News and Intelligence

December 30, 2019

Practicefirst would like to notify our clients of important changes as outlined by CMS for CY 2020 regarding Medical Record Documentation.

As per CMS MLN Matters MM11560:

Medical Record Documentation:

CMS is finalizing, for CY 2020, a proposal to reduce burden by implementing a broadened general principle beyond teaching physicians that will allow:

  1. All physicians,

  2. Physician Assistants (PA’s),

    ...

September 26, 2019

Practicefirst would like to notify our clients about a NCCI update that is effective July 1, 2019. National Correct Coding Initiative (NCCI) procedure to procedure (PTP) edits consist of column one and column two codes.

If a PTP edit has a CCMI (Correct Coding Modifier Indicator) of "1", the PTP edit shall be bypassed if submitted with an NCCI-associated modifier. Modifiers 59, XE, XS, XP, and XU a...

September 3, 2019

Medicare fraud costs the United States government hundreds of millions of dollars each year. CMS works with other government agencies and law enforcement organizations to protect the Medicare Program from fraud and abuse. Zone Program Integrity Contractors (ZPIC’s) and Unified Program Integrity Contractors (UPIC’s) investigate instances of suspected fraud, waste and abuse.

Their primary goals inclu...

April 12, 2019

With an understanding of the definition of critical care from Part 1 of this series, What Constitutes Critical Care?below are essential documentation and coding guidelines for Emergency Management physicians to ensure they receive the reimbursement they deserve.

Critical care is a time-based service and must be documented as the time the provider spent evaluating, providing care and managing the...

April 12, 2019

Emergency medicine physicians are trained to assess patients and make split-second, life-saving decisions, but documenting and coding those encounters can be complex, tedious and time-consuming. Because the relative value units (RVUs) for critical care services are high, the financial implications for physicians and their employers are significant. High RVUs also attract increased scrutiny from pa...

April 1, 2019

Practicefirst’s March client memo referred to the important revisions that CMS has made to Evaluation and Management

Documentation Guidelines, which are effective January 1, 2019.

** Please note the correction to the third bullet below. The requirement should not include the physical exam. We apologize for the miscommunication. 

Highlights of CMS’s revisions include the following:

  • The re...

February 1, 2019

When aspiring medical professionals dream of their future careers, it’s unlikely that they consider the critical role that documentation plays in the healthcare process. Once in practice, providers quickly realize that documentation has a direct impact on their financial success. In addition to the complexity of documentation rules and requirements, the advent of electronic medical records (EMRs)...

January 16, 2019

The average claim denial rate across the healthcare industry is 5%-10%, according to the American Academy of Family Physicians (AAFP). This metric quantifies the effectiveness of your revenue cycle management process. If your practice is experiencing higher than average or increasing claim denials, below are four best practices to help you reduce them.

1. Validate Current Insurance Coverage

An effec...

September 10, 2018


 

Practicefirst has received notification of an update added to the OIG Work Plan, in August, regarding Critical Care E&M services. 

The OIG states: Critical care is usually provided in a critical care area such as a coronary, respiratory, or intensive care unit or the emergency department. Payment may be made for critical care services provided in any location as long as the care provided meets th...

August 9, 2018

Four common coding errors lead to lost compensation for radiology practices.

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