Stories written by Ellen Terry

Get Dates of Service Right on Medicare Claims - 05/30/2019

When you a perform a Medicare service that is global, has both a professional and a technical component, or spans days or months, you need to know what date Medicare considers to be the official date of service when you file your claim. Here is some guidance from the Centers for Medicare & Medicaid Services (CMS) about coding and billing dates of service on professional claims.


Doctor’s Order A Must For Lab Tests - 05/29/2019

The Centers for Medicare & Medicaid Services is paying attention to claims for these lab services because it has found they were paid in error in 2018 by some $28 million. For routine venipuncture, medical necessity errors accounted for virtually all the improper payments. For urinalysis, it was insufficient documentation.


Medicare Critical Care and Initial Hospital Services E and M Slated for Review - 05/17/2019

If you’ve been “probed and educated” twice by Novitas Solutions Inc. for high rate of claims errors regarding certain evaluation and management (E&M) services, you may receive more such review and education this summer.


Dos and Don’ts of Using Modifier 22 - 04/25/2019

Sometimes the work to provide a service is “substantially greater” than typically required on the date of services. When this happens, document the extra work by adding modifier 22 to the procedure code.


Charging Concierge Fees to BCBSTX Patients - 04/23/2019

Although Blue Cross and Blue Shield of Texas (BCBSTX) places limits on the additional fees participating network physicians can charge BCBSTX patients, some are allowed when you provide concierge services.


Go Paperless With UHC Document Vault - 04/22/2019

Looking for ways to reduce the amount of paper your practice uses? One way is to digitally receive claim and prior authorization letters for UnitedHealthcare commercial and Medicare patients through UHC’s Document Vault, rather than by mail.


Ambetter: New Required Field on CMS-1500 Claim Form - 04/18/2019

Ambetter from Superior HealthPlan, a plan available on the Affordable Care Act health insurance exchange, has changed the status of box 18 on the CMS-1500 claim form from a conditional/optional field to a required one, effective July 1.


Make Sure These Medicare Missteps Didn’t Affect Your Claims - 04/16/2019

Because of all of the policies, edits, determinations, rules, and revisions, Medicare’s claims processing sometimes goes awry for certain codes, fees, or other specific claim elements. The Centers for Medicare & Medicaid Services (CMS) reports these errors and their fixes on a regular basis.


Medicare Enrollment Application Revised - 03/04/2019

A new Medicare enrollment application form for physicians and nonphysician practitioners will go into effect May 1.


Expect HEDIS Records Requests From Third Parties - 02/28/2019

If a company called Ciox Health contacts your office on behalf of Blue Cross and Blue Shield of Texas or UnitedHealthcare, it is because both insurers have contracted with Ciox to collect performance data they are required by law to report.


Humana Changes for 2019: Preauthorization, Notification, and Formularies - 02/27/2019

Humana has made changes for 2019 to its preauthorization and notification lists.


Coding Changes Affect UnitedHealthcare Prior Authorization Lists - 02/22/2019

UnitedHealthcare (UHC) has replaced and added procedure codes on its notification and prior authorization (PA) lists.


It’s Time to Pick Your Medicare Status - 12/12/2018

For Medicare physicians, it’s annual par/nonpar decision time. That is, you have until Dec. 31 to change your status as a participating (par) or nonparticipating (nonpar) physician in the Medicare program, starting Jan. 1. If you decide to continue with your current status, do nothing. If you want to change your status, you’ll need to notify Novitas Solutions by mail. 


Help Your Medicare Patients Keep Their Favorite Doctor (You) - 11/28/2018

Medicare’s open enrollment runs through Dec. 7, and some of your patients might be evaluating their plan options. Do they know what plans you take?


These Five Stages Define Colleague Relationships - 11/15/2018

Healthy workplace relationships are born of mutual trust. This applies to your peers, superiors, and the people you manage. As these relationships evolve, you have to work at keeping them productive and fulfilling, especially once the getting-to-know-you phase has come and gone.


New UnitedHealthcare Automated Services Can Save You Time - 11/13/2018

UnitedHealthcare says it has made it easier for you to submit records, have claims paid sooner, and access pharmacy benefit information.


New Tool Helps With HIPAA Compliance - 10/30/2018

An upgraded tool from the U.S. Department of Health and Human Services (HHS) might make HIPAA security risk assessments easier. The Security Risk Assessment Tool 3.0 is designed to help practices with one to 10 physicians identify their risks and vulnerabilities with electronic protected health information (ePHI) and then implement appropriate security measures.


Don’t Fall for Credentialing Scam, Blue Cross Says - 10/23/2018

Blue Cross and Blue Shield of Texas warns physicians to be aware of a scammer that is offering to help doctors become credentialed with the insurance company for $250.


Humana Revises Peer-to-Peer Review - 10/18/2018

Humana has tweaked its peer-to-peer review process for prior authorization requests, giving physicians contracted with its Medicare Advantage plans another opportunity for review before filing a claim.


New Precerts, Edits From Aetna - 10/05/2018

Aetna will require precertification for endoscopic nasal balloon dilation, effective Nov. 1. This is one of several changes Aetna has announced to its National Precertification List.


Humana Peer-to-Peer Review Changing for Medicare Advantage Plans - 10/05/2018

Effective Aug. 1, Humana Medicare Advantage health plans will no longer offer peer to peer reviews after a medical necessity denial. Instead, the company will offer to schedule a peer-to-peer review before Humana issues the denial


United to Add Lab, Change Lab and Other Policies - 10/04/2018

Starting Jan. 1, 2019, UnitedHealthcare will use Quest Diagnostics, in addition to LabCorp, as in-network laboratories for all UHC members (excluding existing lab capitation agreements).


New Medicare Cards Heading to Texas - 09/27/2018

The Centers for Medicare & Medicaid Services (CMS) has started mailing new ID cards to Medicare patients who live in Texas. The mailing will take “at least” a month to complete, CMS said.


Three Things You Need to Know About Texas’ Telemedicine Law - 09/19/2018

Texas’ new telemedicine law and applicable rules have created new opportunities for physicians to care for patients outside the traditional office visit. Here are answers to three basic questions you might have. (Remember: When treating Medicare patients via telemedicine, follow Medicare rules.)


Can Practices Require Employees to Get a Flu Shot? - 08/30/2018

It may seem like the sensible thing to do, but no, you can’t make everyone in your practice get a flu shot.