Using a Scribe? – Documentation Reminder

On December 15th, 2010, posted in: Tips by

When using a scribe, it is important to keep in mind that the scribe cannot interject any personal observations or comments into the medical record. The scribe is simply to be used to document the services that the physician is providing. In addition, the physician must review the scribes documentation and then sign the note, indicating it has been reviewed and he/she is in agreement with what was documented. This will authenticate the note and it is a requirement for billing purposes.

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On December 15th, 2010, posted in: Tips by

Ever wonder what it costs to provide service to your patients? We have a simple formula that will give you a pretty good ball park. Knowing this figure may help in commercial contract negotiations as well as determining if you should continue to see patients from certain payers.

If you are interested in having this calculation performed, we are more than happy to help, for a fee.

We will need overhead numbers from you to provide this information. This service will be provided, on individual request, beginning the 2nd or 3rd week or January, after end of year financials and the New Year craziness slows down.

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Medicare rule reminder – providing /offering service

On December 15th, 2010, posted in: Tips by

Many of you are very well aware of the profit/loss of providing care to your patients. Providing service to some patients may be more ‘profitable’ than it is to others. When that is the case, your first inkling may be to send the less profitable patient to another site for services that are available in your office. Think twice before you send a Medicare patient somewhere else for services you personally can furnish in your practice walls.

In the Medicare Claims Processing Manual, Chapter 1, Section 30..1.3, the policy states “a provider may not refuse to furnish treatment for certain illnesses or conditions to Medicare beneficiaries if it furnishes such treatment to others.” The rule also states failing to abide by this rule is cause for termination from the Medicare program.

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Home Therapy

On December 15th, 2010, posted in: Tips by

If you are providing any home therapy to your patients, effective immediately you must document and report one of the following “V” codes, or your claim will be denied.

V57.1         Care involving other physical therapy
V57.21       Care involving occupational therapy
V57.3         Care involving speech-language therapy
V57.81       Care involving orthotic training
V57.89       Care involving other specified rehabilitation procedure

Each V code must be followed by the diagnosis representing the specific condition requiring the therapy service. Claims without a secondary diagnosis will be denied.

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Clarification on “Split/Shared” Billing with NPPs

On December 15th, 2010, posted in: Tips by

Split/shared rules come into play when one of your physicians and a qualified NPP (PA or NP) both see a patient face to face in the hospital where incident to rules do not apply. Each provider, physician and NPP must provide a distinct part of the service.

Remember, it is stated in the Medicare Claims Processing Manual, Chapter 12, Section 30.6.1.B; NPP’s cannot bill incident to in a facility setting. If an NPP provides this service independently, the service MUST be billed under the NPP’s individual NPI which will reimburse at 85% of the allowed amount.

If split/shared billing is truly performed and documented, not just a statement by the physician that you agree or disagree, (Medicare states “ if the physician doesn’t document the face-to face encounter with the patient, even if he signs off on the documentation supplied by the NPP, the visit MUST be billed under the NPP only) but a independent documented exam and medical decision making by the physician, then and only then, can the service be reported under the physician NPI. When reported in this manner, the reimbursement is 100% of the allowed amount.

Documentation must include:

  • Combined written notes by both the physician and NPP that support the E/M level
  • A statement clearly identifying the NPP and physician of service
  • A link between the physician’s documentation and the NPP’s
  • The physician and NPP encounter must occur on the same day in the hospital
  • Legible signatures of both the physician and NPP

Please abide by the guidelines for all Medicare patients, federal and advantage plans. It would also be safe, if you followed these guidelines for state run programs (Medicaid).

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ENT – Epley Maneuver – good news

On December 15th, 2010, posted in: Industry News, Tips by

After two years of arguments, you will finally get paid for this procedure. CPT code 95992 (Canalith repositioning procedures(s) (e.g. Epley maneuver, Semont maneuver), per day). The code will have a 0.75 RVU value.

Remember if you perform and document a medically necessary E/M that is different from the maneuver, you may bill the E/M code, modified appropriately.

However, Medicare will not reimburse for audiologist performed Epleys- physicians only please.

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Medicare new annual wellness visits

On December 15th, 2010, posted in: Tips by

Even though these visits may reap you significant billing opportunities, you must follow the rules in order to avoid denials. Please go to:

Visits may be denied for reasons such as: “Lifetime benefit maximum has been reached”; “This service is paid only once in a patient’s lifetime”; “This service was denied because it occurred to soon after your Initial Preventative visit”; “This service was denied because Medicare doesn’t cover annual wellness visits within the first 12 months of Part B coverage.”

If you believe you will provide these new services, please call me. Let’s review the guidelines together.

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Potential new billing opportunities

On December 15th, 2010, posted in: Tips by

Perhaps it’s time to think about how to get those patients that may have fallen through the cracks back into your office.

Primary care practices, as example, may want to consider running a list of patients, who will become Medicare eligible within the next year, remind them to enroll, and then offer them the New annual wellness visit. Tell them this visit is without co-insurance cost, so no out of pocket for them, and it may get the patient on a regular routine follow up in your office.

Gastroenterologists may want to run a list of patients who are turning 50 this year. Contact them and schedule their first screening colonoscopy.

GYN practices should run that list of annual checkups, who didn’t show last year? Call and make that appointment.

Think about your specific practice, what type of patients do you see annually? At what age do you start seeing them on a routine basis? This may be a way to increase volume and the bottom line. If you need patient listing by age or by a specific diagnosis, give us a call. We are more than happy to help.

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Medicare Authorization/Signature on File

On December 15th, 2010, posted in: Tips by

Please remember to have Medicare patients sign the correct signature on file form. A few years ago I distributed a form with the exact verbiage CMS requires. If you are not sure you are using the correct form, or need it sent again, please do not hesitate to contact the office.

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Medicare pay cut fix passes Senate

On December 15th, 2010, posted in: Industry News by

The Senate agreed to a 12 month Medicare pay fix. The House adopted the bill on December 9th. President Obama has indicated he will sign the bill but has not done so as of this writing, December 10, 2010 2:15 p.m.

Details of the bill that will affect your bottom line:

  • Reverses the 30% reduction and extends current Medicare payment rates through December 31, 2010
  • Extends the existing floor of 1 for work RVUs index through December 31, 2011. Physicians practicing in areas of the country with GPCI work values are below 1 stand to benefit from this provision. Those practicing in areas with work GPCI above 1 will not be affected.
  • Extends the use of KX modifier , for use with therapy claims in those patients who have exceeded the $1,870 cap through December 31, 2011
  • Extends the ability of independent labs to receive direct payment for the technical component for certain pathology services through December 31, 2011
  • Extends the 5% increase in payment for certain Medicare mental health services through December 31, 2011

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