Part II – Medical Coding Modifiers

Modifiers can generally be grouped by function or category. Some modifiers are used for tracking or informational purposes only, while others affect measurement of time, effort, or result in altered reimbursement. Some have multiple functions. An example is modifier "AI"; this is a level II HCPCS modifier which indicates the principal or admitting physician. This ...

Healthcare Transaction activity under a Trump Presidency

A large amount of change in the healthcare market is anticipated with the election of Donald Trump.  The degree to which changes to the Affordable Care Act and its funding mechanisms will have on transaction activity is yet to be seen.  Some experts believe that continued enforcement of antitrust statues is likely to continue.  Others ...

Medical Office Building Valuation & Real Estate Syndication

Medical office building syndication is a common investment and alignment strategy.  This involves the formation of an entity which possesses real estate so that individual investors may be offered fractional ownership.  How these entities are formed, the way in which ownership offering is structured, and control and governance issues can make these entities tricky to value. Two major areas ...

Physician Goodwill & Purchase Price Allocation

In a recent California court case, Monarch Healthcare and physician Margo Jaffe Orr, MD squared off regarding a non-compete issue.  Dr. Jaffe sold her medical practice to Monarch for $34,700 in a deal which purportedly included all tangible and intangible assets.  However, the purchase price allocation afforded all of the purchase consideration to furniture, fixtures, equipment and ...

Use of Modifiers in Medical Coding and Billing

Modifiers in medical coding and claim submission The use of modifiers in coding and billing can be crucial in obtaining proper reimbursement for services.  Proper coding also allows for the remittance of accurate patient encounter data, which is increasingly important in value-based healthcare. Using modifiers can also be an area of risk if not properly documented.  ...

Two-midnight rule discontinued for inpatient payment cuts

The Centers for Medicare and Medicaid has discontinued enforcement of the two-midnight rule.  This move followed a notable court case related to the cuts as well as intense industry criticism.  There will be a one time pay increase as a result, in order to compensate hospitals for previous cuts.  In 2017 hospitals also will see ...

Verity Health System outlook revised to “Stable”

Verity Health System (fka Daughters of Charity Health System) has received a revised outlook from Standard and Poor's of "stable" from "negative".   This marks a positive step in the turnaround the $1.4 billion dollar distressed system which includes 6 major hospitals located throughout California.  In 2014 and 2015 the system reported operating losses of $12.1 million and $59.2 million respectively. The ...

Valeant Pharmaceuticals Turmoil

Valeant Pharmaceuticals is always an interesting company to read about.  Over the years the drug maker has frequented the news with talk of takeovers, failed bids, C-suite and board drama, shady business practices, and activist investors.  In its most recent drama-filled episode, Valeant's share price has fallen over 88% from its 52 week high in part due ...

MedPAC Report to Congress

The Medicare Payment Advisory Commission released its annual report to Congress on March 15th, noting that most indicators of hospital payment adequacy were good but also found that the average Medicare margins were negative and expected to decline. The commission recommended that inpatient and outpatient hospital payments should be increased.  It also recommended a controversial proposal to reduce ...