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Medical Coding and Billing Articles

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Alternative Payment Models (APMs) and Advanced APMs

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When CMS Released the NPRM regarding the Quality Payment Program (QPP), it included two payment tracks: MIPS and Advanced Alternative Payment Models (APMs). Accountable Care Organizations (ACOs), Patient Centered Medical Homes, and bundled payment models are some examples of APMs. So how do these payment models differ?  According to a fact sheet ...

Tags:  Topic: Fees    Topic: Medicare    Topic: Quality Payment Program   

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Assistant-At-Surgery Services

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An "assistant at surgery" is a physician who actively assists the physician in charge of a case in performing a surgical procedure. The "assistant at surgery" provides more than just ancillary services. Codes eligible for reimbursement for an assistant surgeon are designated by the Centers for Medicare and Medicaid Services (CMS) ...

Tags:  Payer: CMS|Medicare    Specl: General Surgery    Topic: Billing    Topic: Modifier Coding   

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How APC Payment Rates Are Set

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The payment rates for most separately payable medical and surgical services are determined by multiplying the prospectively established scaled relative weight for the service’s clinical APC by a conversion factor (CF) to arrive at a national unadjusted payment rate for the APC.

Tags:  Payer: CMS|Medicare    Topic: APC Coding    Topic: HCPCS Coding   

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Links Gone Bad

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Thank you for using the resources links for your book. Unfortunately, sometimes when we include information in our books, that information is changed or even removed by the original source. We tried to find an alternative, but were not able to do so. As a result, this resource is no ...

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ABN FAQs

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This handy FAQ addresses the uses and mis-uses of the ABN form.

Tags:  Payer: CMS|Medicare    Specl: All Specialties    Topic: Medicare   

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Benchmarks

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Benchmarking is simply a standard or point of reference against which things may be compared or assessed. For all businesses, it is a way of comparing your business processes to another business in the same industry to determine where shortfalls exist or improvements can be made to maintain profitability.

Tags:  Topic: Auditing    Topic: Compliance    Topic: CPT Coding    Topic: Practice Management   

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NAMAS: 2017 CPT Updates Bring Big Changes to Physical Therapy

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For 2017, the new physical therapy (PT), occupational therapy (OT), and athletic training (AT) evaluation codes are the first major changes to the physical medicine and rehab codes in over twenty years. The new evaluation codes (97161-97168) replace the current PT and OT evaluation codes 97001 and 97003. The...

Tags:  Specl: Physical Medicine|Physical Therapy    Topic: Coding    Topic: CPT Coding   

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VACCINE AND VACCINE ADMINISTRATION PAYMENTS UNDER MEDICARE PART D

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Please note: The information in this publication applies only to Medicare Part D; the Prescription Drug Benefit. Except for vaccines covered under Medicare Part B, Medicare Part D plans cover all commercially available vaccines as long as the vaccine is reasonable and necessary to prevent illness. Health care professionals (sometimes known as ...

Tags:  Payer: CMS|Medicare    Topic: Medicare    Topic: Pharmaceutical   

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CMS Announces Additional Opportunities for Clinicians Under the Quality Payment Program

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Today, the Centers for Medicare & Medicaid Services (CMS) announced more new opportunities for clinicians to join Advanced Alternative Payment Models (APMs) to improve care and earn additional incentive payments under the Quality Payment Program, which implements the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Beginning in January...

Tags:  Payer: CMS|Medicare    Topic: Quality Payment Program   

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International Classification of Diseases (ICD)-10 Code Updates and Impact to 4th Quarter 2016 Eligible Professional Medicare Quality Programs

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On October 1, 2016, new International Classification of Diseases (ICD)-10-CM and ICD-10-PCS code sets went into effect. Updating of these codes traditionally occurs on an annual basis, however, during the immediate years leading up to the ICD-9 to ICD-10 transition there was an extended freeze to code updates to support...

Tags:  Payer: CMS|Medicare    Topic: PQRS   

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Health Risk Assessment

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Risk Adjustment models are used to calculate risk scores used in predicting average beneficiaries healthcare expenditures. Currently Medicare Advantage and Prescription Drug programs include a risk adjustment as a component of the bidding and payment process to standardize bids, compare bids, and adjust plan payments. If you are not familiar ...

Tags:  Payer: CMS|Medicare    Specl: All Specialties    Topic: Coding   

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60 Day Final Rule

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Effective March 14, 2016, the CMS Final Rule clarifying the standards for handling overpayments for both Medicare and Medicaid takes effect. Failure to report and subsequently return an overpayment within 60 days after the overpayment was “identified” is a violation of the False Claims Act.

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

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Discounts

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All healthcare providers need to be aware that there are both appropriate and inappropriate ways to discount your fees. Both state and federal laws can impact your practice financial policy regarding fee discounts. Additionally, we recommend carefully reviewing either Chapter 1.5-Fees of the Behavioral Health DeskBook or the Insurance and Reimbursement chapter ...

Tags:  Topic: Billing    Topic: Practice Management   

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Workers Compensation

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Workers’ Compensation is for work related illness or injuries on the job. The employer pays for insurance which covers medical costs incurred, and replaces lost wages. Fees are based on a specific fee schedule that varies by state. There are three possible scenarios regarding workers’ compensation: the patient is covered by ...

Tags:  Topic: CPT Coding    Topic: Workers Compensation   

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New Mapping Tool - CPT/HCPCS Medicare Denial Rates & Average Charges

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Use this tool as a part of an important strategy to improve your processes and stay ahead of denials. Check your most commonly used codes to give your practice a heads up on denial rates and average charges. This is a quick way to view a group of codes or ...

Tags:  Topic: CPT Coding    Topic: ICD9v3 Coding   

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Medical Billing and Coders Professional Liability

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Companies who regularly handle such sensitive information as patient medical records have a particular responsibility to maintain the confidentiality of the data. Failure to exercise the appropriate degree of care – whether intentional or not – can have a significant adverse financial impact on your firm. The Federal Health Insurance Portability ...

Tags:  Specl: Billing    Topic: Coding    Topic: HIPAA    Topic: Practice Management   

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E/M 101

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E/M stands for "evaluation and management". E/M coding is the process by which provider-patient encounters are translated into five digit CPT codes to facilitate billing. CPT stands for "current procedural terminology." These are the numeric codes which are submitted to insurers for payment. Most billable procedures have their own CPT ...

Tags:  Specl: Billing    Topic: CPT Coding    Topic: Practice Management   

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What is the Quality Payment Program?

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If you are a part of the team of Medicare’s Part B clinicians, Medicare is providing you with a new quality payment program. You will get to chose from Advanced Alternative Payment Models (APMs or Merit-Based incentive Payment system (MIPS). The MIPS is a new program that combines parts of ...

Tags:  Topic: Medicare   

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Advanced Life Support Ambulance Services: Insufficient Documentation

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Ambulance suppliers often submit Medicare claims for Advanced Life Support (ALS) ambulance services which lack sufficient medical record documentation. The 2015 Comprehensive Error Rate Testing (CERT) Report states that the improper payment rate for ALS services was 14.5 percent with improper payments projected at $226 million. The most frequent errors ...

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You can charge for Advanced Care Planning (ACP)

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Did you know you could be charging for Advanced Care Planning (ACP). Effective January 1, 2016, payment for the service described by CPT code 99497 (Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or ...

Tags:  Topic: CPT Coding   

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Past Articles

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Articles: ICD-10

Articles: Medical Coding

Articles: Medical Billing

Articles: Medical Billing and Coding (General)


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