CMS Starts ICD-10 Claims Testing This Week
The Centers for Medicare & Medicaid Services (CMS) will be conducting a national testing week, from November 17 to 21, 2014.
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November 18, 2014
CMS Update Policies, Payment Rates for Dialysis Facilities for 2015
On Oct. 31, the Centers for Medicare & Medicaid Services issued a final rule that will update payment policies and rates under the End-Stage Renal Disease Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after Jan. 1, 2015.
November 3, 2014
CMS Considering Alternatives To ‘Two-Midnight’ Rule
Faced with withering criticism, CMS officials are asking for ideas on how to design a new payment system for treating Medicare patients who need only a day or so in…
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May 21, 2014
Postponed Billing System Causes Pain For M.D.s
A delay in requiring all providers of medical care to use a new health-records and billing system to describe treatments is giving small medical offices major headaches. Billing is a…
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April 29, 2014
5 Tips for a Successful ICD-10 Transition for Physician Practices
Despite the rapidly approaching conversion date, recent surveys have shown many providers still have a lot of ground to cover before they're prepared to take on ICD-10. A study released…
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March 19, 2014
Pay and Practice: CMS to Test ICD-10
Mark your calendars -- the Centers for Medicare and Medicaid Services (CMS) announced it will conduct front-end testing of ICD-10 billing code submission between Medicare Administrative Contractors (MACs) and providers.…
January 31, 2014
Medicare Gives Guidance on Claims During ICD-10 Changeover
As of Oct. 1, 2013, claims submitted in the United States must use ICD-10 codes and insurers will reject claims with ICD-9 codes. So what happens if a claim for…
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October 31, 2011
Why Must CMS Overreach on Rules?
Joseph Goedert Health Data Management Blogs, September 2, 2011 To prove meaningful use of electronic health records, providers must collect, organize and report data culled from certified electronic health records…
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October 10, 2011
Modifier 57 Remains Handy Post Removal of Consult Codes
Take a hint from a CPT®’s global period when choosing between modifiers 25 or 57
Contrary to popular thinking, modifier 57 does not apply exclusively for consultation codes only. Medicare may have stopped paying for consult codes, but this doesn’t mean you have to stop using modifier 57. Here are two tips on how you can use this modifier to suit your practice’s needs.
Background: Starting January 1, 2010, the Centers for Medicare and Medicaid Services (CMS) eliminated consult codes from the Medicare fee schedule.
Non-Consult Inpatient Codes Keep Modifier 57 Alive
With CMS eliminated consult codes (99241-99245, 99251- 99255) for Medicare patients, you might have wondered if modifier 57 (Decision for surgery) would remain useful. The answer? You can still use this modifier for a non-consult inpatient E/M code, so long as your documentation supports it. This is because any major procedure includes E/M services the day before and the day of the procedure in the global period, says Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J. “The only way you can be paid properly for an E/M performed the day before the major surgery or the day of the surgery is to indicate that it was a decision for surgery (modifier 57), which also indicates to the payer that the major procedure was not a pre-scheduled service,” she explains.
Past: Say the pulmonologist carries out a level four inpatient consult in which she figures out the patient requires thoracoscopy with pleurodesis for his recurring, persistent pleural effusion (511.9). The physician decides to perform thoracoscopy with pleurodesis the day after the consult. In this case, appending modifier 57 to the E/M code (99254, Inpatient consultation for a new or established patient, which requires these 3...
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June 24, 2011
Put Your ePrescribing Knowhow Into Meaningful Use
Get your system moving before June 30th or you’ll pay the price.
If you do not have an electronic prescribing (ePrescribing or eScribing) system yet in place, or have not integrated one into your electronic medical record (EMR) system, you better get a move on it. You only have until June 30, 2011 to submit at least ten claims to Medicare demonstrating that you are a successful eScriber for 2011. Otherwise, you are at risk of not only losing the bonus in 2011 but according to the rulemaking for 2011, also facing penalties assessed, reducing your Medicare fee schedule by 1 percent in 2012.
With limited time, it is smart to consider a stand-alone internet based system which you can implement relatively easy. You could get this system up and running right away, at a low cost, with simplified a implementation timeline and without depending on your electronic health record (EHR) selection and implementation which is both much more extensive, costly and more complicated to implement.
If you’re still asking, “Can our practice afford not to adopt ePrescribing?” Then, the answer is NO. Today you need to start doing something.
Background: eScribing is part of Centers for Medicare and Medicaid Services’ (CMS) incentive program called the Physician Quality Reporting System (PQRS). PQRS offers incentives to practices that meet CMS-set goals for the implementation and practice of electronic prescription on a regular basis. The system was designed with “a carrot and a stick”. While we have been enjoying the “carrot” for the past few years, the “stick is on the cusp of being implemented as of June 30th per the 2011 Rulemaking. CMS will pay you when you implement eScribing in 2011 (a 1 percent bonus), it will penalize you when you don’t put it into practice, a 1percent penalty...
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May 10, 2011