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Category Archives: Healthcare

Be prepared for radiology coding changes in 2017

Get ahead the changes of radiology-specific in 2017. Mammography codes are overhauled and summarized.

Changes in Mammography Codes 2017

New Codes Description Deleted Code
77065 Diagnostic mammography, including CAD when Performed; unilateral 77055 / 77051
77066 Diagnostic mammography, including CAD when performed; bilateral 77056 / 77051
77067 Screening mammography, bilateral (2-view study of each breast), including CAD when performed 77057 / 77052

 

Experts LRN’s seamless effort Overturned denied claims for payment.

Bristol healthcare services partnered a FL Medical billing company this May 2016 to clear a huge backlog of +18,000 accounts to move for the next level.  We were able to identify most of the claims denied resulting insufficient medical notes, we know these denials are recoverable through the filing of effective appeals.  With experts in mind Bristol Healthcare Services partnered with remote registered nurse to navigate these complex appeals process for them to overturn denied claims for payment and to reduce unnecessary write-offs.  Our onsite licensed RN’s carefully review medical records to effectively prepared and sent appeals from the start to resolution.  We acted as an extension of the medical practice along with the RN’s using their working knowledge of various payer authorization requirements, medical criteria and protocols necessary to make the case for successful appeals.  In addition to clinical experience, our team offered follow-up and support during the adjudication process as needed to overturn even difficult denied claims paid.

Bring together your team for a successful contract negotiation.

Our Credentialing specialist team lead by Mr. Albert Marvin successfully implemented and negotiated contract for a Neurology physician this April, 2016.

Very recently we introduced ancillary healthcare services to encourage our clients utilizing Credentialing and Contracting services at no extra cost.  We know “Nothing fits the same for all”. Also, we recommend our physicians to demand their annual report card that lets physicians know how they stand with their peers.

All Healthcare Payers GOAL is to place physician’s front and center in the mission to improve the health of their members, and LOWER OVERALL HEALTHCARE COSTS.

Physicians/Practice Managers are you sure you are getting the best rate available for your healthcare services?

Your practice future depends on effectively negotiating with your private payer plans.

Become PQRS Expert.  Negotiate your low hanging fruit; create your top 10 Dx code along with cost associated CPT, Monitor your payer mix from year to year, because payer contributions to your business can change over time.

Know when each of your contracts expires and how much notice you must give to make changes.  Experts recommend the following contractual elements as areas to which practices should pay attention:

  • Retro/Authorization procedure for treatment.
  • Period allowed appealing a denied claim.
  • Requirements relating to use of oral or injectable drugs.
  • Time specified for clean claim payment, and interest paid for late payment.
  • Procedure for adding new service lines.
  • Period required for providing notice of modification proposals.
  • Cancellation clause, including the advance notice required.

Feel free to e-connect or call Bristol Healthcare Services to find HOW and WHEN to negotiate or renegotiate your current contracts to include the best reimbursement rate for your practice.   www.bristolhcs.com

Healthcare Ancillary services – Engage and identify the possibilities to overcome

Take a look at the Bristol Healthcare Services recommends feature, or request a demo of our Services.  There is no one-size-fits all solution, so Bristol Healthcare Services developed a number of different ways for you to get the insights you need.

Ancillary healthcare services refers to the wide range of services to single / Group physicians, Healthcare Facilities, Diagnostic lab’s and other healthcare entities.

Many a times, physicians have to deploy resources such as capital, equipment, software and admin staffs to deal with insurance reimbursement delays.  More often than not, some of these issues can be avoided if only the credentialing process had been carried out properly and thoroughly.

  • Credentialing services
  • Fee schedule negotiation
  • Medicare Revalidation
  • Clearing house / EDI and EFT setup

Bristol Healthcare Services added 4 more clients in the state of California this March, 2016.

Bristol Healthcare Services acknowledged the Invitation from a California based Surgery coding company and few other Medical Billing companies.  Company deputed Mr. Raymond Kelly for a short trip to USA this March, 2016.  His +16 years vast experience and techy process knowledge in Healthcare Revenue Cycle Management by finalizing and have the contract signed with all of the companies invited.

