Tag Archives | Medicare Reimbursement

Medical Billing Codes Do Not Address Full Scope of Primary Care

Current Procedural Terminology (CPT) codes used for medical billing did not account for all the care provided by primary care physicians in about 60.3 percent of visits, a recent Journal of the American Board of Family Medicine study showed. The observational analysis of over 980 family physician-patient ambulatory visits revealed that CPT codes used for […]

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Medicare Physician Pay Cut Update

On Tuesday evening, the Senate passed H.R. 4691, which freezes the Medicare conversion factor at current levels through March 31.

Because of this vote, you will not face the 21% pay cut until April 1, explains Part B Insider editor,…

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  2. SGR Update: What’s Up With That 21 Percent Physician Pay Cut? Here’s what you should be watching on Capitol Hill….
  3. How Obama’s Medicare Cuts Hit Physician Reimbursement  The budget released Thursday suggests we cut $300 billion from…
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CMS Tells MACs to Hold Claims For 10 Days

The latest on the 21 percent Medicare pay cut.

If your practice leans heavily on Medicare for reimbursement, expect your cash flow to taper off a bit.

CMS has instructed the MACs to hold claims for the first ten business…

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OIG Hit List: Perfect Your 38220, 38221, and G0364 Usage

Don’t sweat reporting 38220-59 if you meet these Medicare-approved conditions.
If your oncologist takes both a bone marrow biopsy and a bone marrow aspiration, whether you’ll see Medicare reimbursement depends on the two guidelines below. But watch out: With OIG scrutiny and a HCPCS twist, these guidelines will put your coding savvy to the test.
Append 59 […]

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  3. Multiple Bronchoscopy Coding Crash Course Head off denials & ratchet up reimbursement with these…
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Coding Compliance: OIG Targets Transforaminal Epidural Injections

Verify that you’re counting injections and levels correctly to keep claims clean.
The Office of Inspector General (OIG) Work Plan for 2010 includes a closer look at Medicare payments for transforaminal epidural injections. The Work Plan specifically states, “We will review Medicare claims to determine the appropriateness of Medicare Part B payments for transforaminal epidural injections.”
Stay […]

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  1. Save Time Coding Facet Injections With This Coding Tool Hint: Location, number and substance are key. Several factors…
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  3. Trigger Point Injection Coding: Count Targets, Not Shots Become the top TPI gun in your coding department…
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Coder’s Navigation Tool: 2010 Medicare Physician Fee Schedule

It’s that time of year coders — yes, time to comb through pages and pages and pages of the final 2010 Medicare Physician Fee Schedule. We’ve got a handy place to start.
If you want a quick overview of fee schedule’s financial impact on your physician practice’s specialty, go here and scroll to page 1171. There, […]

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  1. Proposed 2010 Physician Fee Schedule: A Closer Look21.5 percent cut looms for your services Last week, Coding…
  2. How Obama’s Medicare Cuts Hit Physician Reimbursement  The budget released Thursday suggests we cut $300 billion from…
  3. CMS Issues Corrections to 2009 Physician Fee Schedule Final RuleIt’s that time of year again — time to get…
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OIG Auditors to Cardiologist: You’re Billing Medicare Properly

Report reveals what he and his billing staff did right. Does your practice have the right stuff?
Turns out the old saying is true: If you haven’t done anything wrong, an OIG audit is nothing to worry about.
A New York cardiologist who collected over $1.3 million over a three-year period for 5,061 claims caught the OIG’s […]

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  1. Double Ultrasound Codes Spell Double Trouble With AuditorsAuthorities scrutinize medical necessity for 76830 & 76856. The OIG…
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  3. HHS Plans to Crack Down on Fraud, Improper BillingMedicare loses $60 billion a year in improper payments. A…
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Service Doesn’t Meet Incident-To Rules? Report Under NPP’s NPI

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 […]

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  3. 5 Rules Pinpoint Date of Service for Laboratory ClaimsTip 3: Here’s DOS advice for archived samples. You can’t…
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