EHRs may reduce medical liability for some errors, but could create new forms of medical liability and expose existing liability issues, says report.
Tag Archives | Medical Practices
Hint: Just because your doctor visits the ICU doesn’t mean he can report critical care.
Most medical practices report outpatient E/M codes (99201-99215) every day, but some Part B providers are still falling victim to several of the most common E/M myths. Button up your coding processes by dispelling these three commonly-held misunderstandings.
Myth 1: When reporting 99211 “incident to” a physician, you should bill it under the name of the physician on record for that patient.
Reality: When a service such as a nurse visit (99211, Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of the physician) is billed incident to the physician, make sure you file the claim under the supervising physician’s name. The OIG recently found that many practices are billing incident to services under a physician’s name who was not on the premises during the encounter. Often, practice management systems use the physician of record rather than the supervising physician when billing services. This arrangement makes allotting finances between physicians easier, but it causes incident to criteria to appear to be unmet. “Incident to” requires that the supervising physician is directly available, generally considered to be in or immediately adjacent to the office suite.
Myth 2: If a patient has symptoms of a particular illness, you can count that information toward both the history of present illness (HPI) and review of systems (ROS).
Reality: You can’t “double dip” and count the same information toward two separate elements.
Example: If the patient suffered a sprain or fracture, the doctor would typically address the musculoskeletal system during a ROS. Examples of a musculoskeletal ROS might include symptoms such as poor range of motion, joint pain, dislocation, or muscle stiffness, among others. These can be…
You’re not only losing revenue—you’re also coding improperly.
CMS data from previous years shows that medical practices undercodè E/M claims to the tune of over $1 billion annually—that’s money that physiciáns could have collected based on their documentation, but forfeited because they reported a lower-level codè than they should have. But remember that your responsibility as someone who submits claims to Medicarè is to codè based on the documentation—anything else is incorrect coding.
If you’re one of the practices that’s downcoding claims, take note of the following reasons that you should codè based on your documentation rather than undercoding.
Could You Be Triggering an Audit?
The number one reason that many practices undercodè is because they don’t want to “trigger an audit.” However, coding all low-level E/M codès is sure to get a payer’s attention, because the claims reviewers will be wondering why you never offer high-level evaluations to your patients.
When claims reviewers review “bell curves” to determine whether a practice is coding outside the norm, they aren’t just looking for upcoding—they are looking at trends across the board. This means that a practice with all 99212s and 99213s will be vulnerable, because nearly every practice sees more complex patients requiring high-level E/Ms at least once in a while. If an auditor reviews your rècords and determines that you’re deliberately downcoding claims, they’ll conclude that you’ve been coding improperly.
Consider Compliance Implications
If you’re deliberately undercoding your claims to stay under the radar, you’re technically violating the False Claims Act because you are knowingly submitting a false claim. “It’s a violation just as much as deliberate upcoding is a violation, but the government most likely isn’t going to pursue it because ultimately it savès the Medicarè program money,” says John B. Reiss, PhD, JD, a health care attorney…
As per the latest CMS regulation, all claims with modifier GZ appended will be denied straight away. It is not unusual even in the best-run medical practices that the physician performs a noncovered service and doesn’t get an ABN signed.
If you shoul…
You won’t face the same nail-biting payment woes in 2011 as you did this year, thanks to a Senate Finance Committee bill that will freeze Medicare pay at current levels for another 12 months. The House of Representatives passed the Medicare and M…
CMS says keep patient medical records for 6 years.
Medical practices often hear conflicting advice regarding how long they must hang on to a patient’s medical records, but CMS intends to clear up any misinformation with new MLN Matters article SE1022…
After a year’s worth of extensions of the Red Flags Rule, medical practices were ready to buckle down and ensure that their plans were in place, because the rule was set to take effect on June 1.
However, just days shy of that deadline, the Federal Trade Commission (FTC) announced that it would be delaying enforcement until Dec. 31, 2010, “at the request of several Members of Congress,” according to a May 28 FTC news release.