With pool of expertise and experts in end to end medical billing and multi-specialty coding services we were able to transition all the process from the day one the contract was signed.   Also, Our Human resource team played a vital role by sourcing few more industry experts to keep our clients at a 100% production and TAT.

Also, Bristol Healthcare Services implements – Billing Audit Services

Our billing audit team will assist your organization in identifying the primary issues that may be keeping it from realizing its true financial potential.  To that end, Bristol Healthcare Services will review your operation and measure performance from first point of contact to fully paid claims and everything in between.

Patient intake/eligibility verification                 Patient and insurance payment posting

Patient referral authorizations                          Patient account adjustments

Patient copay                                                        Unpaid and underpaid patient claims

Advanced beneficiary notice (ABN)                   Denied claims

Coding analysis and trends                                Patient accounts receivable reporting and analysis

Charge capture assessments                             Collections prioritization

Patient charge ticket tracking                             Practice management software analysis

Pre-billing review                                                  EHR/EMR integration issues

Clearing house communication                         Medical fee schedule analysis

Electronic claim submission                               … and much more.

Our value added services include:

  • Credentialing
  • Re-Credentialing
  • Fee Schedule Negotiation

We work 24/7, so contact us and let us help you unlock the potential of your practice Why not you benefit the same as rest of our other clients do

CALL +1 (800) 253-7320 or click here we will call you.

New Guidance – Medicare Physician Fee Schedule

Some changes you’ll find in the April 2016 update actually went into effect the first of the year.

They are:

HCPCS Level II code G0464 Colorectal cancer screening; stool-based DNA and fecal occult hemoglobin (e.g., kras, ndrg4 and bmp3) is now assigned a procedure status of I Not valid for Medicare purposes. Medicare uses another code for reporting of, and payment for, these services. (Code not subject to a 90 day grace period)

CPT 10030 is now assigned global period days of 000 Endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only included in the fee schedule payment amount; evaluation and management services on the day of the procedure generally not payable.

CPT 77014 is now assigned a PC/TC indicator of 1 Diagnostic tests/radiology services. These codes generally have both a professional and technical component. Modifiers 26 and TC can be used with these codes.

CPT 80055 is now assigned a procedure status of X Statutory exclusion. These codes represent an item or service that is not in the statutory definition of “physician services” for fee schedule payment purposes. No RVUs or payment amounts are shown for these codes and no payment may be made under the physician fee schedule. (Examples are ambulances services and clinical diagnostic laboratory services.)

Medicare administrative contractors will not search their files to either retract payment for claims already paid or retroactively pay claims. It is the responsibility of the healthcare provider to correct claims for these codes.

Effective for services performed on or after April 1, 2016:

G9678 is assigned a procedure status of X

G9481 (Remote E/M new patient 10 mins) has a PE RVU = 0, all other MPFS indicators/values = 99201

G9482 (Remote E/M new patient 20 mins) has a PE RVU = 0, all other MPFS indicators/values = 99202

G9483 (Remote E/M new patient 30 mins) has a PE RVU = 0, all other MPFS indicators/values = 99203

G9484 (Remote E/M new patient 45 mins) has a PE RVU = 0, all other MPFS indicators/values = 99204

G9485 (Remote E/M new patient 60 mins) has a PE RVU = 0, all other MPFS indicators/values = 99205

G9486 (Remote E/M est. patient 10 mins) has a PE RVU = 0, all other MPFS indicators/values = 99212

G9487 (Remote E/M est. patient 15 mins) has a PE RVU = 0, all other MPFS indicators/values = 99213

G9488 (Remote E/M est. patient 25 mins) has a PE RVU = 0, all other MPFS indicators/values = 99214

G9489 (Remote E/M est. patient 40 mins) has a PE RVU = 0, all other MPFS indicators/values = 99215

G9490 (Joint replace mod home visit) with all MPFS indicators & RVUs = those of G9187.

Codes G9481-G9490 are new and are assigned Type of Service 1 Medical care.

Source: MLN Matters MM9531