Blog

December 12, 2017

If your physician practice has ever engaged in the process of strategic planning, you know that the planning retreat is just one step in the process.  Practices spend precious time and resources preparing for a planning retreat, then spend time away from the office to attend the retreat and create the plan.   Everyone leaves the …

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December 8, 2017

In 2016, overall national health spending increased 4.3 percent following 5.8 percent growth in 2015, according to a study by the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS) published today as a Web First by Health Affairs. Following Affordable Care Act (ACA) coverage expansion and significant retail prescription drug spending …

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December 7, 2017

CMS recently issued guidance (accessible here) on the three-part “Prevention of Information Blocking” attestation which physicians and other eligible clinicians will need to submit to CMS in order to qualify for points under the “Advancing Care Information” category of the Merit-based Incentive Payment System (MIPS). Although making this attestation and reporting to CMS regarding use …

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Heart Center to pay large settlement

December 1, 2017

From The Business Journal: A cardiology clinic with offices in Fresno and Clovis will pay a seven-figure settlement regarding allegations of billing health care programs for medically unnecessary testing. According to a press release from U.S. Attorney Phillip A. Talbert, Cardiovascular Consultants Heart Center (CVC Heart Center) and its shareholder physicians—Dr. Kevin Boran, Dr. Michael …

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Can you collect the co-insurance from your Medicare patients on the date of service when you know the patient does not have co-insurance coverage?

November 28, 2017

Answer: Yes, you may collect the co-insurance on the date of the service from patients who advise you that they do not have co-insurance coverage. My question to you: Why aren’t you trying to collect the co-insurance amount at time of service from your Medicare patients? So you’d rather bill and collect and then send …

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Eight Steps to Keep Online Data Safe

November 27, 2017

During the holiday shopping season, shoppers are looking for the perfect gifts. At the same time, criminals are looking for sensitive data. This data includes credit card numbers, financial accounts and Social Security numbers. Cybercriminals can use this information to file a fraudulent tax return. This tip is part of National Tax Security Awareness Week. …

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Evaluation and Management: Are You Coding Correctly?

November 21, 2017

Novitas recently reported in a study report, the Office of the Inspector General (OIG) noted that 42 percent of claims for Evaluation and Management (E/M) services in 2010 were incorrectly coded, which included both upcoding and downcoding (i.e., billing at levels higher and lower than warranted), and 19 percent were lacking documentation. A number of …

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CPT 2018 update delivers 4 new E/M codes, mass revisions and revised guidelines

November 20, 2017

DecisionHealth provides a nice overview of the CPT changes for year 2018; see the link below. In the blog post, you’ll find that a total of 314 code changes throughout your 2018 CPT manual, including updates that range from revised observation visits in the E/M chapter to new photodynamic therapy services in the Medicine chapter and …

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Virtual Group for MIPS in 2018: Apply by December 31

November 16, 2017

Solo practitioners and groups can choose to participate in the Merit-based Incentive Payment System (MIPS) as a virtual group for the 2018 performance period. To form a virtual group, follow the election process, and submit your election to CMS by December 31. For More Information: Virtual Groups Toolkit MIPS Overview webpage If you need help …

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Medicare Overpayments

November 10, 2017

Overpayments are Medicare funds that you or a beneficiary has received in excess of the amount allowed payable under the Medicare statute and regulations. Once a determination of an overpayment has been made, the amount of the overpayment is a debt owed to the United States Government via one of its Medicare contractors. Voluntary Refunds A …

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