Category: Blog

The multiple procedure payment reduction (MPPR) means that if a healthcare provider performs multiple procedures during a single patient encounter, Medicare (and many commercial insurers) typically will pay “full price” for only the highest-valued procedure. The reason is explained in Chapter 1 of the National Correct Coding Initiative (NCCI) Policy Manual: Most medical and surgical […]

The one thing doctors should be doing is making sure their patients have their address correct with Medicare. The patient won’t get a new card if their address is not correct. This simple reminder could diminish ongoing problems for providers in the massive transition underway to distribute new Medicare ID numbers. Since its inception in […]

Get a jump on five new HCPCS Level II codes going into effect July 1,2018. All are Q codes and they help patients with opioid addiction, knee pain, cystic fibrosis, and hemophilia. Q9991         Injection, buprenorphine extended-release (Sublocade), less than or equal to 100 mg Q9992         Injection, buprenorphine extended-release (Sublocade), greater than 100 mg Sublocade is […]

There is nothing more frustrating to physicians than knowing a patient needs a certain diagnostic test or medication and having them not be able to get it because their health insurance company won’t cover it. All too often, many services require prior-authorization (PA). It wouldn’t be so bad if the insurance companies made the guidelines […]

Blue Cross Blue Shield of Michigan is piloting a bundled payment program with 64 surgeons at seven health systems in the state. Here are the four highlights. BCBSM aims to shave 10 percent off the average cost of non-complicated knee or joint replacements, which can total between $28,000 and $55,000, through the bundled program. The […]

Learn the right way to code ‘incomplete’ colonoscopies Billing Medicare and other payers for endoscopy services is pretty different from billing for other types of procedures. And if you’re like most coders/billers, you’re probably making some common mistakes that can cost you lost time and valuable reimbursement dollars. When billing for endoscopy services, you need […]

Key: Amount of time spent with the patient indicates which code to use. Coding for physician inpatient services, especially critical care, is deceptively straightforward. The reality is that the details of each code requirement can complicate things to the point of complete confusion. Despite the challenges, there are specific strategies you can use to correctly […]

Beth Morgan, president and CEO of Medical Bill Consultants, has over 40 years of experience coding and billing for various providers and facilities. She provided these three tips: Read the notes carefully. If coders and billers don’t read notes carefully, they might miss a key component that the provider also missed. For example, if the […]

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, requires us to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A new Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number (HICN) on the new Medicare cards for Medicare transactions like billing, eligibility status, and claim status. The […]

Q: When you are basing an office visit on time, do you need to meet the levels in history, exam and medical decision-making too? A: It is not unusual to spend a considerable amount of time face-to-face with a patient reviewing problems, adjusting medication dosages and counseling or coordinating care, only to find that you […]