Revenue Cycle Blog

Modifier 50 (bilateral) is used as a payment, rather than information, modifier. The addition of this modifier can affect payment depending on the procedure code and the BILAT SURG indicator. In some instances, procedure codes do not indicate on which side of the body a procedure is performed. In those instances, the modifier LT (left) or RT (right) is used to indicate the side of the body on which a service or procedure is performed.

The regulatory environment around HIPAA has gotten more stringent over time. This is partly due to consumers, who are becoming more aware of its importance in keeping their data private and safe. There are many ways that you can start protecting your business from HIPAA penalties today. Below are six tips that can help mitigate your risk of incurring willful neglect penalties.

The popularity of paying bills online has increased significantly as technology continues to advance. Paying an outstanding balance electronically has become both convenient and cost-effective. In the healthcare industry, this is especially true.

On Monday, July 6, 2015, the Centers for Medicare and Medicaid Services released new guidance to assist physicians in preparation for the October 1, 2015 ICD-10 implementation date.

Centers for Medicare & Medicaid Services (“CMS”) closely evaluates the proper use of modifier 25 by physicians. In order to utilize modifier 25 correctly, please review the following helpful tips included in this article.

The cloud is a centralized location where everything from applications and servers, to databases and networks, are stored and running. The cloud can be public, private or both. As long as your practice has internet-enabled devices, you are in business. How does the cloud affect your practice?

The U.S. Department of Veterans Affairs (the “VA”) has updated its timely filing guidelines for appeals of specified claim denials processed by the VA.

As previously reported, on April 1, 2015, the Medicare Physician Fee Schedule (“MPFS”) was updated using the Sustainable Growth Rate (“SGR”) methodology as required by current law. The SGR methodology required a 21% decrease in all MPFS payments beginning April 1, 2015. Pending possible intervention by Congress,

Should you bill an evaluation and management code every time you bill a minor procedure? The decision to perform a minor procedure or endoscopy includes the E&M service on the same date of service and should not be reported separately.

Currently, PPM is holding Medicare claims for clients unless specifically told by the client to release these claims.

As we recently reported, yesterday, March 26, by a vote of 392 – 37, the House of Representatives passed H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015, which, among other things, would permanently repeal and replace the SGR formula.

By a vote of 392 – 37, the House of Representatives passed H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015, which, among other things, would permanently repeal and replace the SGR formula.

As the March 31 deadline for Congressional action to prevent a 21% cut in physician fee schedule payments approaches, we want to take this opportunity to update you on where things stand in terms of Congressional enactment of a long-term vs. short-term SGR fix.

On certain occasions, providers may have to reduce services or discontinue a procedure for medical reasons. How do providers properly bill in these instances? Providers capture these particular services by appending modifiers 52 or 53 to the applicable claims.

The Measure-Applicability Validation (“MAV”) is a process utilized by Centers for Medicare & Medicaid Services (“CMS”) to determine whether eligible professionals or group practices should have reported additional measures to CMS for a specified reporting period. Specifically, MAV determines whether eligible professionals or group practices have earned the 2014 Physician Quality Reporting System (“PQRS”) incentive and thereby avoided the 2016 PQRS payment adjustment.

The legislative “patch” that is keeping a looming SGR 21% cut in Medicare payments from taking effect is about to expire on March 31.

On January 5, 2015, Centers for Medicare & Medicaid Services (“CMS”) implemented new rules for Modifier 59 to define subsets of the modifier and specification for their usage. Specifically, as of this date, Modifier 59 should not be used when a more descriptive modifier is available. The more-descriptive modifiers are the new modifiers XE, XS, XP and XU, which are described here.

The subject of encryption has been very prevalent in the news recently, and those in the healthcare industry likely encounter the topic on nearly a daily basis. Security threats to a physician practice’s private communications may seem like a necessary evil in today’s world, and yet they do not have to be. One tool healthcare professionals can utilize is email encryption.

On January 29, 2015, the Centers for Medicare & Medicaid Services (“CMS”) announced its intent to engage in rulemaking to update the Medicare and Medicaid Electronic Health Record (“EHR”) Incentive Programs to shorten the Meaningful Use reporting period in 2015 to 90 days, among other things.

