iMAXX Medical Billing Solutions Knowledge Hub

iMAX Medical Billing Knowledge Hub

OIG Continues to Focus on POS Errors, and So Should You


Once again, the OIG has included place of service (POS) errors as a focus of its annual Work Plan: We will review physicians’ coding on Medicare Part B claims for services performed in ambulatory surgical centers and hospital outpatient departments to determine whether they properly coded the places of service. Context—Prior OIG reviews determined that physicians did not always correctly code nonfacility places of service on Part B claims submitted to and paid by Medicare contractors. POS errors are more than “clerical.” As the work plan explains, “Medicare pays a physician a higher amount when a service is performed in



Services You Should Never Code Separately


Medicare bundles (includes without separate payment) certain services and supplies when they are provided with other, more comprehensive services. According to the National Correct Coding Initiative (NCCI), Chapter 1 (General Correct Coding Policies): Examples of services integral to a large number of procedures include: – Cleansing, shaving and prepping of skin – Draping and positioning of patient – Insertion of intravenous access for medication administration – Insertion of urinary catheter – Sedative administration by the physician performing a procedure – Local, topical or regional anesthesia administered by the physician performing the procedure – Surgical approach including identification of anatomical landmarks,



Modifier 22: Difficult Isn’t Enough


Difficulty alone doesn’t justify appending modifier 22 Increased procedural services. The procedure must be unusually difficult in relation to other procedures of the same type. The values assigned to CPT® codes assume an “average” service. Only rare, outlying cases—those that are far beyond the average difficulty—call for modifier 22. The AMA’s CPT Changes 2008 explains, “This modifier should be used only when additional work factors requiring the physician’s technical skill involve significantly increased physician work, time, and complexity than when the procedure is normally performed.” Most commonly, modifier 22 will accompany surgical claims—although modifier 22 also might apply to anesthesia



New Reporting Requirements for Labs will Determine Future Payments


[lightbox link=”http://columbusohmedicalbilling.com/wp-content/uploads/2015/11/cms.jpg” thumb=”http://columbusohmedicalbilling.com/wp-content/uploads/2015/11/cms-300×218.jpg” width=”300″ align=”left” title=”cms” frame=”true” icon=”image” caption=””]The Centers for Medicare & Medicaid Services (CMS) released, Sept. 25, a proposed rule that will significantly revise the Medicare payment system for clinical diagnostic laboratory tests (CDLTs) and advanced diagnostic laboratory tests (ADLTs) paid under the Clinical Laboratory Fee Schedule (CLFS) beginning in 2017. The new payment system will base payments on a weighted median of private payer rates, as reported by certain laboratories during a specified period. Method for Calculating Payments Federal law limits the reduction in payment amounts that may result from implementation of a new payment methodology within



Key Points When Implementing Healthcare Compliance


Vulnerabilities in your healthcare organization are expensive. Compliance is a cost of doing business, and must be a priority for all healthcare organizations. As you enact your compliance program, keep in mind: A culture of compliance starts at the top. Treating compliance as a partnership, instead of a police action, will help to obtain buy-in from staff. A good compliance program that addresses vulnerabilities is analogous to practicing preventative medicine for the practice. Identifying and correcting potential vulnerabilities in your practice will speed and optimize proper payment of claims, minimize billing mistakes, reduce chances of an audit by the Centers



Insufficient Documentation No. 1 Reason for Claims Denials




Post-op Care Reporting Requires Attention to Detail


Q: A Medicare patient visits his primary care physician for dressing changes two weeks after a major surgery, which a surgeon performed. How would you code the PCP’s services? A: It depends. If the physician has a transfer of care agreement with the surgeon, you would append modifier 55 Post-operative management only to the surgical code. Modifier 55 explains that a transfer of care occurred during the global period of a surgical procedure. If an official transfer does not exist, occasional post-op services performed by a physician (other than the surgeon) are reported using the appropriate evaluation and management code, without modifier 55. All necessary



Acronyms in the Medical Record: Dos and Don’ts


Acronyms are acceptable in the medical record, as long as they are commonly recognized. When using abbreviations that are not industry standard, you should maintain a list of the abbreviations with definitions and how they are used, and submit the documentation anytime an audit is performed. Because confusing abbreviations can create problems with patient care, the Joint Commission (JC) has published a standard for the appropriate use of abbreviations as well as a “minimum list” of dangerous abbreviations, acronyms, and symbols: Official “Do Not Use” List Do Not Use Potential Problem Use Instead U, u (unit) Mistaken for “0” (zero), the number



The Chief Complaint: A Vital Documentation Element


he CPT® codebook defines the Chief Complaint (CC) as “A concise statement describing the symptom, problem, condition, diagnosis, or other factor that is the reason for the encounter, usually stated in the patient’s words.” CPT® recognizes five levels of presenting problems: Minimal, Self-limited or minor, Low severity, Moderate severity and High severity. The CC can be problem-oriented or preventative. The CC is related to the Nature of the Presenting Problem or “disease, condition, illness, injury, symptom, sign, finding, complaint, or other reason for the encounter,” according to the CPT® manual. The definitions for the CC and the Presenting Problem overlap. Centers for



Patient May Be “New” If Seen by Different Specialists within the Practice


Question: If a patient seen at internal medicine then referred to cardio subspecialty within our clinic, is the patient new or established to cardiology? Answer: A patient is new if he or she has not received a face-to-face, professional service from the provider, or a provider of the same specialty/subspecialty in a group practice, within the previous 36 months. The Centers for Medicare & Medicaid Services (CMS) advises: Interpret the phrase “new patient” to mean a patient who has not received any professional services, i.e., evaluation and management service or other face-to-face service (e.g., surgical procedure) from the physician or