BC Advantage

Billing, Coding and Compliance solutions

When to Hire a Consultant - December, 2011
By: Sean Weiss, CPC, CPC-P, CCP-P
Consultants can be a blessing and a curse depending on who you ask. For the past 18 years I have been working with physician groups of all sizes and specialties helping to uncover lost revenues as well as identifying areas of risk. During my years of working in health care I have had my share of success stories and not so great moments but at the end of the day every engagement worked out and that is what has kept clients coming back year after year. Granted, some clients call only when there is a crisis when others want to be proactive and look for things before they become an issue or result in lost revenues.
- Read more...

Not Your Father's Evaluation and Management Services: How Not Understanding These Services Impacts Your Bottom Line - October, 2011
For as long as I have been in this industry (judging by my gray hair, it has been a while) Evaluation and Management Services has been the killer thorn in everyone's side. No matter how many webinars or live training sessions are offered and no matter how many times providers attend these they always walk away with more questions then they arrived with.
- Read more...

The Time for Change is Now: Things Will Only Get Worse - September, 2011
For years I have written for BC Advantage about the coding, compliance and practice management issues always sensitive to my readers but recently it am finding it hard to remain quiet about the state of the industry. I have always found myself on the side of the physicians, working tirelessly to wrong injustices brought about by unethical individuals at carriers and payers. Until recently I threw the total blame at these individuals without really looking at the real culprit(s).
- Read more...

Medical Decision Making: Making the Right Decision - July, 2011

Medical Decision Making (MDM) has been a bone of contention for as long as I have been in this industry, which judging by my newly identified gray hair is a very long time. Evaluation and Management Services (E&M) continue to be on top of the list of audit targets for all carriers; not just Medicare. E&M services are the easiest to assess overpayments against and, they represent the single largest expense to insurers, including Medicare.

- Read more...

Financial Crisis In Health Care - February, 2011
It has been some time since I have been able to write for my favorite publication, BC Advantage. During the last year I have had to depend on the very physicians I serve as a compliance officer and consultant for to take care of me. It was a very frightening and trying time. However, with the help of some of the nations brightest and best physicians and just about all of my personal savings account, today I am able to resume my normal way of life (which is not so normal for those of you who know me personally!)
- Read more...

Health Care Reform "An Impact More Far Reaching Than First Thought" - March, 2010
Health care has often been seen as a recession proof industry. However, times are changing and I am afraid not for the better. The government is in trouble and there are no two ways about it. When Democrats and Republican both send out the same message it means they can no longer hide behind cryptic messages and positive spin to the public.
- Read more...

Recovery Audit Contractors - YOU CAN WIN - July, 2009
As if physicians and health care professionals did not already have enough to worry about, now there is a new threat! Much like the Swine Flu, RACs cause fever, muscle weakness and sore throat from all of the screaming done when you received one of two types of letters from these "Bounty Hunters."
- Read more...

Identified Compliance Risks, Investigations and Development of Corrective Action Plans - May, 2009
In the last article I wrote for BC Advantage I talked about the type of consulting projects our firm provides for clients all across this great nation. Many times I talk about what the potential problems are as well as how best to take action to correct the identified deficiencies. Like last time I am structuring my article a bit differently to help aid in your efforts to identify potential compliance risks, perform the necessary investigation and develop a corrective action plan that would be deemed acceptable by the OIG or DOJ if things for your practice ever got elevated to that level. This time I am writing about an issue that many of your practice or organizations can identify with.
- Read more...

Identified Compliance Risks, Investigations and Development of Corrective Action Plans - March, 2009
For years I have been writing for BC- Advantage about the type of consulting projects our firm provides for clients all across this great nation. Many times I talk about what the potential problems are as well as how best to take action to correct the identified deficiencies. However, this time I have decided to structure my article a bit differently to help aid in your efforts to identify potential compliance risks, perform the necessary investigation and develop a corrective action plan that would be deemed acceptable by the OIG or DOJ if things for your practice ever got elevated to that level.
- Read more...

Stark Clarifications - January, 2009
Recently there have been new releases and clarifications to the Stark regulations. There are so many aspects to these regulations there is no possible way we can evaluate each in this article so we have decided to identify the most pressing issues in our opinion and share their impact with you.
- Read more...

