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Viewing:  Feb 27, 2017

Medical Coding and Billing Articles

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How to Properly Dispose Protected Health Information (PHI)

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HIPAA requires covered entities to properly dispose of Protected Health Information (PHI) in the following manner: Paper, film, or other hard copy media has been shredded or destroyed such that the PHI cannot be read or otherwise cannot be reconstructed. Electronic media has been cleared, purged, or destroyed consistent with NIST Special Publication 800-88, Guidelines for Media ...

Tags:  Specl: All Specialties    Topic: Compliance    Topic: HIPAA   

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Using Time Span Codes

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The date of service (DOS) is the reference point for determining the frequency of code submission and subsequent reimbursement during that period, generally if the service was provided in a different calendar month, the service would qualify for reimbursement.  Modifiers will not override a time span code if it is billed with ...

Tags:  Topic: Billing    Topic: CPT Coding   

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Physician Compensation Fraud Alert

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In June 2015, the Office of Inspector General (OIG) issued a Fraud Alert focused on physicians and compensation arrangements. Providers need to ensure that these arrangements do not violate the Anti-Kickback Statute. Healthcare providers found to have committed fraud are subject to possible criminal, civil and administrative sanctions.  In this alert ...

Tags:  Specl: All Specialties    Topic: Compliance   

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Telehealth Growth Continues

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Telehealth is proving to be the wave of the future as the number of practices offering these services continues to grow. An online poll by Medical Economics asked those who visited their site about the implementation of telehealth services implemented by their individual practices this year. As of February 2, 2017, the results were significant: 30% ...

Tags:  Specl: All Specialties    Topic: CPT Coding    Topic: Modifier Coding   

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Medicaid Reviews

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All federal healthcare programs are required to implement programs to prevent and reduce provider fraud, waste, and abuse and this includes the Medicaid program. Two groups work in conjunction with the Centers for Medicare and Medicaid Services (CMS) and the Office of the Inspector General (OIG): the Medicaid Integrity Program (MIP) works at ...

Tags:  Payer: AMC|Medicaid    Topic: Compliance    Topic: Medicaid   

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Emergency Preparedness Final Rule

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Compliance has a new standard for emergency preparedness plans. On September 8, 2016, CMS issued the final rule titled  “Emergency preparedness requirements for Medicare and Medicaid participating providers and suppliers.” This rule creates emergency preparedness Medicare Conditions of Participation (COPs). There are specific standards for each of the named types of providers ...

Tags:  Payer: AMC|Medicaid    Payer: CMS|Medicare    Topic: Compliance   

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Global Periods

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What are the types of global periods?

Tags:  Specl: All Specialties    Topic: Modifier Coding   

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Mobile Devices are HIPAA Security Concern

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Mobile devices are one of the most problematic areas for HIPAA security. Their ease of portability also makes it easy for them to be stolen or hacked. Because so many of the HIPAA breaches reported involved mobile devices, additional guidance has been issued by HealthIT.gov. Their informative web page offers additional ...

Tags:  Topic: HIPAA   

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Telehealth Psychiatric Service

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Telehealth (also known as telemedicine) is playing an ever increasing roll in the reimbursement process. Internet services continue to expand and many insurance payers/providers are now covering (paying for) telehealth services. Telepsychiatry (providing behavioral health services in a telehealth environment) has been highly successful because video conferencing makes providing psych ...

Tags:  Specl: Behavioral Health|Psychiatry|Psychology    Topic: Coding    Topic: CPT Coding    Topic: HCPCS Coding    Topic: Modifier Coding    Topic: Reimbursement    Topic: Technology   

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Diagnostic Criteria for Behavioral Health

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In order to arrive at a diagnosis and check for related complications, a healthcare provider needs to evaluate the patient condition. This may include: History: This can include the patient's personal history as well as that of the patient's family. Physical exam: The healthcare provider will try to rule out physical problems ...

