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Wednesday Aug 04, 2021
Major insurer reviewing, downgrading some E/M codes for outlier physicians
Friday Feb 22, 2019
New reports look at family medicine office visit billing
Friday Aug 18, 2017
Medicare claim review to become more targeted
Wednesday Nov 02, 2016
How to avoid E/M errors and denials
The Centers for Medicare & Medicaid Services (CMS) says approximately 15 percent of evaluation and management (E/M) services are improperly paid and accounted for 9.3 percent of the overall Medicare fee-for-service improper payment rate in 2014. To help you avoid improper payment of your E/M claims and prevent payment denials, CMS has released a new fact sheet of compliance tips for E/M services.
Monday Oct 31, 2016
Comprehensive Primary Care Plus program reopening to practices
Practices that missed the application deadline for the Comprehensive Primary Care Plus (CPC+) program will have another opportunity to apply next year. The Centers for Medicare & Medicaid Services (CMS) recently announced it was reopening CPC+ applications for both payers and practices.
Tuesday Aug 18, 2015
Avoid errors when coding pulmonary diagnostic procedures
The latest issue of the Medicare Quarterly Provider Compliance Newsletter includes a useful reminder that billing for evaluation and management (E/M) services and pulmonary diagnostic procedures provided to the same patient on the same date often requires the use of a modifier. Failure to use the appropriate modifier may result in getting paid only for the procedure and not the E/M service. Alternatively, it may result in Medicare identifying it as an overpayment and requesting repayment.
Tuesday Jun 30, 2015
Place of service matters in Medicare billing
Last December, I reported that the U.S. Department of Health and Human Services Office of Inspector General (OIG) planned to examine place of service (POS) coding by physicians as part of its fiscal year 2015 work plan. Last month, the OIG revealed its findings: Medicare contractors overpaid physicians $33.4 million between January 2010 and September 2012 as a result of incorrect coding related to POS. Specifically, physicians were incorrectly paid for performing these services in non-facility locations, such as physician offices or independent clinics, when they were actually working at facility locations, such as ambulatory surgery centers (ASCs) or hospital outpatient centers.
Tuesday May 19, 2015
More answers to questions about chronic care management
The Centers for Medicare & Medicaid Services (CMS) this month released a set of frequently asked questions (FAQs) about the chronic care management (CCM) service for which Medicare began paying this year. The FAQs reaffirm some of what was already known about CCM and clarify other areas.
Tuesday Dec 02, 2014
OIG to focus on place of service coding by physicians
As part of its Fiscal Year 2015 work plan (which began Oct. 1), the Health and Human Services Office of Inspector General (OIG) says it will examine place of service coding errors by physicians. Specifically, the OIG will review physicians’ coding on Medicare Part B claims for services performed in ambulatory surgical centers (ASCs) and hospital outpatient departments to determine whether they properly coded the places of service. Here’s what you need to know to avoid such errors in your practice.
Tuesday Nov 25, 2014
Comparative Billing Reports: what do they mean?
Family physicians have recently received Medicare comparative billing reports (CBRs) from Medicare contractor eGlobalTech. These reports measure an individual physician’s use of CPT codes 99211 through 99215 (established patient office visits) and CPT modifier 25 (a significant, separately identifiable evaluation and management service by the same physician on the same day). The reports have raised some questions and concerns, which I’ll try to address.
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