Thriving in Trying Times: What Healthcare Organizations Can Do To Succeed - November, 2008
With the current economic downturn, healthcare executives are scrambling to ensure not only that physician compensation remains intact, but that their organizations as a whole survive.
- Read more...

Recovery Audit Contractors (RACs): Current Status and The Future - September, 2008
During the past 3 years a demonstration project that was put in place as part of the Medicare Modernization Act of 2003 section 306 directed the Department of Health and Human Services to begin the process of using Recovery Audit Contractors in an effort to thwart over and under payments to health care providers.
- Read more...

What to do When You Are Wrong "The Risks and Benefits of Self Disclosure" - July, 2008
Every practice makes mistakes; after all we are all human. I have been writing for BC Advantage now for almost 4 years and I have had the privilege to get to know a lot of the readers personally. As most of you know, I have been working in healthcare since 1989 in different capacities but have really focused on working with healthcare providers regarding compliance, coding and practice management issues since 1997. During the past eleven years I have run into some very interesting and unique situations and in some cases I found myself just wanting to get out of the facility with all my faculties still in place.
- Read more...

Incident-To: The Rules Just Got Tougher - June, 2008
Incident-To billing provisions just got a bit more difficult to bill for. Pub. 100-02 Medicare Benefit Policy, Transmittal 87, which was released on May 2, 2008 and became effective on June 2, 2008 places further restrictions and requirements on providers if services are to be billed Incident-To. According to the Transmittal the term INCIDENT TO (with or without quotes) refers to services incident to the service of a physician or other professional permitted by statute to bill for services incident to their services when those services meet all of the requirements applicable to the benefit. In addition to the existing guidelines surrounding Incident-To CMS has enacted additional guidelines to make billing for these services a bit more difficult. When we are talking about Incident-To in an office or physician owned and operated clinic, the additional requirements based on the above listed Transmittal are:
- Read more...

Death: How To Code It - April, 2008
Talking about death is never pleasant, however in the health care industry it is a cold reality we cannot avoid. Robert Half once said, "Death is the penalty we all pay for the privilege of life." Dating back to the mid 1990's when I was a Senior Consultant for then Medical Management Institute I always used to get a chuckle form the audience when I was asked how to code for a physician pronouncing a patient's death. My answer with a grin would be "Code it as a discharge, a final discharge." After reading my last sentence it really is much funnier in front of a live audience, not that death is funny.
- Read more...

Modifier 57 with E/M Question - April, 2008
I have been using modifier 57 with E/M when decision for surgery has been made, this could be between 2weeks before the surgery to 1 day before the surgery. A co-worker went to a meeting and they told her to only use modifier 57 when the office visit is within 24 hrs of surgery. Which is correct.
- Read more...

NPP Question - April, 2008
I read all your articles on "Split/Shared Visits and I use it as a guide. I have a question if an NPP helped gather information along with the physician and the physician tells the NPP what to dictate, can the NPP act as a scribe and dictate the consults, critical care and H&P's notes. There is some confusion regarding this issue with the physicians.
- Read more...

Split/Shared Visits - Q and A - April, 2008
I read your article "Split/Shared Visits" and found it to very helpful . We recently added a PA to our surgical office and the rules for PA billing are extremely confusing and many times contradictory by payor. And the recent change by Michigan BCBS regarding PA's has totally muddied the waters with no resolution in sight.
- Read more...

Global post-op - Q and A - April, 2008
I work at a provider-based facility. A physician has recently become employed at our facility after working for the other facility in the city. While at the other facility, he performed multiple surgeries on patients that he is now seeing in post-op care at our facility. To bill appropriately from our perspective, do we bill the global post-op code (99024)
- Read more...

Split/Shared Visits - April, 2008
After spending so much time working with mid-level practitioners around the country in both inpatient and outpatient hospital settings it became obvious to me that there is a lot of misunderstanding regarding how Split/Shared Visits work. A lot of articles focus on "Incident-To" so I thought I would focus on just Split/Shared Visits.
- Read more...

Articles 1 to 20 of 59

Last