Under the Red Flags Rule, “certain businesses and organizations — including many doctor’s offices, hospitals, and other health care providers — are required to spot and heed the red flags that often can be the telltale signs of identity theft,” according to an article on the Federal Trade Commission’s Web site.
To comply with the Red Flags Rule, covered entities are expected to create a written red flags program to prevent and detect potential identity theft cases.
According to the FTC, the rule applies to businesses that qualify as creditors or financial institutions, and the FTC’s broad definition indicates that it applies to many medical practices. “Health care providers are creditors if they bill consumers after their services are completed,” the FTC Web site says. “Health care providers that accept insurance are considered creditors if the consumer ultimately is responsible for the medical fees.”
However, simply “accepting credit cards as a form of payment does not make you a creditor under the rule.”
Congress requested the delay in part to “pass legislation that will resolve any questions as to which entities are covered by the Rule,” the FTC press release indicated. “Congress needs to fix the unintended consequences of the legislation establishing the Red Flags Rule — and to…
Heads up: These vaccine admin codes are excluded from incident-to requirements.
Incident-to rules don’t always apply to diagnostic services, but many medical practices aren’t aware of that.
And based on a new wave of scrutiny directed toward incident-to claims, you should know physician supervision rules inside and out.
A recent audit from the HHS Office of the Inspector [...]
- Nonphysician Providers and Incident-To: Your Coding Questions AnsweredHere’s why you should keep your physicians’ work schedules on…
- Use This Incident-To Checklist to Breathe Easy During an Audit You don’t need to second-guess the way you bill…
- 5 Rules Pinpoint Date of Service for Laboratory ClaimsTip 3: Here’s DOS advice for archived samples. You can’t…
- Oncology Practices Face the Biggest Change in Coding Since the Computer, ICD-10 March 6, 2014
- ICD-10 Cheat Sheet for Physical and Occupational Therapy March 5, 2014
- ICD-10 End-to-End Testing: 3 Steps to Take March 5, 2014
- Medical Coding, One of America’s Fastest Growing Jobs March 4, 2014
- AAFP Raises Serious Questions About ICD-10 Testing, Readiness March 3, 2014
- ICD-10 Will Affect All Specialties, Some More Than Others February 10, 2014
- ICD-10: Minimizing the Financial Hit December 16, 2013
- The Average Medical Coding Salary For 2013 – AAPC January 23, 2014
- Updated 2014 ICD-10 Implementation Costs Summary February 17, 2014
- Approved Manuals For The Medical Coding CPC Exam From AAPC January 29, 2014
- Oncology Practices Face the Biggest Change in Coding Since the Computer, ICD-10 | MedicalCodingNews.Org: […] Create a Cheat Sheet […]...
- Medical Coding, One of America’s Fastest Growing Jobs | MedicalCodingNews.Org: […] qualified Medical Coder can be expected ...
- AAFP Raises Serious Questions About ICD-10 Testing, Readiness | MedicalCodingNews.Org: […] letter to Sebelius, AAFP Board Chair Jef...
- ICD-10 deadline won\'t be delayed, Tavenner tells HIMSS | MedicalCodingNews.Org: […] for no relief from the looming, Oct. 1 c...
- CMS Launches ICD-10 Website For Small Physician Practices | MedicalCodingNews.Org: […] are used in the practice, how to identif...
- Oncology Practices Face the Biggest Change in Coding Since the Computer, ICD-10 | MedicalCodingNews.Org on ICD-10 Cheat Sheet for Physical and Occupational Therapy
- Medical Coding, One of America’s Fastest Growing Jobs | MedicalCodingNews.Org on Mastering Medical Coding is Not as Hard as You Think
- AAFP Raises Serious Questions About ICD-10 Testing, Readiness | MedicalCodingNews.Org on Updated 2014 ICD-10 Implementation Costs Summary
- ICD-10 deadline won't be delayed, Tavenner tells HIMSS | MedicalCodingNews.Org on CMS Launches ICD-10 Website For Small Physician Practices
- CMS Launches ICD-10 Website For Small Physician Practices | MedicalCodingNews.Org on ICD-10 Will Affect All Specialties, Some More Than Others
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