The “Medicare Program: Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs” (42 CFR 423.120(c)(6)) final rule, published in the Federal Register on May 23, 2014, requires physicians and other eligible professionals who write Medicare Part D prescriptions for Medicare patients to enroll in an approved status, or to have a valid opt-out affidavit on file for their prescriptions to be covered under Part D by June 1, 2015.

Primary care providers have a number of options available to seek Medicare reimbursement for monitoring services or other activities that occur outside of a face-to-face encounter.

As 2014 came to a close, the Meaningful Use program continued to fall short of its intended goals. In this article are key 2014 Meaningful use program statistics and indicators provided by the Healthcare Billing and Management Association.

CMS has instituted the hold to allow the Medicare Administrative Contractors (“MACs”) sufficient time to implement RVU and conversion factor changes to the Medicare Physician Fee Schedule effective January 1, 2015.

On December 5, 2014, the Centers for Medicare and Medicaid Services (“CMS”) published the Requirements for the Medicare Incentive Reward Program and Provider Enrollment Final Rule.

Did you know that your practice needs to comply with HIPAA Security Regulations to successfully attest for Meaningful Use?

Providers are allowed to use documentation templates per CMS guidelines; however, the encounter note must be specific for the patient, date of services, the diagnoses specific to today’s treatment plan and services rendered. You should consider these basic compliance guidelines provided by WPS Medicare.

Centers for Medicare & Medicaid Services (“CMS”) has announced that four new modifiers will refine the use of the 59 modifier effective January 1, 2015. These new modifiers, referred to as the X modifiers, will describe the circumstances appropriate to override a CCI edit.

Healthcare professionals often engage in online information-gathering activities. Such activities inevitably lead to internet browsing at websites that deploy online advertising methods.

The Centers for Medicare & Medicaid Services (“CMS”) recently updated its Frequently Asked Questions site with clarification of the transition of care measure for purposes of attestation of stage 2 of meaningful use.

With constant advances in health information technology comes the constant need to maintain and secure e-PHI within any healthcare organization. The “Security Standards for Protection of Electronic Protected health Information,” better known as HIPAA’s “Security Rule,” requires organizations to implement policies and procedures to prevent, detect, contain and correct security violations.

Centers for Medicare & Medicaid Services (CMS) has reopened the submission period for hardship exception applications for eligible professionals and eligible hospitals to avoid the 2015 Medicare payment adjustments for not demonstrating meaningful use of Certified Electronic Health Record Technology (CEHRT).

With the flu season among us, it is important to remember that the Centers for Medicare & Medicaid Services covers the flu vaccine and administration for eligible Medicare patients at no out-of- pocket cost under Medicare Part B.

Transitional Care Management (“TCM”) Services – CPT codes 99495 and 99496 – were introduced by Medicare in January 2013. While it is commonly known that TCM services are reimbursable by Medicare and Medicare replacement plans, many may not be aware that other payers reimburse for TCM services as well.

In the age of data breaches and the resulting, significant fines, it is absolutely necessary to secure your data. One of the most important and most easily-mined components of any physician practice is messaging. Many are not aware there is no security when sending emails, text messages and instant messages.

On August 22, 2014, CMS issued Change Request 8812 to establish a new physician specialty code for Interventional Cardiology (C3).

The Department of Health and Human Services recently issued a Final Rule officially resetting the ICD-10 effective date as October 1, 2015. To this end, here are a few quick tips that will help you improve your clinical documentation:

Later this year, the Department of Health and Human Services is expected to begin its permanent HIPAA Audit Program. Consider this list of activities to help you get started:

Practices with declining profitability often experience similar roadblocks that lead to a drop in revenue or an increase in practice expenses. In such instances, this article includes a couple of key areas worthy of review.

As patients move between insurance plans at an increasingly high rate, the timely and thorough verification of patient eligibility has become extremely important for hospitals and physician practices.

It is a common misconception that the administration fee for the injection of vaccines and toxoids should be charged per injection site. The proper method is to charge an administration fee for each component of a vaccine or toxoid. With the high costs of medication, it is important for any physician practice to ensure its costs are covered and that revenue opportunities are not lost.

