Category Archives: Business Process Outsourcing

Medicare Part B Premiums/Deductibles

On October 12, 2018, the Centers for Medicare & Medicaid Services (CMS) released the 2019 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs.
Medicare Part B Premiums/Deductibles
Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.
The standard monthly premium for Medicare Part B enrollees will be $135.50 for 2019, an increase of $1.50 from $134 in 2018. An estimated 2 million Medicare beneficiaries (about 3.5%) will pay less than the full Part B standard monthly premium amount in 2019 due to the statutory hold harmless provision, which limits certain beneficiaries’ increase in their Part B premium to be no greater than the increase in their Social Security benefits. The annual deductible for all Medicare Part B beneficiaries is $185 in 2019, an increase of $2 from the annual deductible $183 in 2018. Premiums and deductibles for Medicare Advantage and Medicare Prescription Drug plans are already finalized and are unaffected by this announcement.

AMA Releases 2019 Coding Changes

The American Medical Association (AMA) has released the 2019 Current Procedural Terminology (CPT®) code set. The code set for the coming year includes 335 code updates as well as significant changes to certain descriptors.
Key changes include:
 Three new remote patient monitoring codes.
 Two inter-professional internet consultation codes.
 New and revised codes for skin biopsy, fine needle aspiration biopsy, adaptive behavior analysis and central nervous system evaluations, including psychological and neuropsychological testing.

EmblemHealth Policy Change Effective 01/01/2019: Correct Laterality ICD-10-CM Diagnosis Coding Policy

According to the ICD-10-CM Manual guidelines, some diagnosis codes indicate laterality, specifying whether the condition occurs on the left or right, or is bilateral.
One of the unique attributes to the ICD-10-CM code set is that laterality has been built into code descriptions. Some ICD-10-CM codes specify whether the condition occurs on the left or right, or is bilateral. If no bilateral code is provided and the condition is bilateral, then codes for both left and right should be assigned. If the side is not identified in the medical record, then the unspecified code should be assigned.
Beginning January 1, 2019, EmblemHealth will implement two claim edits associated with laterality diagnosis coding.
1. Diagnosis-to-Modifier – The Diagnosis-to-Modifier comparison assesses the lateral diagnosis associated to the claim line to determine if the procedure modifier matches the lateral diagnosis.

DIAG1: H60.332 (Swimmer’s ear, left ear)
DOS: 10/20/2015
CPT: 69000 (Drainage external ear, abscess or hematoma; simple) MOD: RT

Explanation: The diagnosis code is inappropriately coded. H60.332 indicates left ear, but the modifier indicates right ear; therefore, the claim line will be denied since the provider should have billed diagnosis H60.331 (Swimmer’s ear, right ear) instead.

2. Diagnosis-to-Diagnosis – The Diagnosis-to-Diagnosis comparison assesses lateral diagnoses associated to the same claim line to determine if the combination is inappropriate.

DIAG1: H60.331 (Swimmer’s ear, right ear)
DIAG2: H60.333 (Swimmer’s ear, bilateral)
DOS: 10/30/2015
CPT: 69000 (Drainage external ear, abscess or hematoma; simple)
MOD: 50

Explanation: The provider is billing duplicative, redundant diagnoses. Only diagnosis H60.333 should have been billed; therefore, the claim line will be denied.
• Osteoplasty, femur shortening procedure 27465 since it is performed to correct limb length discrepancy by shortening the longer limb, but the leg length discrepancy diagnoses ICD-10 codes M21.7 and Q72.8 are reported based on the contralateral (shorter) limb.
• Placement of selective, venous, arterial access catheters 36222-36228, 36555-36598, 36600-36640 and bone marrow aspiration, biopsy, harvesting procedures 38220-38221, 38230-38232 since they are routinely performed for treatment of an underlying condition (often a malignancy) that is affecting an anatomic site distinct from the site of the procedure.
• Diagnosis codes for female malignant neoplasms of the breast since prophylactic bilateral mastectomy procedures may be performed for unilateral breast cancer.

