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Medical Coding and Billing Articles

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The Quality Payment Programs

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Medicare has given the option for participation in the Quality Payment Program offering two tracks you can choose from as well as the option to pick your pace. You can choose to start anytime between January 1 and October 2, 2017: Advanced Alternative Payment Models (APMs) or The Merit-based Incentive Payment System ...

Tags:  Topic: Medicare   

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Office of Inspector General (OIG) - Compliance Program Guidance

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The compliance program guidance documents are listed below. 09-30-2008Supplemental Compliance Program Guidance for Nursing Facilities (73 Fed.Reg. 56832; September 30, 2008) Compliance Program Guidance for Nursing Facilities (65 Fed. Reg. 14289; March 16, 2000) 11-28-2005Draft Compliance Program Guidance for Recipients of PHS Research Awards (70 Fed.Reg. 71312; November 28, 2005) NSTC Launches Government-Wide Initiative ...

Tags:  Topic: Compliance    Topic: CPT Coding    Topic: OIG   

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The Office of Inspector General (OIG)

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The Office of Inspector General (OIG) has the responsibility to identify and detect fraud, waste, and abuse for the United States Department of Health and Human Services (HHS) (also known as the Health Department). The mission of the U.S. Department of Health and Human Services is to enhance and protect ...

Tags:  Topic: OIG   

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Definitions for Character #3 of PCS Codes Medical and Surgical Root Operations

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Character #3 of PCS codes Medical and Surgical Root operations definitions Alteration Modifying the anatomic structure of a body part without affecting the function of the body part   Bypass Altering the route of passage of the contents of a tubular body part   Change Taking out or off a device from a body part, and putting back an ...

Tags:  Topic: Hospital    Topic: ICD10PCS Coding   

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False Claim Penalties Increase Again

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On February 3, 2017, the Department of Justice (DOJ) issued a Final Rule to increase the civil monetary penalties assessed under the False Claims Act (FCA), due to inflation for the year 2017, to an all-time high of $10,957 (minimum) to $21,916 (maximum). Thirty years ago, in 1986, Congress amended the False ...

Tags:  Specl: All Specialties    Topic: Compliance   

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Less Efficiency with New Employee - What to do?

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Q:  I have recently hired a new staff person.  We have conducted training and I feel like she is a great addition to my practice.  However, a couple of the basic job duties and required procedures we have in place aren't being done as efficiently as they had been with ...

Tags:  Topic: Admin   

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2014 brings big volume of changes to CCI edits

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Expect the biggest set of CCI changes you’ll see in 2014 to take effect on Jan. 1, as the edits are synched up to CPT® and HCPCS code changes that start next year. There are 61,120 new edit pairs coming next year, along with 13,107 deletions and 137 modifier changes....

Tags:  Topic: Coding    Topic: CPT Coding   

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National Association of Chiropractic Attorneys (NACA) Directory

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National Association of Chiropractic Attorneys (NACA) Directory Listed by state

Tags:  Specl: Chiropractic    Topic: Practice Management   

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E/M Table of Risk

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The final sub-component of Medical Decision Making is the Risk of Significant Complications, Morbidity and/or Mortality. The following is the official Evaluation and Management Table of Risk. The level is selected by choosing one element from three criteria (Presenting Problem, Diagnostic Procedures Ordered, and Management Options), with the highest level selected ...

Tags:  Specl: All Specialties    Topic: E+M Documentation and Coding   

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Newly Revised "Common Procedure Codes" section in the 2016 ChiroCode DeskBook

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The force used to create a degree of tension of soft tissues and/or to allow for separation between joint surfaces. The degree of traction is controlled through the amount of force (pounds) allowed, duration (time), and angle of pull (degrees) using mechanical means. Terms often used in describing pelvic/cervical traction ...

Tags:  Topic: CPT Coding    Topic: HCPCS Coding   

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Acute Postoperative Pain Management

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Caution needs to be observed when reporting post-operative pain management (POPM). In accordance with NCCI edits policies, postoperative pain management is considered bundled in the surgical code(s). There are only a few instances where it may be billed separately. Medicare Global Surgery Rules prevent separate payment for postoperative pain management when ...

Tags:  Specl: Anesthesia|Pain Management    Specl: General Surgery    Topic: CPT Coding   

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Double Dipping in the History of the Evaluation and Management Note

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There are many rules and guidelines a coder must be aware of when it comes to appropriately selecting an Evaluation and Management (EM) code and avoiding doubling dipping is one of them.  Double dipping occurs when the same information is used in more than one of the subcomponents of history. The subcomponents of history include: Chief Complaint ...

Tags:  Specl: All Specialties    Topic: Auditing    Topic: Coding    Topic: Compliance    Topic: CPT Coding    Topic: Documentation    Topic: E+M Documentation and Coding    Topic: Fraud   

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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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Past Articles

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Articles: ICD-10

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Articles: Medical Billing and Coding (General)


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