Reminder 2011 CPT.   Use of the 2011 CPT codes are mandatory as of January 1, 2011.  Our MedCorp Compliance Network distributes an annual review of all codes (CPT, HCPCS, ICD-9) each year to clients.  Do you still know how to code "facet injections", nerve testing or ultrasound guidance procedures? There were hundreds of changes in the various coding manuals this year. While you were waiting for the books, our clients had the changes in the ICD-9_CM  in July and the CPT change review and analysis in October.

Coding Updates 

UHC: When unattended electrical stimulation is delivered, 97014 is no longer considered the most appropriate code to describe the treatment. This modality should now be reported under HCPCS code (G0283) which better describes the service being rendered.  This is the same code used for Medicare reporting. They have also adopted coverage policies consistent with CMS guidelines to only permit reimbursement up to a maximum of four timed codes (equivalent to one hour of therapy) per date of service. This policy describes reimbursement for ALL timed therapeutic services including timed modalities.

The "BLUES":  Attention Chiropractors!  Did you know that most of the BCBS carriers DO NOT COVER "roller tables" as "traction"?

Medicare: ABN modifier coding...  2010 will bring significant changes to Medicare coding.  Improper modifier use will cause denials.

Are you using "incident to" provisions properly? CMS has published extensively with clarifications and any record not in compliance with the new requirements is subject to recovery and possible fraud or abuse actions.  "We believe you knew or should have known".

Did you know that keeping an overpayment is now "against Federal Law"?  If you need to refund Medicare, do you know how? WE do!

Did you know that in 2010, CMS will no longer pay for consultation codes?

AUDITS: RAC's will soon be a thing of the past with these "bounty hunters" being replaced with Zone Program Integrity Contractors.  The "mission", to STOP provider abuse of the system "ONCE AND FOR ALL". ZPICs are to identify cases of suspected fraud, develop them thoroughly and take immediate action against the provider.

RED FLAG ISSUES: FTC repealed the regulations for healthcare providers BUT

 You must still comply with Identity Theft provisions with written policies, procedures and training in your compliance policy manual.  MedCorp will help you prepare your policies and help you institute your training.  Call your MedCorp Consultant "TODAY" at 702-838-0054.