6 Tips for Billing Success at your NC Medical Practice in 2017

 In Articles, Coding & Documentation

2017 is here! A new year brings new challenges and also opportunities for improvement. Here are a few reminders and tips to make 2017 a great year.

1) Know the Plans … The Exchange Plans

For most of the state of North Carolina, BCBS of North Carolina is the only carrier offering exchange plans. United Healthcare and Aetna exited the market completely and Cigna is available in six counties in the Raleigh/Durham area. Premiums for these plans are about 20% higher than last year.

Double check your participation status with all the exchange plans and post updated participation statuses around the clinic, on your website, and in areas that team members reference.

In North Carolina, be sure to check the following:

  • Blue Value
  • Blue Local
  • Cigna Connect – limited network offered in Wake, Orange, Nash, Johnston and Chatham counties only; no out of network benefits unless it’s a medical emergency.

2) Enter new insurance info in the PM System

  • Many of your existing patients will present new insurance information this year. When they do, simply enter an expiration date on the old policy number and enter a new record for the new insurance.
  • Deleting or changing a previously valid insurance can hinder claims follow up and refiles on late 2016 activity.

3) Collect Deductibles and Patient Due Portion

  • Medicare deductible for 2017 increased to $183.
  • Take a look at your collections agency or bad debt write offs for the past few years – have they increased? If so, what strategies have you tried to combat the issue?
  • Consider a credit card on file program…start with new patients as a baby step.

4) Review Your Contracts and Fees

  • Haven’t had an increase in a few years? Get a conversation started with the carrier or reach out to us for assistance in analyzing your current contracts.
  • Haven’t updated your fees in a few years? Review them against current Medicare rates and your other major carrier fee schedules to ensure fees are above reimbursement levels. MSOC completes fee schedule reviews on your behalf at the beginning of each year; your client analyst will contact you if any of your fees need to be raised.

5) North Carolina Medicaid – Monitor Closely

  • The requirement for Carolina Access group NPI on claims was retired, BUT providers should still follow the authorization / referral protocols as required by the Carolina Access program. Document referrals in charts in case of audits.
  • Also, monitor claims for ordering provider denials – several PM vendors were having trouble sending the required loops and segments now required by NC Tracks.
  • And finally, the location mandate has been delayed to Q1 2017 but you should prepare now if you need to add locations to your NC Tracks profiles.

6) Review CPT changes

OT/PT Evaluation codes 97001-97003 replaced with codes based on levels of complexity

97001 (new evaluation PT) replaced by 97161 (low), 97162 (moderate), 97163 (high)

97003 (new evaluation OT) replaced by 97165 (low), 97166 (moderate), 97167 (high)

97002 (re-evaluation PT) replaced by 97164

97004 (re-evaluation OT) replaced by 97168

Spinal Injection codes 62310-62319 replaced; revision of fluro guidance instructions and new codes bundling fluro guidance

62310 replaced with 62320 (without guidance) and 62321 (with guidance)

62311 replaced with 62322 (without guidance) and 62323 (with guidance)

62318 replaced with 62324 (without guidance) and 62325 (with guidance)

62319 replaced with 62326 (without guidance) and 62327 (with guidance)


77002-77003 updated to add on codes with ZZZ global value

62320-62327 updated to include imaging (7703, 77012, 76942)

Mammography _ Computer-Aided Detection: 77051, 77052, 77055, 77056, 77057 will be deleted.

Interventional radiology – 35475, 35476, 36147, 36148, 36870, and 75791 deleted

Presumptive drug screen codes 80300-80304 deleted; replaced with 80305-80307 which are identical to G0477-G0479 required by Medicare this year

80305 – direct optical observation

80306 – instrument assist

80307 – instrumented chemistry analyzer


92235, 92240 updated with new options for bilateral vs. unilateral; also new code for receiving both procedures at same encounter

Flu Vaccination Codes 906% move from age based to dosage based; new descriptions for each 906% code based just on the dosage/type/how given

New code – 90674

See AAPC site for details.

New health assessment choices

96161 –administration of patient-focused health risk assessment instrument with scoring and documentation; benefit of the patient.

99420 replaced with 96160 – administration of caregiver-focused health risk assessment instrument with scoring and documentation; benefit of the caregiver.


90846-7 have addition of 50-minute time criteria

90832-90838 description with removal of “and/or family”

New modifier 95

Telemedicine modifier; replaces GT. Definition – synchronous telemedicine service rendered via real-time interactive audio and video telecommunications systems.

Does your medical practice need more help with your billing needs? Contact MSOC Health.

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