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…
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- State Medical Societies Warn of Disaster with ICD-10 Transition June 24, 2015
- ICD-10 Grace Period Issued For A Year July 13, 2015
- AMA’s Long War of Words Against ICD-10 July 8, 2015
- CMS Will Reimburse ICD-10 Mistakes July 7, 2015
- Legislation to Delay ICD-10 Introduced July 1, 2015
- Medical Coders Get Tips For Transition To New System June 30, 2015
- Clinical Documentation Excellence Program: Tackling ICD-10 Challenges June 16, 2015
- Lawmakers Propose ICD-10 Two-Year ‘Grace Period’ June 10, 2015
- CMS: Successful April Medicare FFS ICD-10 End-to-End Testing June 3, 2015
- Are Practices More Ready for ICD-10 Than They Realize? August 18, 2015
- ICD-10: Coding for Hypertension and Heart Disease August 26, 2015
- With ICD-10 about a month away, healthcare providers say ‘bring it on’ August 25, 2015
- 3 ICD-10 Changes Include Specificity, Expansion, Combination August 19, 2015
- Are Practices More Ready for ICD-10 Than They Realize? August 18, 2015
- ICD-10 Readiness: Physician Practices Lag Far Behind Hospitals August 12, 2015
- 5 Best Practices To Ensure A Smooth, Expedient ICD-10 Transition August 11, 2015
- CMS Revises ICD-10 FAQ List for Billable Code Clarification August 4, 2015
- CMS and AMA Release Clarifications on ICD-10 Guidance August 3, 2015
- Can You Pick The Right ICD-10 Family? July 28, 2015
- Impact of Procedure Code Analysis on Claims Handling Procedures July 21, 2015
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- AMA’s Long War of Words Against ICD-10 | scrubs and suits: […] By admin […]...
- CMS Will Reimburse ICD-10 Mistakes | scrubs and suits: […] By admin […]...
- Legislation to Delay ICD-10 Introduced | scrubs and suits: […] By admin […]...
- Medical Coders Get Tips For Transition To New System | scrubs and suits: […] By admin […]...
- State Medical Societies Warn of Disaster with ICD-10 Transition | scrubs and suits: […] By admin […]...
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- Clinical Documentation Excellence Program: Tackling ICD-10 Challenges | scrubs and suits: […] By admin […]...
- Lawmakers Propose ICD-10 Two-Year ‘Grace Period’ | scrubs and suits: […] By admin […]...
- CMS: Successful April Medicare FFS ICD-10 End-to-End Testing | scrubs and suits: […] By admin […]...