All insurance companies have significantly increased their audits. One of the major reasons is the average penalty for a negative insurance audit is between $100,000 and $200,000! When you do the math, with only ten audits they make $1,500,000! With the number of practices the insurance companies audit, this results in more money than can be obtained in fee cuts!
We realize there is much confusion for doctors regarding the dilation requirement. One of the major reasons for the confusion is the description for Comprehensive Eye Examinations in the AMA Professional Edition CPT manual. It states that a comprehensive eye exam “often includes, mydriasis” (dilation). Many doctors interpret this as dilation is not required.
Over 30 Ophthalmic procedures require an Interpretation and Report. However, 80% of doctors either do not complete a report or do not create it properly. Many doctors consider these optional, but they are required. This document details the requirement, how to create the report and what not to do. We also explain the very expensive ramifications of when you do not create a report.
Provides new information about why you should avoid using the -59 modifier. CMS and all payers are looking more carefully at the use of the -59 modifier claims. There are new modifiers that should be used instead of the -59 modifier when appropriate.
Because of the complexity and the fact systems did not correctly select PQRS and MU reporting options, most practices have not reported correctly. With the relatively low penalties, this was not a major issue.
In January 2017, CMS significantly changed the rules with the implementation of Merit-based Incentive Payment System (MIPS). It combines more reporting, much higher financial penalties (4% to 9%) and possible removal from the panel - No More Medicare billing.
The high penalties and threat of being removed for the CMS panel are too severe. As a practitioner, you no longer have an option of not reporting.
This article has the information you need for MIPS.
ICD-10 has been implemented for years.
From that time and continuing every year, codes have been added,
modified, and many deleted. .
This article explains in detail how to get the ICD-10 codes and more importantly; the correct ones and instantly.
Provides detailed information about choosing the proper Exam type and how to Code Properly. Both the Ophthalmic (92xxx) and Evaluation and Management (992xx) exams are explained.
Many Ophthalmic procedures were previously allowed to be performed as many as four times per year for patients with Advanced Glaucoma damage. Now CMS has restricted and in some cases eliminated certain procedures from being performed depending on the severity level of the patient. This article identifies affected procedures as well as details the Medicare definition of the various severity levels. It is important to note that the new ICD-10 codes for several Glaucoma codes contain the severity.