Quality Measures Finalized for 2019December 18th, 2018 - Wyn Staheli, Director of Research
CMS recently announced that the quality measures for 2019 have been finalized. There are new eligible clinicians so be aware of how that may affect your organization. New ECs are:
Qualified speech-language pathologists
Registered dietitian or nutrition professionals
The following are changes to Electronic Clinical Quality Measures (eCQMs) available ...Auditing looking between the linesNovember 30th, 2018 - BC Advantage
When given the task of auditing a group of charts, most often the scope of the audit is well defined. For me, there are times when my natural inquisitive nature turns on and I find my noticing the "timing" of parts of documentation. These are things that you would not...We've Always Done It This Way and Other Challenges in EducationOctober 19th, 2018 - BC Advantage
As coders, auditors, and compliance professionals, we are the provider's advocates in closing the gap between what is medically necessary and what is required for documentation. Sometimes that places us in the role where we need to save our clinicians from themselves, and the patterns they have fallen into...Wolters Kluwer Drug PricingOctober 17th, 2018 - Find-A-Code
Wolters Kluwer provides unit and package pricing for multiple drug price types: Average Wholesale Price (AWP), Wholesale Acquisition Cost (WAC), Direct Price (DP), Manufacturer's Suggested Wholesale Price (SWP), Centers for Medicare & Medicaid Services, Federal Upper Limit (CMS FUL), Average Average Wholesale Price (AAWP), Generic Equivalent Average Price (GEAP). Average...HIPAA Handling Patient Requests for Medical Record RestrictionSeptember 26th, 2018 - BC Advantage
Healthcare compliance professionals frequently face confusing situations about sharing of protected health information (PHI). The Health Insurance Portability and Accountability Act (HIPAA) supports the protection of privacy of medical records. However, even when a patient does not authorize sharing of his record, there are permitted uses and disclosures, such as...Q/A: Do I Have to Accept Any New Patient?September 24th, 2018 - Wyn Staheli, Director of Research
Question: Is it legal for us to not allow a patient to be seen in our office if their parents have bad debt with us?Getting the Right Eligibility Information for Payment Your Rights and Health Plans RequirementSeptember 11th, 2018 - BC Advantage
We need timely and accurate patient information to bill health plans and receive appropriate payment. Clinical information is, of course, important. But we also need the "administrative" data - patient demographics and especially the insurance information. Physician offices create their clinical information, but usually rely on patients for information on...Finalized Confidentiality of Alcohol and Drug Abuse Patient Records RegulationsAugust 31st, 2018 - Wyn Staheli, Director of Research
In January, the U.S. Department of Health and Human Services (HHS) issued updates to the privacy regulations regarding the confidentiality of patient information of substance use disorder patients (42 CFR Part 2). This notice included references to better alignment with HIPAA regulations, but did state that Part 2 is more protective ...Pricing for ASC’s and APC’sAugust 27th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
For Medicare purposes, an Ambulatory Surgical Center Resources (ASC) is a distinct entity that operates exclusively to furnish surgical services to patients who do not require hospitalization and in which the expected duration of services does not exceed 24 hours following admission. ASC payment groups determine the amount that...PSAVE Pilot Program - What Does it Mean to You?August 20th, 2018 - Wyn Staheli, Director of Research
Noridian's pilot program Provider Self-Audit with Validation and Extrapolation (PSAVE) has been extended which means that it has been successful for the payer, which means that they are saving money. Historically, when a pilot program is proven to be successful, it isn’t too long before other MACs follow. Before signing up to participate, providers need to carefully evaluate the program. Are the benefits worth the costs?Are incident to services worth the riskAugust 13th, 2018 - BC Advantage
Incident-to services allow non-physician practitioners (NPPs) such as nurse practitioners and physician assistants to bill under a supervising physician if they perform services that are incidental to a physician-created plan of care. Incident-to billing offers two key benefits: First, the physician is reimbursed at 100% of the contracted rate with...Risky Business The CMS HCC Risk ModelJuly 27th, 2018 - Terry Ketchersid, MD, MBA
Today's catchy title may invoke memories of that risqué movie from the 80's starring a young Tom Cruise famously dancing in his "tighty whities." But today's post is not about that type of risk. Instead we are going to spend some time with a risk adjustment model that's quietly become...Patients Over Paperwork?! We have Great News!July 18th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Spend more time with patients and less time documenting? Great Concept!
Document meaningful information? Sound good?
CMS is proposing just that! CMS released a new proposal July 12, 2018, focused on streamlining clinician billing and expanding access to high-quality care. The goal is to improve and restore the doctor-patient relationship, modernize Medicare ...Documentation: Face to Face for Home Health CertificationJuly 9th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
As a physician, you are responsible for providing appropriate, accurate supporting documentation of your face-to-face encounters (FTF) with your patients regarding home health care.
