Author Archives: tbsmo

September 2019 Coding Updates

Insurance Carrier September Policy Updates UnitedHealthcare UHC will update their policy on the treatment with Sodium Hyaluronate effective 10/1/19. Complete policy and changes can be found here. Revised coverage rationale indicates Medical Necessity Plans. Added language to indicate: Medical Necessity Plans Coverage for Durolane, Euflexxa, and Gelsyn-3 is contingent on criteria in the Diagnosis-Specific Criteria […]

Read More

Coding Education: Where Do We Go From Here?

“Out of sight, out of mind” is an adage that should not apply to the upcoming ICD-10 requirements. Physicians who heaved a sigh of relief over the implementation delay should use the time wisely to get ready for the roll-out of the new coding requirements that are due to start October 1st, 2015. The fact is that the ICD-10 mandate has four times more codes than ICD-9 and many of those codes aren’t easily mapped from the old system into the new one. Some of the old codes in ICD-9 may even have multiple possibilities when recoding for ICD-10 standards. Now is the time to get a handle on how to integrate the new system so that your office will be able to breeze through the roll-out with flying colors.

Read More

4 Barriers to Private Practice for Med School Graduates

Released in September of 2013, Epocrates’ 8th Annual Future Physicians of America Survey asked more than 1,000 U.S. medical students to share their opinions about healthcare reform, their career goals, evolving technology and other hot button topics. The survey found that today’s medical students are overwhelmingly planning to join group practices or hospitals instead of starting solo or partnership practices.

Read More

8 Months until New Coding Education Implementations, What to Know

Most medical providers are aware that October 1, 2015, is the date they must quit using the outdated ICD-9 billing codes and begin using ICD-10 codes. The implementation date has been postponed more than once and it is not expected to be postponed again (however rumors are beginning to swirl around Congress). In order for your medical practice to maintain collections and avoid having claims denied, you already know that it is imperative for you and your staff to be ready and begin using the new codes on October 1, 2015.

Read More

How the 2015 CPT Coding Changes can effect your Orthopedic Practice

The 2015 CPT coding changes will affect many different venues of healthcare with new and combined coding as well as removed codes. CPT 2015 code changes include: 134 revised, 143 deleted, 264 new as well as changes in guidelines. For orthopedic practices the new coding is already in effect, and needs to be adhered to immediately to ensure proper billing and payments.

Read More

PQRS Penalties in 2015

Orthopedic providers may be subject to a reimbursement penalty on all claims submitted to Medicare for 2015. If you are an eligible professional (EP) that participates in the Physician Quality Reporting System (PQRS) or a group practice participating in the Group Practice Reporting Option (GPRO), then you’re in danger of receiving a negative payment adjustment (penalty) of 1.5% on all covered services rendered this year. The 1.5% is to be deducted from the normal Medicare Physician Fee Schedule (MPFS) for services provided. Keep reading to find out if your practice will be affected by the adjustment.

Read More

MQSA Regulatory Accommodation for Changes to the ABR Certification Examination Process: FDA Guidance

Medical residents who are preparing to graduate this June and who wish to be classified as an interpreting physician according to the MQSA need to be aware of requirements changes that went into effect last year. The ABR made changes to their certification process which led the FDA to come out with guidelines to accommodate those ABR changes. This confusing process, and attendant requirements, are explained below.

Read More

2015 CPT Coding Changes and How It Can Affect Your Radiology Practice

2015 CPT coding changes that are taking effect will mostly cause issues with billings, and denials of billings that are not coded correctly according to the new Coding Rules. In the radiology practice there are not an extraordinary number of changes, but they are important to ensure proper payments. Radiology practices must train not only their billing staff in the new coding procedures, but everyone involved in reporting procedures need to know how to document what treatments were given to ensure that proper codes are used in records and for billing.

Read More

CMS to Audit for Code 99233

Correct documentation is crucial for physician billing to Medicare. Over the past few years, The Department of Health and Human services has been strongly focused on correcting and minimizing healthcare fraud. Currently, evaluation and management (E/M) services are under high scrutiny, especially CPT code 99233. What does this mean for your practice, and how can you protect your assets? We’ve compiled a list of three ways to prepare for random CMS audits of 99233.

Read More

Revenue Cycle Management and Contract Compliance: How to Analyze your Payment Variances

Payment variances may have many causes, but they typically land in two major categories. The first category is when a payer has updated their payment system to account for issues like a new contract fee schedule. The second major category of occurrence that can cause payment variances is when a payer has made changes to their payment system, but the configuration wasn’t successfully applied. Since both of these situations tend to happen at the start of a new contract year, that’s the time to pay attention to issues that crop up by analyzing your payment variances before they get out-of-hand.

Read More