Get Ready! CMS Is Introducing More Specific Pricing Modifiers for Oxygen Flow Rate

Thu, Mar 22, 2018


CMS plans to revise and introduce new pricing modifiers for oxygen flow rate. So if you submit claims for oxygen services, make sure you and your billing staff members are aware of these changes effective April 1, 2018. Here’s a heads-up!

Why the Change?

Medicare has taken this step as the existing modifiers do not meet the needs of the market. There is a need to provide greater specificity in such modifiers where there are varying prescribed flow rates.

Which New Modifiers Are Coming?

The new HCPCS modifiers you’…

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Know When CCI Manual Says to Use Bone Marrow Code 38222

Mon, Mar 19, 2018


bone marrow biopsy, aspiration, or both?

The addition of diagnostic bone marrow and biopsy code 38222 in the CPT® 2018 code set simplified coding in some ways (multiple procedures in one code), but there are still questions to be answered about how to handle specific scenarios. In case you missed it, the 2018 Correct Coding Initiative (CCI) manual answered some of those questions. Read on to get those details.

Get Guidance Straight From the CCI Manual

When your documentation shows diagnostic bone marrow aspiration, diagnostic bone marrow biopsy, or both, the CCI manual gives the following instructions on how to code.

Diagnostic bone marrow aspiration alone: Report 38220 (Diagnostic …

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Chargemaster 101: Quick Tutorial on a Hospital RCM Essential

Fri, Mar 16, 2018


hospital chargemaster

Curious about the world of chargemasters? These three questions will give you a speedy introduction to this crucial revenue cycle management tool used by hospitals.

1. What Is a Chargemaster?

A hospital chargemaster, also called a hospital charge description master, lists the billable services and items that a hospital provides to patients. Some of the elements included in the chargemaster may include an internally generated identification number for the line, CPT® and HCPCS codes (including alternatives when payers require different codes) with descriptions, the revenue code associated with the charge, and the facility’s charge.

2. How Is a Chargemaster Related to the Revenue Cycle?

A sample, simplified scenario may …

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Physicians Support 12.6 Million Jobs in US, According to AMA Report

Wed, Mar 14, 2018


It’s no secret that healthcare is a major player in the U.S. economy. AMA’s new economic impact report indicates that patient-care physicians are one of the top job creators in the country. According to the report, physicians supported the employment of nearly 12.6 million people and contributed $2.3 trillion to the nation’s economy in 2015.

Each Physician Supports 17.1 Jobs on Average

The report — put together by IQVIA — captures economic data from 2015 pertaining to the country’s 736,873 physicians providing patient care. The report includes both office-based and hospital-based MDs and DOs. The report looked at four key indicators — jobs,

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Understand Screening vs. Diagnostic With This Mammography Coding Snapshot

Mon, Mar 12, 2018


Medicare mammography coding

When the CPT® 2017 code set introduced 77065-77067 for mammography, CMS hung on to HCPCS options G0202, G0204, and G0206 a while longer. But now Medicare accepts the CPT® codes, and the HCPCS options have been sent to the discontinued-code pile. Here’s helpful information on screening vs. diagnostic mammography to help you use the CPT® codes correctly.

Start With Screening Mammography

For screening mammography, use 77067 (Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed). Medicare Part B covers a screening mammogram once …

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Answer These Questions to Pinpoint the Correct Coronary Atherosclerosis Code

Fri, Mar 9, 2018


I25 coronary atherosclerosis

About a month ago, yet another report came out about whether omega-3 supplements make a difference in cardiovascular disease risk. The findings of this particular meta-analysis were that supplementation may not reduce coronary heart disease in people at high risk of the disease and more study is needed. But while the research continues, plenty of cardiology patients are presenting for treatment of cardiovascular disease, meaning you need to know how to code it. Here are three questions to ask to get you to the correct code for coronary atherosclerosis

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Turn Back Time With These 2018 MPFS Updates

Mon, Mar 5, 2018


Retroactive Medicare fee schedule changes


Keeping up with 2018 updates to the Medicare Physician Fee Schedule (MPFS) is one thing. Knowing which ones are retroactive adds a whole other level to ensuring you’re applying the right information to your claims. Today we’re covering two groups of retroactive MPFS changes.

Watch for Work GPCI Floor Increase

If you’re in an area where the work Geographic Practice Cost Index (GPCI) started 2018 below 1.000, keep an eye on communications from your Medicare contractor. The Bipartisan Budget Act of 2018, passed on Feb. 9, changed the work GPCI floor to 1.000. This is an extension. A previous rule set the floor at 1.000 for …

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Move Over Q1 MUEs … April 1 Changes Are Coming

Thu, Mar 1, 2018


April 2018 MUE updates


Hey, early birds. Have you checked out the Q2 updates to Medically Unlikely Edits (MUEs)? CMS provides spreadsheets showing quarterly updates so you can see the changes and start preparing ahead of time. Here are some highlights from the changes effective April 1, 2018, to existing practitioner MUE values, along with some tips on understanding what MUEs are.

Start With a Quick MUE Refresher

When you look up the MUE for a code, what you’re seeing is the maximum units of service Medicare expects a provider to report for a single beneficiary on a single date of service. Medicare doesn’t create MUEs …

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Can We Expect Medicare Audits to Be Friendlier in 2018?

Wed, Feb 28, 2018


No matter how careful you are, Medicare audits happen — and if the thought of an audit is keeping you awake at night, there could be some good news coming your way! This year, the government is supposedly taking a more lenient and educative approach to rectifying Medicare billing errors.

Background: For some time now, the American Medical Association (AMA) and CMS have been meeting regularly to talk about MACs and RACs.

According to the AMA, most physicians are honest and make a true attempt to comply with Medicare program requirements. But the government’s attempts to address waste, fraud, and …

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