You must be vigilant in timely releasing patient medical records or face $85,000 in penalties. That’s the amount fined to the second provider since fines began in 2019. In December, Korunda Medical, LLC in Florida was fined $85,000 for slow-walking a patient’s medical records. This is the second enforcement action and settlement leveraged by the […]
The recently released 2020 CMS Telemedicine Policy Final Rule’s changes just went into effect on January 1. Topping the list of improvements are new HCPCS codes, greater flexibility with telehealth location, and more telehealth benefit options. Count Home as Originating Site and 2 Other Sweeping 2020 CMS Telemedicine Changes This major final rule revises payment […]
If your physicians participate in Medicare Advantage Plans, keep a sharp eye on the mail. The final Medicare Advantage Overpayments letter is being mailed to practices the first week of January, and it contains a time-sensitive CMS settlement offer that you must act on this Winter or risk significant financial losses. Medicare Advantage Overpayments Letters […]
QUESTION: I’m pretty nervous about the significant changes to the Evaluation and Management (E/M) codes being made soon. The 2020 CMS Physician Fee Schedule goes into effect January 1, 2020, Does it contain the changes? ANSWER: The 2020 Medicare Physician Fee Schedule Final Rule confirms that the E/M code changes completely take effect in 2021. […]
QUESTION: Our providers have privileges at two separate hospitals. Every couple of years, they make us jump through a variety of hoops to keep our providers’ hospital privileges active. This year, one of the hospitals is asking us to send provider references. Who should we ask? Anonymous, Alpharetta, GA ANSWER: Hospitals typically ask for three […]
Determining whether a patient is new or established shouldn’t be complicated — but coding CPT 99201-99215 office visits is oftentimes not so clear. Miscoding these E/M visits, however, can cost you thousands of dollars each year in lost revenue. In fact, selecting an established patient when you should have billed a new patient office visit […]
Correctly coding for injections and infusions can often feel like a shot in the dark. From assigning codes for multiple drugs to add-on codes to accurately documenting stop and start times, even the most experienced coders feel the pinch of these complex coding guidelines. But code claims incorrectly, and you could be costing your practice […]
You should expect to see Medicare providing more oversight and audits on chart reviews, specifically ones that result in additional patient diagnoses and payment. A U.S. Department of Health and Human Services Office of Inspector General (OIG) December 2019 report has raised concerns over billions of dollars in Medicare Advantage payments generated from chart reviews. […]
Billing mistakes have more serious implications than you just seeing a decrease in your reimbursement. Some of the most common billing errors can get your practice audited, and result in you paying massive violation penalties. Unfortunately, accurately billing for outpatient services is so much more complicated than just submitting a claim or sending an invoice. […]
Preparation is key to any project or endeavor, and payer contract negotiations are no different. If you don’t have your ducks in a row including your fee schedule pricing demands and arguments, you could be shut down before you’re even out of the gate. The fee schedule portion of your payer contract outlines the rate […]
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