TCN Medical Coding Blog

New “X” Modifiers and Impact to UnitedHealthcare Commercial Reimbursement Policies

Jan 18, 2015
New "X" Modifiers and Impact to UnitedHealthcare Commercial Reimbursement Policies

Is Physician Fear of ICD-10 Turning Them Off Preparation?

Jan 18, 2015
Does ICD-10 have physicians running scared? How can the industry respond to their needs and concerns to ensure a successful switch?
Posted in: ICD-10 Readiness,

Medicare Outreach Article - Modifier -59 Could Impact Reimbursement

Jan 06, 2015
Change Request (CR) 8863notifies MACs and providers that the Centers for Medicare &
Medicaid Services (CMS) is establishing four new HCPCS modifiers to define subsets of
the -59 modifier, a modifier used to define a “Distinct Procedural Service.”

CMS Final Payment Rules Focus on Value, Quality, and Transparency

Dec 29, 2014
CMS released final rules outlining how Medicare will pay healthcare providers and suppliers in 2015. According to an October 31 CMS News press release, “The rules reflect a broader Administration-wide strategy to move our health care system to one that values quality over quantity and spends taxpayer dollars more wisely by finding better ways to deliver care, pay providers, and distribute information.”

New Medicare Rules Aim to Reduce Suspicious Billing Abuse

Dec 06, 2014
Announced in the Wall Street Journal on Dec 3, 2014, the Obama administration has strengthened Medicare’s authority to kick doctors and other medical providers out of the federal program for abusively billing the government.

Second quarter PQRS interim claims feedback data available

Nov 27, 2014
Eligible professionals (EPs) who reported at least one PQRS quality measure during 2014 via claims-based reporting can access their data on a quarterly basis using the 2014 PQRS Interim Feedback Dashboard. The dashboard allows EPs to monitor the status of claims-based individual measures reporting to determine if they are meeting PQRS requirements.

The dashboard allows EPs to monitor the status of claims-based individual measures reporting to determine if they are meeting PQRS requirements.

Radiology Billing Company To Pay $1.95 Million To Resolve False Claims Act Allegations

Oct 16, 2014
MBS), which agreed to pay $1.95 million to settle claims that it violated the False Claims Act by fraudulently changing diagnosis codes on claims to Medicare and Medicaid, in order to get the rejected claims paid on behalf of radiologists.

New meaningful use rule: MGMA and CMS offer resources

Sep 20, 2014
Centers for Medicare & Medicaid Services (CMS) recently finalized a rule which expands reporting options for the meaningful use EHR Incentive Program in 2014.

Physical Therapy Providers - The OIG Might Want to Look at Your Records Too

Sep 20, 2014
Lynn Berry, PT, CPCPT, suggests that physical therapy (PT) providers should go to the website, put in their NPI numbers or names, and see where their Medicare billing stood in relation to other providers.

Be Prepared for the X Factor - 4 New HCPCS Modifiers Effective Jan 1, 2015.

Sep 07, 2014
In an effort to reduce inappropriate claim payments due to incorrect use of modifier 59, The Centers for Medicare and Medicaid Services (CMS) will roll out four new HCPCS modifiers to describe specific circumstances when it is appropriate to override a CCI edit. These -X modifiers become effective on January 1, 2015.