co-hosted by: Mark, Scott and Dr. Ray Painter
Urology Coding and Reimbursement Podcast
The Urology Coding and Reimbursement Podcast is for Urologists and urology practice staff: Administrators, APPs, Billers and Coders. We help urologists and staff achieve peak economic and practice efficiency so there is time and energy to focus on patient care and a happy life.
UCR 017: 2021 CMS Proposed Rules and how they impact the Urology Practices
August 6, 2020
Mark outlines the proposed rule and the 8 items that will have the most impact on the Urology practice.
- Final rule posting late this year
- Conversion factor decreasing by 10.6%
- E&M 2021 changes being adopted and will include increased RVUs for the E&M codes
- RVUs for non-facility codes increasing enough to offset conversion factor decrease
- RVUs for facility procedures are all decreasing
- ASC payments are set to increase
- MIPs has a couple of changes but they are not major changes to the current program
- Telehealth is going to continue with the same rules during the Public Health Emergency. Once the PHE is over then covered codes will change and be separated into 3 categories of covered codes
UCR 016: FAQs - Consultation billing? Can you bill catheters and leg bags with 51702? Auditing rules for telehealth? PCNL - 50080/81 and -52?
July 31, 2020
Mark, Ray and Scott discuss answer and discuss questions asked on the Urology Coding and Reimbursement Group.
Can you bill a consultation (99245) when one of our providers is sending his pt to another provider in the same group to discuss doing a RALP. Ins plan UMR/UHC. I don't think you can since they are under the same Tax ID #. The provider that did the consult says you can for a non CMS plan. Please advise. Thanks
UCR 015: How do you ask the right questions to find the right solution / code?
July 17, 2020
Mark, Ray and Scott discuss how to find the right codes or solutions by asking questions. The problem is that if you don't ask the right questions you may get the wrong solution.
Often times in coding and reimbursement the answers are not clear, there are a lot of "gray" areas. Finding the right solution based on all the information you have, is important. Then you need to double check by asking "does my answer make sense"?
UCR 014: FAQs - Telehealth Codes for PA/NP phone only visit? 52281 and 52601 during global, bundling question.
July 10, 2020
For PA and NP phone call only visits, what codes should be used? Additionally, can phone only codes be billed as incident to for established patients?
Good morning!
Can 52281 needing to be performed during global period of 52601 because of developed N35.811 meatal stenosis and increased self- catherizations be billed with a modifier? I am looking and the EncoderPro.com service I have through my employer says: "A modifier is not allowed to override this relationship".
Thanks again!
UCR 013: Kidney Stone Coding - a discussion about the CPT® and CMS rules and how they impact multiple stone billing in different locations.
Mark and Ray present the current CMS and CPT rules and how those rules affect coding for multiple stones. As most are well aware, the rules are not always black and white and in this instance the rules leave plenty of room for interpretation. Mark and Ray present the current rules and lay out a case for a fair interpretation based on work performed.
UCR 012: Maximizing income and efficiency begins with the front office, learn what to look for and how to adjust. Interview with Larry Kemp, FACHE
Larry talks about how teamwork is one of the most important aspects of an efficient office. Learn about one of the best ways to train your office. Larry has helped many urology practices and over the years developed and tested systems and strategies to help practices of all sizes.
How do you know when it is time to part ways with a team member? Is one employee dragging the performance of the rest of the group down?
UCR 011: The 5 most important things for Urologists to include on the home page of their website. Interview with Marketing Expert Brent Stutzman
Brent shares what most Urologists are missing on their website. Do you explain what you do? Have pictures related to your practice? Have a clear call to action? Learn some simple changes you can make to your website to help attract your ideal patient.
Should you have video on your website? How important are testimonials? Get the answers to all these questions and more as Brent discusses what is important for today's urology website.
UCR 010: Cybersecurity: Working from home/remotely? How to protect your network and your practice from cyber attacks and breaches
Cybersecurity: Working from home/remotely? How to protect your network and your practice from cyber attacks and breaches
In this episode, Mark interviews cybersecurity expert Jeffery Daigrepont, from the Coker Group.
Jeffery shares some items you should consider to protect your practice. Did you realize that one of the most important tools is cybersecurity insurance and most out of the box policies don't cover a common cyber breach potential?
Also, most practices don't know that many breaches occur because of individuals actions within the practice. These actions are not intentional but can lead to significant issues.
UCR 009: Modifier -25
Mark, Scott and Ray talk modifier -25. In addition to a general overview about the definition, they give several urology examples.
Modifier -25 definition: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: It may be necessary to indicate that on the day a procedure or service identified by a CPT code was performed, the patient's condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed.
UCR 008: RVUs - Overview and How They Can Help You
Mark discusses RVUs and why they are important to the urology practice. Not only are they important for reimbursement but they can also be used as a tool to assess practice productivity and efficiency.
Learn why not understanding the RVU basics could be costing you in many aspects of your practice.
UCR 007: Voice Recognition in Today's Practice with Brad Sclar
Scott talks with voice recognition expert Brad Sclar. Learn how Brad, who has a Doctorate of Musical Arts, got involved with healthcare. Find out if voice recognition belongs in today's practice. Why the dictation software and algorithms on your phone and computer just don't cut it in the medical profession.
UCR 006: How Dr. John Lin is "reopening" his urology practice as the pandemic restrictions are easing
Mark and Scott talk with Dr. John Lin, a solo practitioner from Gilbert, AZ in the Phoenix metropolitan area. Dr. Lin shares his strategies and the steps he is taking to "reopen" his practice.
Find out if he sees telehealth in his practice moving forward and if there are any efficiencies to be gained from what he has learned.
UCR 005: Do you know what you are not billing?
We hope you and your families are safe and healthy.
In this episode, Scott and Ray discuss two commonly overlooked billing mistakes that cost urology practices money. You can't find this on any report but yet it occurs in all practices unless you have the right system.
Ray outlines the simple but effective way to identify procedures performed, that may not have been billed. They also discuss a second issue, contractual denials, and outline a strategy to address them.
UCR 004: Telehealth/Telemedicine Shared Visits Clarification
We hope you and your families are safe and healthy.
In this episode, Mark clarifies the rules associated with Telehealth/Telemedicine shared visits. We have been getting questions regarding shared visits.
Mark answered a question on the recent webinar and his answer sparked additional discussions on this topic.
UCR 003: How to Document Telehealth/Telemedicine Visits and Comply with the New Rules
This is a replay of a webinar that aired Thursday, April 10th, 2020. Mark outlined how to properly document Telehealth/Telemedicine visits and select the appropriate level of service during the Public Health Emergency.
The rules were released and then adapted to the changed Telehealth environment. Mark also reviews the new rules and how to apply them in a Urology practice.
co-hosted by: Mark, Scott and Dr. Ray Painter
UCR 002: Telehealth/Telemedicine: New Rules in the Wake of the Coronavirus
Congress and the president gave Medicare some additional powers to relax the current restrictions surrounding payment for services provided via telephone, Video chat and through HIPAA secure technology for traditional Medicare. Additionally, Private insurance companies through both Medicare Advantage plans and standard commercial plans have been encouraged to expand telehealth services.
co-hosted by: Mark, Scott and Dr. Ray Painter