Do | Make sure the beneficiary's name matches their ID card exactly. |
Do | Use the right modifiers. Make sure you have used the appropriate modifier (-51 is the most problematic, carriers say). |
Do | List the Medicare identification number (UPIN) for the provider. |
Do | Check your codes against the CCI list to determine which CPT® codes can be billed together for Medicare. Some insurance carriers will follow Medicare's determination of which CPT® codes can be billed together. |
Do | Use the correct diagnosis code for the service. This is a common problem and frequent reason for denials. Check that you haven't submitted a three-digit code when a fourth- or fifth-digit code exists (remember, you must code to the highest degree of specificity), or made any typographical errors. |
Do | List your Clinical Laboratory Improvement Amendments (CLIA) identification number for claims containing laboratory tests performed in your office. |
Do | Properly list purchased diagnostic tests. Those diagnostic services with a professional and technical component are subject to the "purchased diagnostic" provision of the Medicare program. Carriers may decide whether or not the physician performed both components (i.e., did not purchase one of the components from an outside source). To signify whether the test was both performed and interpreted in the physician's office, some carriers require the use of locally assigned codes. Check with your carrier for local guidelines. |
Don't | Submit an operative report and a cover letter for claims filed with unlisted CPT codes or CPT codes with modifier 22, Unusual procedural service. Wait until the carrier sends a request for documentation. When the request comes in, then send your documentation to include the operative report and cover letter. Remember, the operative report is the documentation that describes the procedure performed for which there is no appropriate CPT code or explains what was unusual about the service to warrant additional payment to support modifer 22. The cover letter should detail the procedure performed, explain in layman's terms why the procedure was different, took a longer amount of time or why a higher skill level was required, as the clerk who reviews your claim may not have extensive medical knowledge. This is a change due to the mandatory electronic claim submission implemented by Medicare in July 2005. |
Don't | Bill for a visit that is included in the global period for a surgery or procedure. This rule only applies to those codes with a global period. Remember, you cannot bill for a visit that is used to perform a surgical procedure. Only if the decision to perform the surgery was made during the visit (and modifier -57, Decision for Surgery, is used) can you bill for both the visit and the procedure. |
Don't | Re-submit returned or rejected claim forms. If your claim is returned or rejected for any reason, re-submit a completely new claim. Do not resend the old one and mark it "corrected." This will only result in a second rejection. |
Don't | Bill for an unrelated visit during the postoperative period without modifier -24, Unrelated E&M Service by the Same Physician During a Postoperative Period. A visit during the postoperative period must be unrelated to the surgery to be billed and must include modifier -24. The diagnosis code for this visit should be for something completely unrelated. |
Don't | Automatically resubmit a claim. Remember, it takes roughly 13 days to process an electronic claim and 27 days to process a paper claim. Check the filing date on your original claim before resubmitting. |
Don't | Bill Medicare for routine physical exams and related services. Medicare does not pay for these services. These charges should be collected from the patient. A signed waiver is not required. |
Don't | Write "signature on file" for Item 31 (Signature of Physician or Supplier) of the CMS form 1500 for paper claims. It is appropriate to use "signature on file" and/or a computer-generated signature for electronic claims. |
Friday, May 27, 2011
Do's & Don'ts For Imaging Center Claims Submission
Thursday, May 19, 2011
AMA Is Reseller of Cloud-Based Medical Software
- EHR: Three programs are available, from NextGen Healthcare, Quest Diagnostics, and Ingenix, a business owned by UnitedHealth Group that is changing its name to OptumInsight.
- E-prescribing: The offerings here are Rcopia from Dr. First, CareLab360 Labs and Meds from Quest Diagnostics, and Amagine ePrescribing, said to be "powered" by Allscripts, an electronic prescribing and EHR vendor.
- Revenue cycle management: Infinedi, NaviNet, and AMA PATH provide tools allowing physicians to conduct online insurance verification, transmit claims electronically, estimate a patient's financial responsibility at the point of service, and automate other billing functions.
- Quality reporting and patient registries: Physicians who want to earn "meaningful use" bonuses must report to the Centers for Medicare and Medicaid Services how they manage preventive and chronic illness care for various patient subgroups. Three patient registries called DocSite, WellCentive, and Rcopia-MU help physicians do this.
- Lab ordering and results: The single program in this category — Care360 Labs — allows physicians to submit lab orders and review results online.
- Clinical support: Using the 7 programs in this category, physicians can look up drug interactions, journal articles, and evidence-based diagnostic and treatment advice; order medication samples online; and communicate online with patients.
