ICD9 to ICD10.
·
Medicare fee
schedules including OPPS rates in radiology.
·
Coding
techniques like:
o
Corrective
Coding Initiative (CCI)
o
Medical
Necessity - procedures matching diagnoses.
o
Medicare’s LCD
and NCD.
o
Surgical
modifiers outlining coding guidelines.
o
Global period
for surgical services.
AccuChecker OnLine CLASSIC is
available in two (2) versions:
State Version - Fee Schedules for the State ONLY.
National Version - Fee Schedules for the entire nation –for each zip
code.
For more details
call 305-227-2383 or 1-877-938-9311
Ask for your
Free Trail or Webinar
Paul G. Silverio-Benet
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Tuesday, September 2, 2014
Medical Billing: In-House vs. Outsourcing
Outsourcing, till a few years back was seen as a fad by the experts but today it is an industry in itself. One finds processes being outsourced in almost every business and more recently the field of medicine has also joined the bandwagon. The topic of discussion here is, whether the process of submitting and following up on insurance claims, better known as medical billing should be outsourced by hospitals, clinics or be kept in-house.
There is no right or wrong answer to this debate. It is a different scene for every practice and it depends on factors such as size, need and earnings of the practice. The goal of every medical practitioner is to provide the best medical care to the patients whilst maximizing the revenue and controlling the costs. This is one of the main reasons why choosing an appropriate medical billing methodology is important.
Both the methodologies, in-house and outsourcing medical billing services have benefits as well as drawbacks, and therefore, it is very important that every individual practice weighs the pros and cons well before choosing the best suitable approach for them. Mentioned below are a few pros and cons of both the methods that will be useful to the practitioners.
The Incentive Programs
The Incentive Programs
Meaningful
Use (MU)
The Medicare and Medicaid Electronic Health Records
(EHR) Incentive Programs will provide incentive payments to eligible
professionals and eligible hospitals as they demonstrate adoption,
implementation, upgrading, or meaningful use of certified EHR technology. These
incentive programs are designed to support providers in this period of Health
IT transition and instill the use of EHRs in meaningful ways to help our nation
to improve the quality, safety, and efficiency of patient health care.
HEDIS
Most
of the profiled purchasers and insurers link incentives to some measures that
are included in, or derived from, the Health Plan Employer Data and Information
Set (HEDIS)--a group of standardized measures designed to evaluate health plan
performance.
However, a number of profiles also highlight unique performance
measures
that were developed by progressive organizations. In light of the Institute of Medicine’s
recent reports on the extensive and negative impact of medical errors, some purchasers
and insurers have created incentives designed to improve patient safety and reduce
medication errors.
PQRS
Eligible professionals who satisfactorily report
quality-measures data for services furnished during a PQRS reporting period are
eligible to earn an incentive payment equal to a percentage of the eligible
professional's estimated total allowed charges for covered Medicare Part B
Physician Fee Schedule (PFS) services provided during the reporting period.
Incentive payments for each program year are issued
separately as a single consolidated incentive payment in the following year.
Incentive payments are issued to the first valid group location listed under
the TIN; or, for solo practitioners, to the first valid practice location
listed under the TIN.
The Medicare claims-processing contractors (Carrier or
A/B MAC) will make the payment electronically or via check, based on how the
TIN normally receives payment for Medicare Part B PFS covered professional services
furnished to Medicare beneficiaries. If a TIN submits claims to multiple
Carriers or A/B MACs, each contractor may be responsible for a proportion of
the TIN incentive payment equivalent to the proportion of Medicare Part B PFS
claims the contractor processed during the applicable reporting period.
Understanding
and billing for the different quality Measures requires time and effort. The
physician and staff must be familiar
with all of the regulation in order to qualify each Measure.
AccuChecker
Online is the solution for qualifying
the various Measures:
AccuChecker
introduces the HEDIS Module, the PQRS
Module and the ICD-10 Module . Please take a glance at: www.accuchecker.com
For
details , your Free Trial or a Webinar call 305-227-2383 or
1-877-938-9311 .
Be
part of our Social Sites: Chats /
Information / Webinars
Please feel free to join :
Avoiding Billing Errors
Billing Errors
Billing mistakes can be the cause of many medical office
financial problems. Delayed payments, costly fines and loss of revenue can all
occur when errors are not caught ahead of time. If your medical office is
experiencing financial difficulties, it may be necessary to review your claims
for the most common billing mistakes before billing your claims out.
Common Front End Billing Mistakes:
·
Duplicate charges
·
Canceled tests or procedures
·
Incorrect patient information
·
Upcoding charge
·
Balance billing when in-network
·
Unbundling of charges
·
Incorrect quantity
·
Operating room and anesthesia time
·
HEDIS – did you use the correct codes to qualify the Measure
·
PQRS – did you qualify ALL of the
individuals measures to the Group Measure
·
ICD-10 – have to cross-walked the ICD-9 Codes to the ICD-10
The errors that are being billed to the
health-care payers, whether intentional or unintentional, are increasing due to
the complex billing system .
AccuChecker OnLine is your Complete Tool For Medical
Reimbursement
·
Accurate
·
Updated Quarterly
·
HEDIS Module
·
PQRS Module
·
ICD-10
·
Coding
·
Medicare Fee Schedule
All the information / guidelines you require at your
fingertips – The One Source !
Call for your Free Trial or Webinar : 305-227-2383 or 1-877-938-9311
Be Part of Our Social Sites - Please Feel Free to Join
Monday, September 1, 2014
Coding It Right
Coding It Right
HEDIS
·
Are you using the CPT CAT II codes to reflect
the HEDIS Measures?
·
When the Blood Pressure ( BP ) is taken, are you coding to show the
Pressure?
·
Have you coded to qualify the LDL ? A1C Levels ?
PQRS
·
Are you using ALL the individual Measures that
qualify the Group Measure
·
Are you prepared to face the 2% payment
reduction for NOT coding the PQRS Measures ?
ICD-10
·
Have you prepared for the ICD-10 Transition?
·
Is your staff ready for this change?
AccuChecker is the Coding tool for Medical reimbursement –
All these guidelines / regulations are at your fingertips. Easy to use and
understand. Accuchecker is updated on a quarterly basis .
Ø
Avoid
Denials
Ø
Qualify
your HEDIS
Ø
Code the
PQRS
For details call 305-227-2383 or 1-877-938-9311 Free Trial and / or Webinar Availabe
More information at :
www.accuchecker.com
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