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Wednesday Aug 04, 2021

Major insurer reviewing, downgrading some E/M codes for outlier physicians

Claims will be selected from physicians who code at higher E/M levels compared to their peers with similar risk-adjusted patients.

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Posted at 11:45PM Aug 04, 2021 by Erin Solis | Comments [0]

Friday Feb 22, 2019

New reports look at family medicine office visit billing

Here's what to do with that Medicare comparative billing report you may have received analyzing how you bill family medicine office visits.

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Posted at 11:00AM Feb 22, 2019 by Kent Moore | Comments [0]

Friday Aug 18, 2017

Medicare claim review to become more targeted

The Centers for Medicare & Medicaid Services says it is expanding its medical review strategy, called “Targeted Probe and Educate" later this year. This actually appears to offer some advantages to physicians.

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Posted at 04:14PM Aug 18, 2017 by Kent Moore | Comments [0]

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.

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Posted at 11:57AM Nov 02, 2016 by David Twiddy | Comments [0]

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.

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Posted at 11:59AM Oct 31, 2016 by David Twiddy | Comments [0]

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.

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Posted at 01:20PM Aug 18, 2015 by David Twiddy | Comments [0]

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.

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Posted at 11:58AM Jun 30, 2015 by David Twiddy | Comments [0]

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.

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Posted at 11:26AM May 19, 2015 by David Twiddy | Comments [0]

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.

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Posted at 10:34AM Dec 02, 2014 by David Twiddy | Comments [0]

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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Posted at 02:21PM Nov 25, 2014 by David Twiddy | Comments [0]

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The views expressed here do not necessarily reflect the opinions of FPM or the AAFP. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use.