- 2 to 5 physicians: e-MDs Chart from e-MDs;
- 6 to 25 physicians: Greenway Medical PrimeSUITE Chart from Greenway;
- 26 to 100 physicians: eClinicalWorks EMR from eClinicalWorks; and
- more than 100 physicians: EpicCare EMR from Epic.
Wednesday, May 18, 2011
Medicare EHR Incentive Payments to Be Issued
The First Medicare Electronic Health Record (EHR) Incentive Payments Will Be Issued This Week
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that incentive payments for the Medicare EHR Incentive Program will be sent out this week! Providers who have successfully attested to having met meaningful use, and who have met all the other program requirements, can expect to receive their 2011 incentive payments soon.
What Kind of Payment Can I Expect?
Eligible Professionals (EPs) participating in the Medicare EHR Incentive Program receive a payment based on 75 percent of their total Medicare allowed charges submitted no later than two months after the end of the 2011 calendar year. The maximum allowed charges used for a 2011 incentive payment is $24,000. This means that the maximum incentive payment an EP can receive for the first participation year is $18,000.
Please note that incentive payments will not be made to an EP until the EP meets the $24,000 threshold in allowed Medicare charges.
Incentive payments to eligible hospitals and critical access hospitals are based on a number of factors, beginning with a $2 million base payment.
How Are Payments Made?
Participants will receive their Medicare EHR Incentive Program payment the same way they receive payments for Medicare services, via electronic funds transfer or by paper check. Payments to Medicare providers will be made to the taxpayer identification number (TIN) selected during registration for the Medicare EHR Incentive Program. For electronic transfers, CMS will deposit incentive payments in the first bank account on file and it will appear on the bank statement as "EHR Incentive Payment."
IMPORTANT: Medicare Administrative Contractors (MACs), carriers, and fiscal intermediaries will not be making these payments. CMS is working with a Payment File Development Contractor to make these payments. Please do not contact your MAC regarding EHR incentive payments.
Medicaid EHR Incentive Program Payments
Since January 2011, several states that started their Medicaid EHR Incentive Programs have made payments to many EPs and eligible hospitals who have met the requirements for the Medicaid EHR Incentive Program. To date, over $83 million in Medicaid incentive payments have been issued to EPs and eligible hospitals participating in the EHR Incentive Program.
To view a checklist of how to participate in the Medicare or Medicaid EHR Incentive Program, look at the Path to Payment section of the EHR website.
Want More Information About the EHR Incentive Programs?
Make sure to visit the CMS EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.
Radiology Billing - How to Submit Claims to Insurance
Box 17B. Enter the rendering provider’s information in Service Facility Location Information field (Box 32) and the NPI in Box 32A.
(Box 24F). Enter a 1 in the Days or Units field (Box 24G) for code 71020.
Bilateral Radiography Billed Figure 2. Bilateral radiography billed with unilateral code.
Box 17B. Enter the rendering provider’s information in Service Facility Location Information field (Box 32) and the NPI in Box 32A.
(Box 24F). Enter a 2 in the Days or Units field (Box 24G) for code 70190. This number indicates the procedure is bilateral. Enter in the Reserved for Local Use field (Box 19) that the procedure was performed bilaterally.
Friday, May 13, 2011
New Attestation Resources Have Been Posted
CMS has developed attestation worksheets to help providers successfully attest to meeting meaningful use through the CMS web-based attestation system.
These attestation worksheets allow eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) to log additional data for core and menu measures that might not be obtained only through their certified electronic health record (EHR) system. In order to provide complete and accurate information for certain of these measures, EPs and hospitals may have to include information from paper-based patient records or from other areas. (Please note that clinical quality measures must be reported directly from certified EHR technology).
You can fill out the attestation worksheets electronically or manually, and then keep the worksheet on hand as you attest so your data is easily accessible.
You can find the worksheets by clicking the links below. Make sure to use the worksheet that pertains to you:
Updates to the Comprehensive EHR Incentive Program FAQs Document
CMS has also posted the latest FAQs document on the CMS website. This interactive document provides updated FAQs up to the end of April 2011. Each FAQ is sorted by topic to help you more easily review information about various aspects of the EHR Incentive Programs. CMS will continue to provide updates as new FAQs are added.
Want more information about the EHR Incentive Programs?
Make sure to visit the CMS EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs
Group Practice Association Leery of ACO Rules
May 12, 2011 — An association representing the nation's largest multispecialty medical groups is telling the Obama administration to simplify proposed rules for accountable care organizations (ACOs) if it expects physicians to sign up for them.
