The Centers for Medicare & Medicaid Services (CMS) issued a MLN Matters article ( MM10412 Revised) on May 31 with a retroactive effective date of January 1, 2018 clarifying documentation requirements when performed by Medical Students in a teaching situation. Confusion About Provider Participation There was confusion when this rule was first issued because coders, auditors […]
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Tag Archives: Rules
Proposed Rules Offer Facilities Give and Take
Newly-released proposed rules provide a preliminary view of the fiscal year (FY) 2019 payment and policy updates to the Medicare program for hospices, inpatient psychiatric facilities, skilled nursing facilities, and inpatient rehabilitation facilities. The Centers for Medicare & Medicaid Services (CMS) released the four proposed rules on May 8. Hospice Update and Reporting Requirements This proposed […]
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CMS clarifies rules on texting patient info
CMS confirmed that care team members are allowed to text patient information over a secure messaging app. However, texting medical orders is still verboten.
Intracoronary nitroglycerine during PCI procedures – unbundle rules??
Hi all,
I understand that 93463 and any PCI (92920, 92921, 92928, 92929,etc) are bundled. Is there ever a situation in which it is separately reported? Just trying to understand when it can and cannot be billed with a PCI. Our doctors are dropping 93463 with the PCI.
For example: patient is admitted through the ER for unstable angina. No prior visits to this facility, no prior cardiac cath studies on file for this patient, first time our dr is treating the patient. Doctor performs a cardiac cath, and determines that the LC needs to be stented. During the procedure the physician administers nitroglycerine, ad places the stent.
3 Top Rules For Marketing Accountability in Your Medical Practice
One of the biggest sins in practice marketing is not being able to answer yes to the following question:
Is There Financial Accountability For ALL Of The Marketing In Your Practice?
Following are 3 of my top rules to make sure your answer to this question is a resounding, “Yes!”
Rule #1: Don’t Ever Spend Without A Plan
The majority of practices and businesses I’ve worked with have virtually NO marketing plan or strategy in place before implementing my systems. For the most part, everything they’re doing is scatter shot – some of the strategies getting results, some getting none. What’s interesting about this is that most of the time, practices without a sound strategy in place spend MUCH MORE on marketing and advertising, primarily because what they’re doing is not generating results. You must have a purposeful plan in place.
Rule #2: Don’t Do It If You Can’t Track It
If you’re considering spending money on something you really can’t track, then you don’t do it. Period. If you can’t track it, you’ll never know if it works so there is no point in spending any marketing dollars on it whatsoever. In reality, there really aren’t many things that can’t be tracked, it’s that most practices just don’t do it.
I recently worked with a plastic surgeon who had paid a lot of money to an advertising firm to have a commercial created for his practice which played on a big screen at a busy health club. Other than the fact that the commercial did not have a specific marketing message, any potential calls from this ad were not being tracked. He had no tracking identifier for the ad, and his front office staff didn’t know how to gather this information from potential new patient calls generated from the ad. The Result? NONE (except money down the drains). Which leads me to…
Rule #3: Track It!
Once you’ve spent hours and hours and a bunch of money on a marketing strategy, if you don’t religiously track it, you’ve wasted TONS of time, and TONS of money for nothing. Once you’ve created a message to your target patient, this is the most critical aspect of anything else you do. You absolutely must know where every call comes from, have a system in place to compile the information, so you can ultimately determine the return (or not) on your invested marketing dollars.
Tip: All of your tracking mechanisms must be in place BEFORE you initiate the marketing campaign.
Purposefully tracking all of your marketing efforts will allow you to follow your plan, focus on what’s working, and eliminating the waste.
Adam Arnette has been recognized as the “Master of Patient & Profit Maximization” for private medical practices across the country.
Change in pathology billing rules
For those with in-house path labs, we just got an important update from DermCoder (www.dermcoder.com).
Medicare now expects you to use the biopsy date as the DOS of the technical component and the read date as the DOS of the professional component. This means that unless your pathologist reads the slides the same day as the biopsy, you will have to start splitting your path claims into separate technical and professional components, with different dates of service for each. (You’ll get paid the same as if you billed the global code.)
Orthopedic Coding Rules: Master the ‘Multiple Scope’ Rule
If your orthopedist carries out several procedures during a knee arthroscopy on the same patient on the same day, you will need to understand the multiple-scope rule to determine which procedures you can actually claim and get the payments too.
Vital orthopedic exception: Remember that the multiple-scope rule applies mainly to shoulder and knee procedures in the orthopedic practice; however it also affects those of the elbow, wrist and hip. On the contrary, it doesn’t apply to ankle or metacarpophalangeal (MCP) arthroscopy, and it does not affect arthroscopically aided procedures (29851, 29855-29856, 29888-29889 and 29892).
Follow these expert-approved tips to clinch your coding every time
1. Look to CPT for scope ‘families’
Prior to worrying about how to apply the multiple-endoscopy rule, you should first know why and when it applies.
The multiple-endoscopy rule is Medicare’s method to avoid paying twice (or more) for ‘inclusive’ services by reimbursing only a portion of any scope carried out at the same time as another scope of the same basic type.
2. Always include the ‘base’ procedure
Let us assume that the doctor has carried out a diagnostic shoulder arthroscopy (29805) plus shoulder arthroscopy for repair of SLAP lesion (29807). How does the multiple-scope rule apply?
Remember that family codes always include the work involved in the base code, and a surgical scope always includes the diagnostic scope of the same type. As such, you would report only 29807 in this case.
What about diagnostic shoulder arthroscopy followed by arthroscopic limited debridement? Once more, you should report only the more extensive procedure – in this case, 29822 (Arthroscopy, shoulder, surgical; debridement, limited).
3. Bill both scopes if there’s no base procedure
If the surgeon carries out two scopes in the same family, neither of which is the base procedure, you should go for both codes. As such, if your orthopedist carries out shoulder arthroscopy with foreign-body removal (29819) followed by shoulder arthroscopy for complete synovectomy, you would submit both 29819 and 29821 (… synovectomy, complete).
4. Watch your reimbursement
Under the multiple-scope rule, Medicare will pay the entire fee schedule amount only for the highest-valued scope in a given code family during the same operative session. Medicare carriers will reimburse any additional scopes in the same family by subtracting the value of the base scope in that family and paying the difference.
For more details on this and for other orthopedic coding updates, sign up for an audio conference and stay informed.
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Stitch Together the Pieces of Telehealth Rules
Payers vary on documentation and coding requirements for telehealth services. The rules for documenting and coding telehealth services are a patchwork. Guidelines for Medicare payers, although evolving, are well established. Private payer rules vary depending on the insurer, the patient’s individual plan, and the state where the services are rendered. Regardless of payer, you’ll need […]
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New Information on the Medicare Rules for Appropriate Use Criteria and Clinical Decision Support
New information has been provided by The Centers for Medicare and Medicaid Services (CMS) that will supplement our article An Update for Radiologists on Appropriate Use Criteria and Clinical Decision Support. We can now update you from the recent release of the “Proposed Medicare Physician Fee Schedule (MPFS) for 2018” and the “Proposed Rule for Quality Payment Program Year 2.”
New Information on the Medicare Rules for Appropriate Use Criteria and Clinical Decision Support
New information has been provided by The Centers for Medicare and Medicaid Services (CMS) that will supplement our article An Update for Radiologists on Appropriate Use Criteria and Clinical Decision Support. We can now update you from the recent release of the “Proposed Medicare Physician Fee Schedule (MPFS) for 2018” and the “Proposed Rule for Quality Payment Program Year 2.”