According to a recent study, use of observation care codes has continued to increase over the past several years, triggering payers to more closely scrutinize the billing of the codes to ensure medical necessity. What can be done to assist your practice with billing the observation care codes accurately?

Precision is pleased to share some of the services from which its clients have been benefitting in 2014, which range from operational workflow tools and IT analysis to marketing and social media services!

Every medical practice at times has an interaction with an unhappy patient. The key to maintaining a positive relationship with the patient is to ensure the patient’s complaint is properly and fully addressed.

A medical practice’s failure to release clean claims – claims that pass the clearinghouse, arrive at the payer and are paid upon first review – results in significant, adverse consequences to the practice’s revenue and cash flow.

On Tuesday, May 20, 2014, Centers for Medicare & Medicaid Services published a proposed rule that would permit eligible providers added flexibility to successfully achieve meaningful use attestation.

In today’s healthcare industry, the need to access a myriad of healthcare and hospital websites is critical to any organization’s success. Applications and programs are regularly installed locally on computers to facilitate functionality with outside websites.

When claims are entered into the Medicare system, they are issued a tracking number known as the internal control number (“ICN”). The ICN is a 13-digit number assigned to each claim received by Medicare.

Coding hospital discharge visits requires the careful consideration of numerous elements to ensure the coding is completed in a proper manner and the charge results in payment for the services rendered. Among the considerations include the time spent with the patient, the timing of the visit and whether the patient was in fact admitted to the hospital.

Orthopedic physicians and support staff likely know that CPT code 29826 (arthroscopy, shoulder surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament release, when performed) became an add-on code on January 1, 2012. As Precision works with Orthopedic practices, we have discovered there are still misunderstandings regarding when this CPT code should be billed and therefore want to clarify the proper use of this code.

April 8th marked the end of support for one of Microsoft's most popular and successful operating systems (OS), Windows XP.

On Thursday, March 27, 2014, the House of Representatives approved a one-year postponement of the 24% SGR cut in Medicare physician payment rates slated to take effect today, April 1, 2014. However, the legislation went well beyond temporarily fixing the SGR problem.

PPM has launched the ICD-10 training program for providers and their staff.

The last day eligible professionals can register and attest to demonstrating meaningful use for the 2013 Medicare EHR Incentive Program is March 31, 2014. You must successfully attest by 11:59 p.m. Eastern Daylight Time on March 31 to receive an incentive payment for your 2013 participation.

With the October 1, 2014 ICD-10 implementation fast approaching, now is the time to prepare.

Physicians and other eligible professionals have been given an extra month to attest to the “meaningful use” EHR Incentive Program, the Centers for Medicare and Medicaid Services (CMS) announced Friday.

With the ICD-10 transition eight months away, many practices are feeling anxious and unprepared for what lies ahead. At Precision, we believe the key to successfully navigating the transition to ICD-10 is proper preparation and planning.

As the incentives relating to the Centers for Medicare & Medicaid Services PQRS (Physician’s Quality Reporting System) program will shortly draw to a close, we want to share with you the latest information on the PQRS program and let you know that we stand ready to help you earn the last of the incentives available and avoid PQRS penalties in the future.

We continue to see progress in improving the nation’s health care system, and a key tool to helping achieve that goal is the increased use of electronic health records by the nation’s doctors, hospitals, and other health care providers. These electronic tools serve as the infrastructure to implementing reforms that improve care – many of which are part of the Affordable Care Act.

On Thursday, December 12, the Senate Finance Committee and House Ways and Means Committee each approved their respective versions of legislation to repeal and replace the SGR formula.

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According to a recent CMS announcement, CMS intends to instruct its contractors to turn on the ordering and referring edits on January 6, 2014.

The Centers for Medicare and Medicaid Services (CMS) published Transmittal 2407, entitled "Revised and Clarified Place of Service (POS) Coding Instructions," in February of 2012 with an (at the time) effective date of April 1, 2012. There were many awaiting the February 2012 issuance, as in 2009, CMS attempted to clarify the POS instructions for the professional (PC) and technical components (TC) of diagnostic tests and later rescinded that clarification in anticipation of future guidance.