Category Archives: iMAX Medical Billing Insights

Q/A: What’s the Difference Between Q5 and Q6 for a Substitute Provider?

Question In the situation of a locum tenens/substitute provider, can you help me understand the difference between the Q5 and Q6 modifier and when it would be appropriate to use each one? Answer It’s important to understand that these modifiers are not interchangeable. These modifiers recently had their descriptions changed to clarify some of the problems previously associated with them. Use Q5 when there is a reciprocal billing arrangement and use Q6 when there is a fee-for-time compensation arrangement. Medicare has some specific rules about the time involved so be aware of individual payer policies and their time requirements.

Understanding NCCI Edits

Medicare creates and maintains the National Correct Coding Initiative (NCCI) edits and policy manual, which identify code pairs considered integral to one another or bundled. An NCCI code pair consists of two codes representing procedures that, when performed during the same operative session, on the same patient, and by the same provider, should not be billed separately because they are considered part of the greater procedure. A different way of explaining this would be to consider how upset you might be if you went to a restaurant and paid for a nice meal but were then asked to pay a separate fee

OIG Announces – New Review For Medicare Part B Payments for Podiatry and Ancillary Services

Due to prior OIG work identifying inappropriate payments for podiatrists and ancillary services, the OIG announced in Feb 2019 they will begin a new review starting in 2020.  The OIG stated they will review Medicare Part B payments to determine if medical necessity is supported in accordance with Medicare requirements.   Part of the OIG’s review and attention will include ancillary services reported in the Podiatrist practice. To better treat patients, improve outcomes and their bottom line, more and more podiatrists are adding ancillary services to their practices.  If you plan on adding ancillary services or are currently reporting these services, be sure you have

Voluntary Repayments

Should you volunteer to repay money from Medicare or other federal healthcare programs if you believe they were the result of errors on your end? The penalties for not doing so could be severe. Under the Federal False Claims Act, if retained overpayments can be shown to be to false claims, they are punishable by up to three times the amount of the false claim, plus between $11,181 and $22,363 per false claim. In 2016, the government published regulations, for Medicare Part-B only, that clarified that retained overpayments must be returned to Medicare within 60 days of the date on

Spotlight: Services Excluded from Global Surgery Payment

The following services are excluded from global surgery payment according to Noridian Medicare.  These services may be paid for separately. The initial consultation or evaluation of the problem by the surgeon to determine the need for surgery. Please note that this policy only applies to major surgical procedures. The initial evaluation is always included in the allowance for a minor surgical procedure; Services of other physicians except where the surgeon and the other physician(s) agree on the transfer of care. This agreement may be in the form of a letter or an annotation in the discharge summary, hospital record, or ASC record;

Q/A: I Submitted a Claim to the VA and it’s Being Denied. Why?

Question I submitted a claim to the VA and it’s being denied. Why? Answer There are several reasons why your claim might be denied by the Veterans Administration (VA). However, without more information about the claim itself (e.g., services billed), we can only provide the following general information about the VA and chiropractic care. Although the VA has expanded care options for veterans, like all payers, they do have policies that need to be followed. Unless you are contracted directly with the VA, you are most likely billing through their Patient-Centered Community Care Program (PC3) or the Veterans Choice Program

An active shooter in physician offices: Planning for the unthinkable

Safety, Difficult Patients, Managers Administrators, Older Patients, Patient Relations, Risk Assessment, Risk Management, Training An active shooter or an armed intruder at a medical practice office is unthinkable, but it has happened. Every healthcare provider has to accept the reality and realize it can happen anywhere, including at your practice. It doesn’t matter how well you think you know your patients, their families, your staff, or anyone else. There are hundreds of documented cases where the victims shared a common thought afterward: “I’d have never dreamed he/she would do something like that.” Therefore, it is imperative that medical practices everywhere, of all specialties and sizes, prepare for

Position your newly hired clinician for success

Whether you’re hiring a physician or a non-physician provider, odds are you’ll spend a great deal of time (and probably money, too) attracting the right clinician candidate to your practice. If that new hire ultimately doesn’t work out, your practice will face the costs of going back to square one—as well as lost revenue while that job remains unfilled. Effective onboarding can help ensure your new hire knows what is expected and become productive more quickly. Yet despite the high stakes involved, getting new hires off to a good start often gets much less attention than recruiting does. Protect that

Private practice and professional satisfaction

A recent study published in Medical Care Research and Review found that hospital systems that employ physicians perform worse on certain quality measures than those who contract with physicians. In fact, patient satisfaction was actually lower when physicians were employed. This is probably no surprise to independent doctors. It’s not that independent doctors work harder—they work differently. The incentives and motivations are different when you have your own practice, with your name on the door and personal relationships with your patients. The business model of employing physicians at large systems had good intentions—it was meant to improve the continuity of care and

Allscripts EHR System Acquisition Receives Grand Jury Subpoena

Practice Fusion, the EHR vendor acquired by Allscripts last year, has received a grand jury subpoena as part of a criminal investigation. Allscripts recently revealed its EHR system offering acquired through Practice Fusion is the subject of a grand jury subpoena, according to an Allscripts Securities and Exchange Commission (SEC) filing released May 3. The criminal investigation centers on how Practice Fusion obtained health IT certification. Allscripts officially acquired Practice Fusion on February 13, 2018 in a $100 million cash deal. Practice Fusion’s EHR technology complements Allscripts existing ambulatory clinical portfolio as a value offering to accommodate under-served clinicians in small and