Created by the new healthcare reform law, ACOs bring together physicians, hospitals, and other providers in various combinations for the purpose of coordinating the care of Medicare patients who otherwise might fall through the clinical cracks and run up a higher bill as a result. Beginning in 2012, ACOs can share in any savings they produce for Medicare, provided they also meet certain quality-of-care standards. The bonus would come on top of their usual fee-for-service revenue.
The Centers for Medicare and Medicaid Services (CMS) touts ACOs as a way to reward providers for the quality of their patient care, as opposed to the quantity of services rendered. First, however, it must persuade physician groups to sign up, which may be a hard sell. In a letter sent yesterday to CMS Administrator Donald Berwick, MD, the leader of the American Medical Group Association (AMGA) said that 93% of its members would not enroll in an ACO under proposed regulations that CMS released March 31.
"On its face, [the proposed rule] is overly prescriptive, operationally burdensome, and the incentives are too difficult to achieve to make this voluntary program attractive," wrote AMGA President and Chief Executive Officer Donald Fisher, PhD. His association represents large medical groups such as the Mayo Clinic and integrated healthcare delivery systems, in which more than 113,000 physicians practice.
Dr. Fisher said AMGA members find fault in particular with the formula for splitting Medicare savings with providers, the requirement for risk-sharing that exposes providers to financial losses, and quality measurement requirements. As it stands now, ACOs would have to meet 65 different quality standards to receive any bonus.
For example, at least 50% of primary care providers must demonstrate "meaningful use" of electronic health record (EHR) systems by the start of the second year of a 3-year "shared savings" program. The expression "meaningful use" comes from the economic stimulus legislation of 2009 that promises incentive payments under Medicare and Medicaid to providers if they deploy EHRs in ways that improve patient care while cutting costs.
Leaders in organized medicine worry that small physician practices may lack the resources — such as sophisticated EHRs — needed to jump through ACO hoops. The medical groups in the AMGA are arguably the most sophisticated, computerized, and well-heeled of all, and the fact that even they find the ACO too complicated to participate in is telling. Dr. Fisher hinted as much when he wrote, "As you know, most policy experts believe multi-specialty medical groups are best poised to become ACOs in the short term." Then he dropped the bombshell that the vast majority of his members view ACOs as unattractive.
The AMGA promised to submit a more detailed critique of the proposed ACO regulations during the official comment period, which runs through June 6. Other provider associations are filing responses as well, all in the hopes of reducing the hassle factor. CMS is expected to release a final version of its regulations this summer. More information about ACOs is available on the federal Web site HealthCare.gov.
Saturday, May 7, 2011
Advantages of Electronic Medical Records
Confusion! She is the one who knew, precisely, which stack of records contains the bunch of papers that represents so and so patient. The use of electronic medical records gets over this problem. Let’s go over the other electronic medical records benefits.
Above article published on http://www.buzzle.com/articles/advantages-of-electronic-medical-records.html
Wednesday, May 4, 2011
CMS Removes Credentialing Barrier to Telemedicine
May 3, 2011 — New regulations issued yesterday by the Centers for Medicare and Medicaid Services (CMS) remove a barrier to telemedicine that had nothing to do with computer technology.
The problem, CMS said, was its own old regulations on how hospitals should vet physicians who are hundreds or thousands of miles away, yet practice medicine within their walls by virtue of digital technology.
If an oncologist on the medical staff of a big city hospital, for example, sits down with a Medicare or Medicaid patient at a rural hospital via teleconference, the rural hospital also needs to grant him or her staff privileges to stay in the good graces of CMS. In the past, CMS required the hospital on the receiving end of telemedicine to follow the same credentialing procedures with remote physicians as it did with local ones. That meant relying on the recommendation of its medical staff, which has the duty of appraising candidates for practice privileges and verifying their credentials.
However, CMS recently concluded that this requirement was not only duplicative but also burdensome on small hospitals that might lack the resources to vet physicians practicing telemedicine. The agency noted in its new regulations on the subject that small hospitals often lack in-house medical staff who have the clinical expertise to "adequately evaluate and privilege the wide range of specialty physicians that larger hospitals can provide through telemedicine services."
Acknowledging that its requirements might make it harder for small hospitals to take advantage of telemedicine, CMS has opted for a simpler approach. Under the new regulations, a hospital still must grant practice privileges to a telemedicine physician based on the recommendation of its medical staff. However, the medical staff can dispense with its own fact-finding and instead rely on the credentialing and privileging decisions of the distant hospital where the physician in question practices.
In a press release issued yesterday, CMS Administrator Donald Berwick, MD, stated that his agency wants to "devise policies that reflect the most innovative practices in delivering care to all patients, especially patients in rural or remote parts of the country through telemedicine."
More information on the new CMS regulations is available on the agency's Web site.