Tags:  Specl: Behavioral Health|Psychiatry|Psychology    Topic: Coding   

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CMS Issues Proposed Rule to Increase Patients’ Health Insurance Choices for 2018

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The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule for 2018, which proposes new reforms that are critical to stabilizing the individual and small group health insurance markets to help protect patients.

Tags:  Payer: CMS|Medicare    Topic: Insurance   

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Podiatry Class Findings

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The following modifiers are required when reporting medically necessary routine foot care services per Medicare guidelines: Q7: One Class A finding Q8: Two Class B findings Q9: One Class B and two Class C findings Appropriate: With foot care (podiatry) codes to indicate covered foot care Inapproriate: With any code not related to foot care When the foot ...

Tags:  Payer: CMS|Medicare    Specl: Podiatry    Topic: Modifier Coding   

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Medicare Conversion Factor

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In April of 2015, the Sustainable Growth Rate (SGR) formula which is used to calculate the Medicare Physician Fee Schedule (MPFS) Conversion Factor was repealed as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The conversion factor will increase by 0.5% each year until 2019 and ...

Tags:  Specl: All Specialties    Topic: Fees    Topic: Medicare   

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Medicaid EHR Incentive

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The Medicare and Medicaid incentive programs are different. The Medicare EHR incentive program has been incorporated into the new Quality Payment Program (QPP). However, providers may be unaware that there is still a Medicaid EHR incentive program. The time period for signing up for the Medicaid EHR incentive program ended in 2016. ...

Tags:  Payer: AMC|Medicaid    Specl: All Specialties    Topic: EHR    Topic: Medicaid   

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Medicare Revises their Appeals Process

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On January 17, 2017, a Final Rule was published in the Federal Register outlining changes to the Medicare Appeals process in an order to streamline procedures and reduce the current backlog of appeals at the third and fourth levels of appeal. This new policy takes effect on March 20, 3017. ...

Tags:  Specl: All Specialties    Topic: Appeals    Topic: Medicare   

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Quality Reporting is not Just for CMS

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If you thought that quality reporting is just for CMS, you are wrong. Other payers recognize the need to establish quality metrics.

Tags:  Topic: Fees    Topic: Quality Payment Program   

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Psychotherapy Notes Provision of HIPAA

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Of special interest to all behavioral health practitioners (both Covered Entities and NON-covered entities) is HIPAA's provision for psychotherapy notes. The privacy rule recognizes that psychotherapy notes need more protection than other types of PHI. Even if you are not a covered entity, we recommend understanding and implementing office procedures ...

Tags:  Specl: Behavioral Health|Psychiatry|Psychology    Topic: HIPAA   

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Medicare Coverage of Behavioral Health Services

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Tags:  Specl: Behavioral Health|Psychiatry|Psychology    Topic: CPT Coding    Topic: ICD9 Coding    Topic: Medicare   

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A Must Have for Every Dental Office!

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Don’t let managed dental plans sneak up on you! Announcing InstaCode's 2017 Reimbursement Guide for Dental with Medical crosswalks. We are excited to introduce a truly unique product that will be even more beneficial to the financial health of your practice. Some of the new features include: CDT, CPT, ICD-10-CM and HCPCS CDT to CPT ...

Tags:  Specl: Dental   

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Code Sets - Health Care Provider Taxonomy Code Set Link

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Every Provider needs to know their Health Care Provider Taxonomy Codes. The Taxonomy Codes define the provider type, classification, and area of specialization. We have provided a link and instructions to help you locate your code.

Tags:  Payer: CMS|Medicare    Specl: All Specialties    Topic: Medicare    Topic: Practice Management    Topic: Taxonomy Code Sets   

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Past Articles

Many of the following articles have been tagged with the tags shown above. These are displayed here again for historical purposes.

The following articles are published here and elsewhere on the Internet. If you would like to publish one of these articles on your website, please contact us and let us know which article you would like to publish and where you will be publishing it.

Articles: ICD-10

Articles: Medical Coding

Articles: Medical Billing

Articles: Medical Billing and Coding (General)


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