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Billing

Billing

Infusion Administration

Recognize Infusion Administration Types to Ensure Proper Payment

Coding infusions is far from run-of-the-mill, and if you don’t get it right, you’ll likely see reduced — if not denied — claims. One of the key concepts when reporting this service is understanding the type of infusion you’re providing. Get it right, and your claim sails through, but get it wrong, and you’ll be […]
Published Date: July 18, 2017
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Chronic Care Management

Get on Board With CCM and Stop Leaving Money on the Table

Although Medicare began paying for chronic care management (CCM) services in 2016, the Centers for Medicare and Medicaid Services (CMS) reports that many practices are not taking advantage of the new coverage, even after more than a year. And if you’re not billing this service for those who are likely your sickest patients, you’re losing […]
Published Date: April 11, 2017
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Ortho Management

Ortho Management (97760) Billing

Can an orthopedic practice bill for orthotic management? One of the most commonly asked question is, “Can I bill 97760?” If you are an orthopedic practice, you really can’t. This is because it should always be a therapy service, and it has to be under a therapy plan of care. If your physician asks an […]
Published Date: February 17, 2017
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Telemedicine Originating Site

Medicare (CMS) Telemedicine Originating Site

What does Medicare consider an originating site for Telemedicine services? Medicare (CMS [Centers for Medicare and Medicaid Services]) has some guidance to help you identify what might qualify as an originating site. You will need to verify with your other payers if you are dealing with someone other than Medicare. The Medicare originating site locations […]
Published Date: February 9, 2017
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Telemedicine Claim Denials

Avoid Telemedicine Claim Denials by Knowing Your Site

In 2017, the Centers for Medicare and Medicaid Services (CMS) has added even more services to its approved telemedicine list, and you can be sure that the agency will continue this trend in coming years. That’s great news for both your potential patients and your practice. But the coding is hardly straightforward, and you have […]
Published Date: January 24, 2017
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Medicare Claims Denied

Medicare Claims Denied For NCCI Edits

What do you do when an insurance payer denies a claim for NCCI edits, but it is contrary to the NCCI edits found on CMS’s website? Whose edit guidelines take precedence? When you are looking at NCCI verses a local coverage determination, the local coverage determination trumps the NCCI. One of the reasons for this […]
Published Date: December 22, 2016
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X Modifiers Over Modifier 59

When to Use X Modifiers Over Modifier 59

Consistent misuse and abuse of modifier 59 has put it on the Office of the Inspector General’s active radar. Meaning they are just waiting for you to slip up. To make matters worse, modifier 59 sub-modifiers (XE, XS, XP, XU) and varying carrier guidelines, make it even more difficult to get it right. In fact, […]
Published Date: December 20, 2016
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Complex Care Management

In 2017 Get Paid for the Complex Care Management You Provide

In 2016, Medicare added chronic care management (CCM, 99490) to its list of reimbursable codes. Starting Jan. 1, the agency is adding complex CCM services (99487-99489) to that list as well. But there are specific rules you must follow to get the payment you deserve. Most likely, you’re already providing these much needed extra services […]
Published Date: December 6, 2016
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Incident to and 15% Payup

Proximity Unlocks Incident to and 15% Payup

We recently held a webinar on billing nonphysician practitioner (NPP) services incident to the physician. And you wouldn’t believe the number of questions that came out of that session. This is certainly not a new topic, but there continues to be a great deal of confusion surrounding it. And many of the questions had to […]
Published Date: November 22, 2016
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Physician Fee Schedule Final Rule

2017 Medicare Physician Fee Schedule Final Rule Released

The Medicare Physician Fee Schedule (MPFS) 2017 Final Rule offers some big updates related to global periods, non-face-to-face services, telehealth, and moderate sedation coding, among others, according to the Centers for Medicare and Medicaid Services (CMS) when it released the rule Nov. 2. For instance, the MPFS rule addresses the agency’s efforts to collect data […]
Published Date: November 3, 2016
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