In late November 2013, the Centers for Medicare & Medicaid Services released the final 2014 Medicare Physician Fee Schedule. As the American Academy of Dermatology notes, dermatology services saw a 1.5% reduction in Medicare payments as a result of the final rule.
To help providers of dermatology services understand the changes in the 2014 fee schedule, AADA published a number of helpful resources which are accessible online for free.
1. Frequently Asked Questions: 2014 Medicare Physician Fee Schedule (pdf) — This resource addresses 10 questions including (1) What will my 2014 fee schedule look like?; (2) How will the recalculation of the Medicare Economic Index affect my practice?; and (3) If there are only five dermatology-related measures in PQRS, how can I report on the required nine measures to earn a 2014 incentive?
2. 2014 Medicare Physician Fee Schedule impact chart (pdf) — This chart identifies common dermatology codes and notes the percentage payment difference between 2013 and 2014. The largest decrease noted was for CPT 64650 (Chemodenerv eccrine glands), down 39.6%, while the largest increase was for CPT 17003(Destruct premalg les 2-14), up 47.4%.
3. Analysis of the 2014 fee schedule components — Using a series of expandable menu items, AADA provides analysis on the components of the 2014 fee schedule. This includes analysis of (1) destruction codes, and their associated reduced reimbursement rates; (2) altered payment for Mohs micrographic surgery codes; and (3) reduced payment for the photochemotherapy family of codes.
With CMS reducing reimbursement for dermatology services, dermatologists billing has even less room for error — practices simply cannot afford to leave any money on the table. One way practices can more effectively capture the reimbursement dollars they earn is to outsource their billing to an experienced medical billing company. An experienced medical billing company like PGM Billing will increase a practice's revenue by boosting collection rates while reducing denials and delays in payment.
While the transition from ICD-9 to ICD-10 may be a change to the codes for diagnoses and inpatient procedures, if you provide medical billing for a surgery center, the switch significantly affects your work as well.
With the October 1 deadline for the transition to ICD-10 fast approaching, it is imperative that billers are preparing themselves — and helping prepare their ambulatory surgery center — for this change. Failure to adequately prepare could lead to a dramatic increase in denied claims that impacts cash flow and drives an ASC's average number of days in accounts receivable up.
If you are unsure of the difference between ICD-9-CM and ICD-10-CM, here is a helpful comparison chart:
|Code Length||3–5 characters||3–7 characters|
|Number of Codes||Approximately 14,000 codes||Approximately 68,000 codes|
|Code Makeup||Digit 1 = alpha or numeric
Digit 2-5 = numeric
|Digit 1 = alpha
Digit 2 = numeric
Digit 3–7 = alpha or numeric
|Expandability (space for new codes)||Limited||Flexible|
|Code Detail||Vague||Very specific|
Striking against or struck accidentally by other stationary object without subsequent fall
Walked into lamppost, initial encounter
There are many resources available to assist surgery centers in the transition, including an extensive list of free fact sheets, guides, timelines and checklists provided by CMS.
Several associations are publishing information on ICD-10 as well, including the following:
In addition, surgery centers can consider partnering with an ASC and physician medical billing solution like PGM Billing.
The ICD-10 deadline may seem like it is still far away, but ASCs and their business office personnel would be wise to start taking steps in preparation sooner than later. There is much to be done to ensure a smooth transition that keeps an ASC's revenue flowing.
Late last year, CMS updated and issued a pair of educational resources that address Medicare coverage of chiropractic services.
The Medicare Learning Network booklet on chiropractic services (pdf) outlines the standards chiropractors must meet to render payable services under the program; common care provision scenarios (including exceptions) and actions that Medicare would take as a result; payment requirements; and frequently asked questions.
The Medicare Learning Network misinformation on chiropractic services fact sheet (pdf) seeks to clarify eight pieces of misinformation. They are as follows:
The rules for chiropractor billing are quite complex, which is why many providers choose to outsource their chiropractor billing services to a company like PGM Billing, one of the nation's leading chiropractic billing vendors. PGM has more than 30 years of billing experience, and a team of certified, expert billers dedicated to billing for chiropractic services.
Medicare is paying closer attention to organizations that bill evaluation and management codes reported with allergy testing or allergy immunotherapy.
