Reimbursement and Coding

Don’t Be Overwhelmed with 2012 CPT® Coding Changes Members Only Document

We often hear that our members and practice managers are overwhelmed each year with CPT changes. 2012 is no exception with more than 500 coding changes. The following breakdown can help you understand the coding changes and avoid feeling overwhelmed.

New ICD-9 Codes Effective Oct. 1, 2011
New ICD-9 diagnosis codes went into effect Oct. 1, 2011. There will be no grace period for Medicare providers. There are significant coding changes, especially for some specialties such as dermatology, that physicians need to be aware of.

Reminder: How to Bill for Preventive Services and a Problem-Focused E/M on the Same Day Members Only Document

Understanding reimbursement for evaluation and management services despite third-party payers’ varying policies can be challenging, but correctly coding and documenting these services is a good first step toward receiving proper reimbursement.

Use Modifier 22 Appropriately and Successfully Members Only Document

Appending modifier 22 (increased procedural service) can help increase your reimbursement if your documentation supports a greater-than-usual effort during a surgical service. But if you don’t use modifier 22 correctly you are unlikely to get paid.

Checklist to Prepare for the ICD-10 Transition Members Only Document

Ready or not, on Oct. 1 2013, ICD-10 becomes a reality. Understanding ICD-10 and preparing for the changes now will give your practice a strategic advantage.

CMS Publishes Guides to Help Practices Assess HIPAA 5010 Readiness
The Centers for Medicare & Medicaid Services published three guides to assist providers with preparing for the transition to HIPAA Version 5010.

Workers' Compensation Fees Increased for 2011 Members Only Document

The workers' compensation fees increased 1.5 percent for 2011.

Collecting In Tough Times: Five Ways to Smooth the Process Members Only Document

Collecting copays, deductibles, and other patient self-pay dollars is critical but sometimes unpleasant. These five tips can help help.

Pathology Disclosure Law Affects Billing
Physicians who order and pay for lab tests, and then bill their patients, will have new reporting requirements as of Jan. 22, 2011.

How to Correctly Document 99204 and 99205 Members Only Document

New patient visit codes require documentation of all three key components: history of present illness, physical examination, and medical decision making.

How to Bill for Preoperative Histories and Physicals Members Only Document

Find out when you can bill for preoperative histories and physicals and then take a quiz to test your knowledge.

United to Require Outpatient Imaging Preauthorization
Most physicians will need preauthorization from United Healthcare for outpatient advanced imaging procedures.

Join Network to Provide Care for Refugees
Physicians interested in providing care for refugees can join the Pennsylvania Refugee Health Program provider network.

Pennsylvania E&M Reimbursement Lower Than Many Nearby States
Pennsylvania’s average evaluation and management (E&M) code reimbursement is lower than many other states in the region, according to a report from the Pennsylvania Medical Society.

IBC to Increase Reimbursement for Primary Care
Independence Blue Cross (IBC) will increase reimbursement for primary care physicians beginning July 1, 2010.

New Online Tool Can Help You Fight Claim Denials
Use this free tool to fight electronic claim denials.

Medicaid Won't Reimburse Hospitals for Preventable Serious Complications
Medicaid will not reimburse hospitals for preventable serious complications—or “serious adverse events."

Collection Protocols for the Medical Practice
Manage your accounts receivable and prevent them from becoming delinquent. “Collection Protocols” includes tips on managing accounts and also useful collection techniques.

Workers' Compensation: The Application for Fee Review Process
A Workers' Compensation (WC) insurance carrier has 30 days to pay your bill, deny the worker's claim for benefits, or request a utilization review. If your payment is late or incorrect, file for fee review.

Act 6: A Crash Course in Auto Accident Reimbursement
A concise run-down of the steps you need to take to get appropriately reimbursed for care of patients injured in a motor vehicle accident.

Your Right to Timely Payment Under Act 68
Act 68 requires health insurers to remit payment for clean claims within 45 days of receipt.

Billing Tactics to Maximize Revenue
Improve your practice's cash flow by implementing 10 tactics to maximize revenue.

Beware of Automatic Participation Clauses in Payer Contracts Members Only Document

Don't be fooled into thinking that you've washed your hands of a contract just because you didn't sign it. Automatic participation clauses require you to send a written opt-out notice within 60 days to void the agreement.

ICD-9, CPT Codes for Overweight, Obesity and Associated Complications Members Only Document

A list of codes most frequently used when treating overweight, obese, or at risk patients.

About PA-NEDSS: The Online Disease Reporting System
Physicians and practices must use this system to report communicable and non-communicable diseases.

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