by Cindy Pezza, PMAC, CEO Pinnacle Practice Achievement
January 08, 2025
By tahlia@tldsystems.com
0 Comments
Keeping rejection rates as low as possible is important (5% or less; I used to say 3%, but payers often reject for no reason banking on the fact that you are too busy to follow up)
The #1 reason for rejection continues to be SIMPLE HUMAN ERROR so train your staff to be diligent in their attention to detail.
“I am wondering if any other podiatry practices are having issues with Aetna Medicare getting paid for CPT 11730? The denial of the claims focusses on “LCD guidelines.” We are sending numerous appeals along with medical documentation and the actual article from Medicare (L34887).”
“In many cases requiring an arthroplasty of the proximal interphalangeal joint (PIPJ) 5th digit (especially when associated with a heloma molle), I often do an arthroplasty PIPJ, flexor lengthening and a partial syndactylization (advancing the webspace but differently than the description of Ruiz-Mora). I have always simply billed for an arthroplasty PIPJ 5th toe. Now I have been forced to pay attention to coding because of my EMR program. Should I have been billing this differently for all these years?”
MIPS consists of 4 components Quality Reporting, Promoting interoperability, Improvement Activities and Cost. Another way to participate in MIPS is through an MVP. When reporting traditional MIPS you can report on individual measure or you can report a MIPS Value Pathway (MVP). Each year CMS updates the MIPS program.