This is according to a recent issue of Medicare Quarterly Provider Compliance Newsletter (pdf), a newsletter from CMS developed to help providers understand the major findings identified by Medicare administrative contractors, recovery auditors and other governmental organizations, such as the Office of Inspector General.
As the newsletter notes, E/M codes reported with allergy testing or allergy immunotherapy are appropriate only if a significant, separately identifiable service is performed. Obtaining informed consent is included in the immunotherapy service and should not be reported with an E/M code. If E/M services are reported, modifier -25 should be utilized.
Recovery auditors have concluded that the services were provided and medically necessary, but the provider billed and Medicare paid for all or part of them more than once.
Here are two scenarios CMS provided to illustrate reasons for adjustments the recovery auditors make to align provider payments with Medicare guidelines:
Example: On August 23, 2012, a professional bill was submitted with E/M code 99214 and Immunotherapy injections code 95117. Finding: The billing of these two codes without modifier 25 to indicate that a significant, separately identifiable service was performed resulted in an overpayment.
Example: On October 25, 2012, a professional bill was submitted with E/M code 99213 and Immunotherapy one injection code 95115. Finding: The billing of these two codes without modifier 25 to indicate that a significant, separately identifiable service was performed resulted in an overpayment.
How to Avoid These Problems
According to Chapter 12, Section 200, subsection C of the "Medicare Claims Processing Manual" (pdf), to receive payment for a visit service provided on the same day that the physician also provides a service in the allergen immunotherapy series (i.e., any service in the series from 95115 through 95199), bill a modifier -25 with the visit code, indicating the patient's condition required a significant, separately identifiable visit service above and beyond the allergen immunotherapy service provided.
Medical necessity remains the key as typically allergy injections are pre-scheduled and no other services beyond the injection are scheduled. The injection code includes the minimal amount of work needed to make the determination that the patient is fit to undergo the procedure. However if the patient has a significant, separately identifiable problem that meets the requirements of an E/M service, this may be billed using modifier -25 for claims processing.
CMS advises providers to consider focusing on E/M services tied to typically scheduled services and pull the documentation and compare the "visit intent" against the content of the notes. By monitoring the occurrences of E/M services billed in conjunction with scheduled services, allergist billing errors are less likely.
If you are struggling to properly bill for allergy testing or allergy immunotherapy, consider outsourcing your allergy billing to a medical billing company such as PGM Billing. PGM is a veteran firm with more than 30 years of coding and billing experience. PGM is well-versed in the nuances of allergy billing, and works hand-in-hand with practices to identify problem areas and ultimately ensure they receive proper compensation for services provided.
The rules for mental health billing are so complex that it's easy to make mistakes — both big and small — that can lead to denied claims and ultimately lost revenue. Here are four of the most common behavioral health billing mistakes.
1. Submitting claims to the wrong insurance carrier. Mental health-related claims do not always go directly to the medical plan. For example, for some BlueCross BlueShield plans, mental health claims should be submitted to Magellan Behavioral Health or Value Options. If a claim is not submitted to the proper recipient, it will likely be denied, thus delaying payment.
2. Incorrectly understanding how to read an "explanation of payment" (EOP) report. The EOP report from a payor shows how the claim was processed, and details the allowable amounts, paid amounts and patient responsibility. If this is not understood properly, a practice will not be able to tell if a claim was paid at the accurate contracted rate for that specific insurance company. In addition, a practice will not know whether it can bill patients for other owed expenses, leading to lost revenue.
3. Failure to verify patient's eligibility status with insurance companies. There are instances when patients provide their caregiver with incorrect insurance information (e.g., old insurance cards, wrong identification numbers, additional insurance coverage information). Failure to verify this information will lead to problems with submitting bills in a timely manner to the correct insurance.
4. Missing claims submission deadlines. Many insurance companies require practices to submit claims within 3-6 months of the date the service. If a practice falls behind on submitting claims or has problems submitting claims properly, deadlines can easily be missed and a practice will not be paid for its services.
If you struggle with mental health billing, consider outsourcing to a medical billing company such as PGM Billing. PGM, with more than 30 years of billing experience, helps practices nationwide increase their revenue by boosting collection rates while reducing denials and delays in payment.
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