BC Advantage

Billing, Coding and Compliance solutions

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.
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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."
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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.
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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.
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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.
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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.
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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.
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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.
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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:
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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.
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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.
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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.
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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.
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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)
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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.
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Wishing Someone Special Well - April, 2008
Normally, I write about coding/billing, compliance and practice management issues but I wanted to put that all aside this week and tell you about a very special person that a lot of us in our industry respect, depend on and consider a good friend. The person I am talking about is Mr. Steve Verno. I have had the pleasure of knowing Steve since 2001, when he was an attendee at a conference I was speaking at in New Orleans for The Medical Management Institute. Since that time Steve and I have had several opportunities to spend time together at conferences as well as serving together on the editorial board for BC-Advantage.
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Revising The Medicare ABN - What it Means to You - March, 2008
Recently CMS decided to revise their CMS 141G form (better known as the ABN). One of the main changes you will notice is that it is now referred to as the Advance Beneficiary Notice of Noncoverage, which was done to more clearly convey the purpose of the form according to CMS.
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Back to Basics in 2008: "Compliance in the Medical Practice" - March, 2008
Here we are in the beginning of another year ready and eager to take on the world of reimbursement. We have been armed with all of the changes for CPT®, ICD-9-CM, HCPCS II, etc... but how many of you are truly ready to take on the insurance carriers or CMS? Since the mid 90's I have been involved in compliance in some shape or form and over the years some labeled me as an expert in compliance. Plus FREE OIG Compliance program
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Tips for getting reimbursed - January, 2008
For years and years we have worked with providers on this particular topic. No matter how many times we write articles about it or provide a written guidance to one of our clients we still find we are asked tons of questions about his tricky situation and how providers can be assured they are doing thing correctly.
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Increasing Collections and Reducing Denials - November, 2007
As an industry I believe we are struggling and we will continue to struggle with the collections from patients and insurance companies until we realize how we need to go about doing it the right way. I personally believe 80% (if not more) of medical practices in the United States are struggling with this component of their practice.
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