Tag Archives | Physicians

Why We Need To Stop Calling Physicians “Providers”

It’s a change in nomenclature that’s come a bit out of the blue over the last few years. The forces appear to be aligning to gradually push the word “doctor” out of the center and towards the periphery of health care. Whether we are talking about administrative communication or health care information technology order entry […]

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What Should Hospital Administrators Concentrate More On?

Hospital administrators have to juggle between various tasks like managing finances, projects and the usual daily hospital operations. To top it all, the priorities are constantly changing from one department to another. Consequently, it is very important to know which task takes precedence over the others. Here are a few points that can help you […]

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Upcoding vs. Downcoding: Know the Difference

“Upcoding” means reporting a higher-level service or procedure or a more complex diagnosis, than is supported by medical necessity, medical facts, or the provider’s documentation. For example, reporting a diagnosis of chronic bronchitis if the patient has acute bronchitis qualifies as upcoding, as would billing a level 5 evaluation and management (E&M) service (e.g., 99215) […]

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10 Free Cloud-Based Tools for Physicians

Say goodbye to the server, the future of health technology lies in the cloud. Thanks to advances in security and reliability, affordable web-based technology is more popular with physicians than ever. A recent Black Book Rankings study found that 7 out 10 small medical practices have now switched to a cloud-based Electronic Health Record system.

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ICD-10 Testers Recommend Certified Coders, Lighter Loads For October

The advice from those who have already tried coding with ICD-10? Hire a certified coder if you don’t have one on staff already.

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Physicians Still Smiling Through Healthcare Changes: 6 key points

Physicians report they are still happy in light of healthcare changes, according to Physicians Practice’s 2015 Great American Physician survey. Kareo sponsored the survey. Here are six key points:

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CMS Will Reimburse ICD-10 Mistakes

The CMS has made a concession in the transition from ICD-9 to ICD-10.

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Why Healthcare Providers Are Concerned About The CMS Data Dump

In two editorials published in the Annals of Internal Medicine, Gail Wilensky, PhD, a former administrator for the Health Care Financing Administration; along with Eric M. Horowitz, MD, and David S, Weinberg, MD, MSc, both of Fox Chase Cancer Center, shared their concerns about the release of physician payment data by CMS.

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Payers Respond to ICD-10 Delay

The questions came flying in from audience members during a recent broadcast of Talk Ten Tuesdays in which two payer representatives — Dennis Winkler from BlueCross-BlueShield of Michigan and Sidney Hebert with Humana —were interviewed.

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ICD-10 Countdown: Obstacles To Physician Education

By the time you put away your Christmas decorations at the end of 2013, you should be breaking out the ICD-10 workbooks for your physicians.  According to the recommended CMS timelines, January 1 should be the beginning of comprehensive training on documentation improvement for clinical and coding staff. 

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Good News: It’s Reimbursement Time Now

Filed a claim during the legal battle between the American Medical Association (AMA) and UHC? There’s good news for you.

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Avoid EHR Penalties with These Proposed Additional Exemptions

 Posted on 07. Jul, 2011 by rpandit in Hot Coding Topics, Provider News Check whether your group might fall into one of four new categories. The push toward e-prescribing is in full swing, with physicians possibly being subjected to a one percent paym…

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Follow 4 Simple Tips for Modifier 62 to Get your Game Plan in place for both Codes and Documentation

When two surgeons work together to perform one procedure, each physician’s individual documentation requirements can get jumbled up.  Make sure your physician isn’t passing the documentation buck and that he or she knows to follow these four tips when you submit claims with modifier 62.

Tip 1: Each physician should identify the other as a co-surgeon. Also make sure that the other physician is billing with modifier 62. A lot of confusion can arise when physicians from different practices are reporting the same procedure.

You may find yourself in a situation where one physician may report the other physician’s work as that of an assistant surgeon, in which case the claims would not correspond. This means a denial will hit your desk. One surgeon cannot simply indicate the other as the co-surgeon. Both physicians must submit claims for the same procedure, both with modifier 62. To accomplish this all you only need to call with a simple courtesy to the other physician’s billing or coding department.

