Medical Billing Blog: Section - Claims
Archive of all Articles in the Claims Section
This is the archive containing links to all articles written in the Claims section of our blog.
Click any of the article links below to read the entire article or browse another section to the right to read articles on another subject.
61% of Physicians Say EHR Systems Reduce Clinical Efficiency
“EHR systems continue to fall short of provider expectations and detract from the joys of practicing medicine, according to a recent national survey by The Doctors Company. More than 3,400 physicians from 49 states and the District of Columbia offered their perspective on EHR technology, federal regulations, value-based care, patient-centered medical homes (PCMHs), and other aspects of the healthcare system. Survey respondents included surgical specialists, primary care providers, and nonsurgical specialists. The majority of respondents were 51 and older. Overall, the majority of surveyed physicians reported that EHR systems have had a negative impact on the patient-provider relationship, clinical workflows, and clinical productivity. Fifty-four percent of surveyed physicians stated their …
Billing and coding for advanced clinical practitioners
Melissa’s Mention… “A 67-year-old patient with diabetes shows up for her appointment. Her A1C levels are high. She reveals during the visit with the advanced practice clinician that she’s not taking her medication as prescribed. The patient’s physician is doing rounds at the hospital and is, thus, unavailable to consult with the patient in person. At this point, the practice needs to answer a couple questions: Can the nurse practitioner (NP) or physician assistant (PA) bill the visit under his/her own national provider identification (NPI) number? Or, is the visit appropriate for “incident to” billing and, thus, billable under the physician who created the patient’s care plan? …
Harnessing Effective EHR Use for Improved Patient Care
Improving EHR use can help reduce physician burnout and strengthen the patient care process. When healthcare providers understand how to best leverage new technologies and are able to adopt and implement an integrated EHR system, both patients and providers will benefit. That has been Kaiser Permanente’s top goal with its EHR safety net programs, looking to reduce errors in the diagnostic process. Kaiser Permanente has developed a total 54 EHR safety net programs, which are collectively called KP SureNet. The programs have helped to close major care gaps over the past few years. Michael Kanter, MD, Medical Director, Quality and Clinical Analysis, Southern California Permanente Medical Group explained to EHRIntelligence.com …
CMS Modifies E/M EHR Clinical Documentation Requirements
The American College of Physicians (ACP) recently applauded a CMS decision to change EHR clinical documentation requirements. Teaching physicians can now verify medical student documentation in a patient’s EHR related to evaluation and management (E/M) code services. “Prior to the change, physicians were required to re-document most work performed by medical students — which is often very thorough and based on careful and supervised evaluation — rather than review, refer to, amend, or correct the student note,” clarified ACP President Jack Ende, MD in a public statement. Changing the EHR clinical documentation requirement allows teaching physicians to educate medical students about EHR use within a more streamlined workflow and reduces …
RCM tip: Invest in automated rules engine to improve RCM
Investing in automation tools, such as a rules engine, can help healthcare organizations decrease their administrative workload, according to Andrew Wade, practice administrator at Conway, S.C.-based Coastal Orthopedics. Mr. Wade shared the following tip with Becker’s Hospital Review: “If we want to truly free up providers from administrative burden and empower them to do the work they love to do — spending more time with patients and delivering quality care — organizations need to invest in tools that automate tasks wherever possible. Thanks to our technology’s rules engine, our claims can be automatically verified and some errors automatically resolved based on knowledge gleaned from the network. We are getting cleaner …
How to Choose Between Modifiers 25 and 57
When reporting an evaluation and management (E&M) service on the same claim with another service or procedure, you must append either modifier 25 “Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the same day of the procedure or other service,” or modifier 57, “Decision for surgery” to the E&M service code. Modifier Identifies Separate Nature of E&M Service A minimal patient evaluation is necessary to determine that a prescribed treatment is appropriate to manage the patient’s condition. For example, if a patient presents for a previously scheduled injection, the provider will briefly evaluate the patient to confirm that the injection remains …
Indiana Makes Top 5 States for EHR Adoption
A recent report by the Center for Data Innovation ranked each state based on its rate of EHR adoption and provided recommendations on how policymakers can enable more efficient data use. Data innovation—specifically in the healthcare industry—is imperative to fostering improvements across the care continuum. Researchers at the Center for Data Innovation stated data insights using EHR technology for preventive care and better clinical decision making could cut costs across the industry by up to $450 billion. States were evaluated and ranked for their level of EHR adoption and use according to the availability of high value data sets, development of useful technologies, and proliferation of human and business capital …
RCM tip: Stop snail mail for electronic billing
Healthcare organizations should offer electronic billing options patients want rather than use snail mail to send paper statements, according to Jim Denny, president and CEO of Duluth, Ga.-based Navicure. He specifically cited a 2017 Patient Payment Check-Up survey that reveals 89 percent of providers still send paper statements through snail mail, although more than 50 percent of patients prefer electronic bills over paper statements. Given this survey, Mr. Denny shared the following tip with Becker’s Hospital Review. “Despite the abundance of technology that is available, many providers are still billing patients via snail mail. Not only does this way of billing cost more (on average paper billing can cost $7 …
EHR Dissatisfaction is Contributing to Provider Burnout
“I am a daily user of two EHR systems. One is a community hospital based complex EHR, and one is a cloud and iPad based EHR that we use in our private practice. The private practice-based EHR is much more user friendly and adapts well to our practice. I am what you would consider a “power-user” on our community hospital based EHR, and spend a fair amount of time helping other members of the medical staff better understand and use it. The integrated dictation, patient education, auto-population of data, and macros are just a few of the elements of the EHR that make my life easier, and has the potential …
EHR Use Negatively Impacts Patient-Provider Relationship
A recent study by Pelland et al. found that while EHR use may reduce medical errors, the technology is also shown to complicate the patient-provider relationship. Researchers at Brown University performed a qualitative analysis of comments submitted to a 2014 Rhode Island Health Information Technology survey to gain insight into physicians’ personal experiences with EHR systems. Both office- and hospital-based physicians in Rhode Island submitted responses describing their perceptions of the impact of EHR technology on patient-physician interactions. Responses from hospital-based physicians were measured against the opinions of office-based physicians for contrast. While both hospital-based physicians and office-based physicians voiced concerns regarding the effect of EHRs on patient-provider interactions, the …
