·       In past years, the proposed PFS has focused on the rates for the upcoming year. This time, the proposed schedule has a more limited scope due to the Protecting Access to Medicare Act (PAMA) of 2014 — signed into law on April 1 – which provides for a 0% increase in fees for services rendered between January 1 and March 31, 2015. However, CMS announced a negative 20.9% update for the remainder of 2015 following the expiration of PAMA.

Sigh. A big red ‘DENIED’ shows up on your unlisted code claim… again. How frustrating! Not only have you already spent a lengthy amount of time combing through your provider’s surgical documentation & deeming that an unlisted code is appropriate, you now need to figure out why this unlisted code is being denied.  Does this scenario sound familiar? It probably does, as all seasoned medical coders have found themselves in a similar situation such as this before. If you’re looking to end the denial cycle of the unlisted code, keep reading for some tools and tips from a payor’s point-of-view that will help you get your claim paid the first time, every time!

The global surgical period is full of complexity with CMS guidelines and payers’ interpretation.  The relationship between services performed and use of modifiers in conjunction with correct coding per CCI can be quite tricky.   In recent years, it has become an area of scrutiny and audit focus as defined by the Office of Inspector General (OIG).  In a 2013 transmittal, the OIG issued the following directive, “We will review the appropriateness of the use of certain claims modifier codes during the global surgery period and determine whether Medicare payments for claims with modifiers used during such a period were in accordance with Medicare requirements. Prior OIG work found that improper use of modifiers during the global surgery period resulted in inappropriate payments.”

With all of the pressures of closing out one year and jumping into the next, sometimes it’s hard to stay up-to-date with all of the 2014 coding changes. If you are a Pain Management Clinic, did you realize that, 64613 and 64614 will no longer be valid for 2014?  Read on if you are experiencing claim denials as the new codes for 2014 have greater specificity between anatomy and medical necessity.

Excel is a powerful tool for storing data however it can be very difficult to analyze the mass amounts of information stored in an intuitive way. Many individuals and organization find themselves spending countless hours manually producing tables and charts in excel.

The current healthcare environment continues to create regulatory complexities so physicians are forced to reduce patient time and focus on regulatory and administrative issues. Keeping a clinic or health system compliant has become the forefront to avoid government and private payor audits.  As physicians try to create efficiencies with implementation of Electronic Health Records/Electronic Medical Records (EHR/EMR’s), a new vulnerability to government scrutiny begins to evolve.

So you are thinking of adding Social Workers to your practice. But you are thinking- Will the services be covered? What requirements must be met? Is it even worth it? What codes can they bill?

Here are the answers to your questions:

How long has it been since you have read the Centers for Medicare & Medicaid Services (CMS) policy manual on Modifier 25? Or are you like many people individuals who have never looked at the policy on the modifier and were only taught by others? In this hectic world, it is can be difficult to take time to settle in and really look at the guidelines however this is a critical step in the process. In this three part series, modifier 25 is addressed in depth mainly with regards to CMS guidelines and occasionally referenced from individual Medicare Administrative Contractors (MACs).

2013 has marked a significant year for coding changes for psychiatry and psychology.  As with other specialties, the AMA provided a clear division of coding for psychotherapy services as opposed to medical management of patient problems.  CMS has adopted most of the new coding regulations put forth by the AMA yet, many State Medicaid plans have narrowed the scope of coverage within the code series.

Non-physician providers (NPPs) continue to integrate and gain credentials offering collaborative billable services in a hospital setting. Yet to this end, the professional side of coding has several gray areas that MAC guidelines don’t address clearly. For the purposes of billing Medicare Part B, medical record documentation must satisfy a few criteria found in the Internet-Only Manual (IOM).