Tip 2: Each physician should document her own operative notes. When surgeons are acting as “co-surgeons,” it is implied that they are each performing a distinct part of the procedure, which means they can’t “share” the same documentation. Each physician should provide a note detailing what portion of the procedure he or she performed, how much work was involved, and how long the procedure took. Including a brief explanation of the need for co-surgeons will help to avoid denials and reimbursement delays.

Tip 3: Each physician must link the same diagnosis code to the common procedure code. Though this requirement may seem obvious, if two physicians serve as co-surgeons to perform one procedure, the diagnosis code(s) they link to the CPT® code should be the same.  Before submitting a claim with modifier 62, someone…

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Follow 4 Simple Tips for Modifier 62 to Get your Game Plan in place for both Codes and Documentation

When two surgeons work together to perform one procedure, each physician’s individual documentation requirements can get jumbled up. Make sure your physician isn’t passing the documentation buck and that he or she knows to follow these four tips when you submit claims with modifier 62.

Tip 1: Each physician should identify the other as a co-surgeon.  Also make sure that the other physician is billing with modifier 62. A lot of confusion can arise when physicians from different practices are reporting the same procedure.

You may find yourself in a situation where one physician may report the other physician’s work as that of an assistant surgeon, in which case the claims would not correspond. This means a denial will hit your desk. One surgeon cannot simply indicate the other as the co-surgeon.  Both physicians must submit claims for the same procedure, both with modifier 62. To accomplish this all you only need to call with a simple courtesy to the other physician’s billing or coding department.

Tip 2: Each physician should document her own operative notes. When surgeons are acting as “co-surgeons,” it is implied that they are each performing a distinct part of the procedure, which means they can’t “share” the same documentation. Each physician should provide a note detailing what portion of the procedure he or she performed, how much work was involved, and how long the procedure took. Including a brief explanation of the need for co-surgeons will help to avoid denials and reimbursement delays.

Tip 3: Each physician must link the same diagnosis code to the common procedure code. Though this requirement may seem obvious, if two physicians serve as co-surgeons to perform one procedure, the diagnosis code(s) they link to the CPT® code should be the same.  Before submitting a claim with modifier 62, someone…

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Ensure Your Physician’s Signatures Pass Muster By Answering 2 Key Questions

EMR signature pitfalls could be a daily challenge with which you often deal. Check your answers against our experts’ advice to verify your group’s signature compliance.

Question 1: Some of our physicians use handwritten signatures on their charts and others prefer electronic signatures. Is either kind acceptable?

Answer 1: According to CMS documents, Medicare requires a legible identifier for services provided or ordered.  The identifier — or signature — can be electronic or handwritten, as long as the provider meets certain criteria. Legible first and last names, a legible first initial with last name, or even an illegible signature over a printed or typed name are acceptable.  You’re also covered if the provider’s signature is illegible but is on a page with other information identifying the signer (letterhead, addressograph, etc.).  Also be sure to include the provider’s credentials.  The credentials themselves can be with the signature or they can be identified elsewhere on the note.

Pre-printed forms might include the physician’s name and credentials at the top, side, or end.  All qualify as acceptable documentation as long as the coder or auditor can identify the provider’s credentials.  You can also use a signature log to back up your physician’s documentation.  The log should contain each provider’s printed or typed name and credentials, along with their signatures and initials. You can reference the signature log in order to verify a note that contains an otherwise unidentifiable signature.  This is an important resource when providers are signing notes that do not include their typed or pre-printed name.

Make sure that you update signature logs at least once a year.  Create separate logs by provider (physicians, CRNAs, AAs, residents, etc.) to help simplify tracking.  Stamped signatures don’t meet the CMS requirements.  Because a signature stamp can be used…

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5 Ways ICD-10 Will Affect the Surgery Center Front Office

Lolita Jones, RHIA, CSS, independent coding and billing consultant, discusses five ways ICD-10 will affect “front office” processes in an ambulatory surgery center. This article is the second installation in a four-part series.

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