Navigating the Credentialing Process to Maximize Revenue and Minimize Denials

What is the best way to get my practitioners credentialed with various insurance companies and networks? It is frustrating to try and navigate this convoluted process. I am asked by each insurance company to complete a mound of paperwork and collect a stack of supporting documents for each practitioner. Then I wait months for approval notifications and effective dates. As a result, we end up losing some patients because they want to be treated at …

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Be Mindful of Dates of Service When Coding for Flu Shots—or Get Claims Denied

Be Mindful of Dates of Service When Coding for Flu Shots—or Get Claims Denied

Among the Centers for Medicare and Medicaid Services’ new codes is one that’s likely to be confusing as patients start coming in for flu shots. A quadrivalent vaccine made and distributed by Sequirus is available for reporting, but if billing staff use the corresponding code, 90756 (Influenza virus vaccine, quadrivalent [ccIIV4], derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use) before January 1, 2018, the claim will be denied. Instead, they’re advised …

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Understand the Rules—and Code Correctly—When Charging a Facility Fee

Understand the Rules—and Code Correctly—When Charging a Facility Fee

Whether an urgent care can bill Place of Service -19 or -22 requires an understanding of the criteria enabling facility code sets. An urgent care joint venture between physicians and a hospital recently inquired about using Place of Service 22 (Outpatient Hospital), enabling facility fees. The key with billing the urgent care as “outpatient hospital” is that it must truly qualify for that service. I have reservations as to whether the urgent care could bill …

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Imaging: X-Rays and Computed Tomography

Q. I understand that there will be reductions for x-ray reimbursements from Medicare in 2017. Is this true? A. To give imaging providers an additional incentive to adopt more advanced x-ray technology, Medicare will reduce reimbursement, beginning in 2017, for the technical component (and the technical component of the global fee) in claims submitted for x-rays performed with analog equipment. The cuts will continue in future years for those using computed radiography equipment (Table 1). …

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How to Talk About Billing Codes to Providers Who Don’t Know Them

Q. How do I talk to my providers about the documentation to support specific International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes when most of them do not really know the codes, but they know the terminology? A. Now that we are 1 year into using ICD-10-CM codes, most expect the Centers for Medicare & Medicaid Services (CMS) to lift the grace period for allowing providers to assign unspecified diagnosis codes. It is …

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ICD-10-CM and ICD-10-PCS Changes Effective October 1, 2016

Because it has been 4 years since the last annual update of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) and because 2016 is the first year for the Centers for Medicare & Medicaid Services (CMS) to make updates to ICD-10-CM, CMS made many edits to the classification’s code set. On October 1, 2016, International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) will include 3651 new codes and 487 revisedcodes,1 and …

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Plantar Warts, Digital Nerve Block in Lacerations, and Established Patients

Q. We had a patient present with 12 plantar warts. The provider used liquid nitrogen to freeze all 12 of the warts. What code should I bill for this procedure? A. In this case, you would bill Current Procedural Terminology (CPT) code 17110, “Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement) of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions.” Use only code 17110 once because the …

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Impacted Cerumen

Q. When a patient comes in with ear pain due to impacted cerumen, the health-care provider would normally instruct the nurse to perform ear irrigation. If the irrigation successfully removed the impacted cerumen, the procedure would be considered part of any evaluation and management (E/M) service and we could not bill for the service separately. With new rules regarding cerumen removal this year, can we get reimbursed for the ear irrigation if it is not …

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Fracture Care

Q. Will you please help me understand initial visit, subsequent visit, and sequelae related to fracture care? If the patient is treated elsewhere for a fracture and the provider just stabilizes the fracture and instructs the patient to then come to my office for reduction, is this a subsequent visit or an initial visit? A. International Classification of Diseases 10th Revision, ClinicalModification (ICD-10-CM) guidelines state that a seventh character, A, is used for the initial …

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Prolonged-Service Codes

Q. The coding staff has relayed to me that we can now bill for times when my clinical staff must spend extra time with a patient. Is this true? What are the requirements for documentation? A. Yes, two new Current Procedural Terminology (CPT) codes added in 2016 by the American Medical Association allow you to bill for clinical staff members’ time spent with a patient above and beyond what is considered to be the usual amount of time. …

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