Analysis of the recent errors identified by the Comprehensive Error Rate Testing (CERT) Review Contractor shows a continuing increase in denials related to documentation for the FTF. The ...The Money in MIPSJune 15th, 2018 - Diana Strubler
Seema Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS), recently announced that 91% participated in the first year of the Quality Payment Program (QPP), barely squeaking by their goal of 90%....Will Medicare's Proposed Reformations Affect Your Practice?June 12th, 2018 - Wyn Staheli, Director of Research
Recently, Medicare's Innovation Center released an informal Request for Information (RFI) seeking input on several different system reformation proposals. As the market moves towards more value based payment systems, innovation and new models are being sought to both reduce costs and increase quality. This article outlines the ideas presented in the ...Three Ways Bundled Payments Can Be a SuccessJune 7th, 2018 - BC Advantage
Bundled payment models continue to attract interest for their potential benefits over traditional fee-for-service payment models. With bundled payments, also known as episode-based payments or packaged pricing, a group of providers is reimbursed based on a contracted price to cover all of the care and services related to a particular ...Q/A: Someone Broke into My Office. What do I do Now?April 23rd, 2018 - Wyn Staheli, Director of Research
My office was broken into last night. I use electronic health records, but we do store some protected health information for my patients in paper files. These files are not secured, so the burglars did have access to them. It did not appear that the files were touched as the burglars were looking for cash. What responsibilities to I have to my patients in a situation like this? Do I need to contact them and advise them that their PHI could have been compromised?Proper Record Keeping and DocumentationApril 19th, 2018 - Christine Taxin
Proper record keeping and documentation is not only essential for today’s dental practitioner, but is also required by law. Moreover, correct, current and accurate records directly enhance patient care by enabling the dentist to plan treatments, monitor progress, and provide essential notations. Clear and concise treatment plans, medical alerts, and ...Are Your Computers Vulnerable to Cyber Attacks?February 1st, 2018 - Wyn Staheli, Director of Research
Healthcare providers must be vigilant in ensuring that software upgrades, also known as patches, are kept current. Failure to do so can lead to a HIPAA Security Breach with all its associated penalties. For example Windows XP no longer has security updates and should not be used in healthcare settings.
On ...Don’t Be Hesitant About Collecting Co-PaysFebruary 1st, 2018 - Christine Taxin
If you are hesitant about collecting co-pays, consider that you may be paying interest on credit cards, property mortgages, and business loans. Each dollar that you do not collect in co-pays could have been used to pay down the practice debt. Without question, if you are having difficulty finding ways ...Mobile Health: Growing Engagement and New ResponsibilitiesJanuary 31st, 2018 - Dugan Maddux, MD, FACP
This week I'm blogging about an M-word. Not MACRA or MIPS, but Mobile Health or mHealth....Developing Coding Policies for ComplianceJanuary 31st, 2018 - Marge McQuade, CMSCS, CHCI, CPOM
Every physician practice depends upon correct coding and billing for their financial success. Coding drives reimbursement. All of the resources available for coding information and guidance are meaningless without the practice manager translating it into provider-specific coding policies and compliance plan. As a practice manager, you need to develop a ...Prescription Drug Discount ProgramJanuary 25th, 2018 - Wyn Staheli, Director of Research
Prescription drugs can be quite costly for those who are uninsured or underinsured. Prohibitive costs have been shown to lead to poor patient outcomes because medications are not taken as prescribed. Medicare has taken steps to address this problem with their Medicare Advantage value based plans (see referenced "Medicare Expands Value ...Better Office Communication Leads to Stronger RCMJanuary 24th, 2018 - Ashley Choate
According to a recent Physicians Practice study, one of the top five reasons for denied medical claims is a lack of adequate documentation. While this might seem like an electronic records issue, the problem may be bigger than that. ...Advance Beneficiary Notice of Noncoverage (ABN) Modifier GuidelinesJanuary 11th, 2018 - Find-A-Code
The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131 may be used for services which are likely to be non-covered, whether for medical necessity or for other reasons. Refer to CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30, for complete instructions.Effective from April 1, 2010, non-covered services should be billed with modifier GA, GX, GY, or GZ, as ...Diagnosis Coding with Diagnostic TestingJanuary 4th, 2018 - Marge McQuade, CMSCS, CHCI, CPOM
Adequate documentation is an essential part of selecting a correct code in any setting. When providers order a test, the information that they document regarding the test results determines the primary and secondary diagnosis codes a coder assigns.
If a physician confirms a diagnosis based on the results of a diagnostic ...