CMS Continues Efforts to help with Hurricane Florence Emergency Response

The Centers for Medicare & Medicaid Services (CMS) announced efforts underway to support Virginia in response to Hurricane Florence. This week, Health and Human Services Secretary Alex Azar declared a public health emergency in Virginia. With the public health emergency in effect, CMS has taken several actions to provide immediate relief to all those affected by the hurricane along the east coast. The actions include temporarily waiving or modifying certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements; creating special enrollment opportunities for individuals to access healthcare immediately; and taking steps to ensure dialysis patients obtain critical life-saving services


The proposed rule for 2019 was released on July 12, 2018. Meridian Medical Management posted a high overview of proposed changes to Payment Policies under the Medicare Physician Fee Schedule. There are also changes proposed for the Quality Payment Program. Amongst the proposed changes are:
• Changing the definition of MIPS eligible clinicians to include physical therapists, occupational therapists, clinical social workers, and clinical psychologists.
• Having a third element of the low-volume threshold determination by adding the number of covered professional services provided of >200. If an eligible professional meets one or two elements of the low-volume threshold determination, they will be given the choice to participate in MIPS which is now referred to as the “opt-in policy”.
• Adding new episode-based measures to the Cost performance category.
• Restructuring the Promoting Interoperability (formerly ACI) performance category.
• Creating an option to use facility-based Quality and Cost performance measures for certain facility-based clinicians.
• The Quality category being worth 45% of the overall MIPS score, and increasing the cost category to 15%.
• Increasing the payment adjustment of 7% compared to 5% this year.
• Performance threshold may change from 15 points this year to 30 points; that is twice as many points needed to achieve a neutral fee adjustment.
• To be considered a high performer this year you need > 70 points, next year they are proposing > 80 points.
These are just a few of the changes proposed for the Merit-Based Incentive Payment System (MIPS) in year 3 – reporting year 2019.

The comment period for the proposed changes to the Payment Policies under the Medicare Physician Fee Schedule as well as the proposed changes to the QPP will end on September 10, 2018 at 5 pm. This is your time to submit any concerns regarding these proposals. It is the responsibility of every practice to review the changes for both the QPP and proposed changes to Payment Policies under the Medicare Physician Fee Schedule as there are many proposals that may negatively impact your practice.

Bristol Byte 2.0 Workflow Management Software release at Healthpac User Meeting

Bristol Healthcare Services a leading company in revenue cycle management was a Bronze sponsor in 14th Healthpac Annual Users meeting conference at Savannah Desoto Hilton, Liberty St., Savannah, GA 31401 from 22 Feb to 24 Feb.

The conference witnessed the active participation of 130+ representatives of nation’s 30 major medical billing companies. Bristol being the Bronze sponsor for the event also shared its vision on implementing new software and upgrading existing technologies.

During the conference, Jay Ganesh, CEO of Bristol Healthcare Services, gave an exclusive presentation on company’s BristolByte workflow management solutions software to Healthpac Users. The presentation outlined on how exactly the software can streamline and automate the workflow of complex healthcare projects. He also showcased about the increased control and visibility that BristoByte can offer to manage billing, productivity and set AR metrics.
Bristol’s management has been in association with Healthpac for last 15 years. There has been a strong ongoing action plan to integrate Healthpac with Bristol Byte workflow management software to provide seamless medical billing services.

‘BristolByte’ Workflow Management software helps to automate medical billing process eliminating obstacles that most hospitals, clinics & billing offices are facing on a regular basis. The automatic applications are easing out the chance of paper-based errors those cater for maximum denials from the payer side. In short, one can track quality, performance and productivity while focusing fully on delivering the service with much ease.

Bristol Healthcare Services has been making serious improvement to the field of healthcare system through innovative software and service solutions. The organization is delivering end to end services for Medical Coding, Eligibility Verification, Cash/Payment Postings, Demographic Registration, Account Receivable Management and Charge / Claim Entries.

Bristol’s offline and online medical billing outsourcing services have gained popularity among many healthcare industries because of their flexible customization plans and error-free deliverance of the service. With a team of experts having knowledge of Payer-specific coding, Insurance, and governmental regulatory requirements ease the process of medical billing and coding for an organization of any size.
As per Bristol’s clients’ testimonials, the service of Bristol has enabled them to save overhead expenses by 40%. With a quick turnaround time and customized client service, the organization has earned good credibility in healthcare industry.

About Bristol Healthcare Services
Bristol Healthcare Services is a leading provider of Medical coding, Medical billing and Revenue Cycle Management. Bristol has achieved a level of managing more than a million coded reports per year and handling revenue cycle management of 90 million per year. The success has been driven by their experience of working with 25+ billing software and 40+ medical specialties.
To know more about Bristol Healthcare Services capabilities on revenue cycle management, medical coding and medical billing visit or call 800-253-7320 or email at