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Measles Coding Considerations

by  Christine Geiger, MA, RHIA, CCS, CRC

Considering the increase in measles cases in the United States and globally, it is a great time to review how we code for this condition. According to Centers for Disease Control and Prevention (CDC) data, updated on May 30, so far this year we have had 1,088 domestic measles...

Medical Coding Haemophilus Influenzae

by  Janine Mothershed

Here's a clear and thorough guide for medical coding and billing for Haemophilus influenzae (H. influenzae) — not to be confused with the flu (influenza virus). This bacterium can cause serious invasive diseases like meningitis, epiglottitis, pneumonia, and sepsis. Common ICD-10 Diagnosis Codes: - A41.3...

What Coders Need to Know: Anticoagulant versus Antiplatelet – Coding Considerations

by  Christine Geiger, MA, RHIA, CCS, CRC

Continuing our look at areas where we see confusion we will examine the assignment of the long term use codes for anticoagulants versus antithrombotics/antiplatelets.  GoodRx.com, in an article titled, “Antiplatelet vs. Anticoagulant Blood Thinners – 4 Things to Know,” details the basics coders need to keep in mind when...

MLN Connects Newsletter

by  CMS - MLNConnects

Walkers: Prevent Claim Denials - Medicare Preventive Services — Revised

Dental Claims Requiring Use of ICD-10-CM Codes

by  Christine Taxin, President - Links2Success

Dental claims now require the use of ICD-10-CM codes. Several states (e.g., Arizona) have begun to mandate that diagnosis codes be reported along with dental codes on claim forms.

Security Risk Assessment Tool Updated

On November 1, 2024, the Office for Civil Rights (OCR) announced the release of their updated Security Risk Assessment (SRA) tool.

Reasons Why Your Attorney Shouldn’t Write a Refund Letter

by  David M. Glaser, Esq.

If your lawyer ever writes you a letter/email telling you to refund money, I recommend you get a new lawyer.  Now, it is very easy to misconstrue what I just said.  I am not suggesting in any shape, way, or form that a lawyer should not recommend that you...

New HIPAA Cybersecurity Rules Proposed

by  Wyn Staheli, Director of Content - innoviHealth

A Proposed Rule has been issued regarding HIPAA security to strengthen protections for electronic protected health information (ePHI). How will these changes impact your organization?

Consumer Health Plan Appeals

As part of the Patient Protection and Affordable Care Act (PPACA) of 2010, expanded appeal rights for patients have been granted in all states. These regulations grant the right to both an internal appeal through the insurance plan, as well as an independent external appeal.

Designation of Authorized Representative for Appeals

A Designation of Authorized Representative is a formal document (form) that allows a third party, such as a friend, family member, attorney, or healthcare provider, to act on behalf of the patient/beneficiary in handling specific aspects of an insurance claim or appeal

Managed Care Organizations (HMO, PPO, etc.)

Managed care is a type of health insurance system designed to reduce healthcare costs while ensuring high quality care through coordinated, cost-effective, and efficient delivery of services. Learn the characteristics of these types of programs.

Medicaid and Children’s Health Insurance Program (CHIP) Quality and Managed Care

Broadly speaking, managed care is a healthcare delivery system designed to control costs, improve quality, and manage how services are provided to enrollees. It integrates healthcare providers, hospitals, and insurers to coordinate patient care in a cost-effective way. Managed care often emphasizes preventive care, streamlined service delivery, and coordinated treatment plans.

What Medicaid Information is in Find-A-Code?

What are the Different Medicaid Payment Systems?

The Medicaid payment system, which funds healthcare for low-income individuals and families, is complex and varies by state. It generally works through a combination of fee-for-service (FFS) and managed care models, with federal and state governments sharing costs. This article contains information to help explain some of the different ways that Medicaid pays for healthcare services.

What is the Medicaid Chronic Illness and Disability Payment System (CDPS)?

The Medicaid Chronic Illness and Disability Payment System (CDPS) is a diagnostic-based risk adjustment model used to calculate payments for Medicaid health plans, particularly for those covering individuals with chronic illnesses and disabilities.

Veterans Administration Geographically-Adjusted 80th Percentile Conversion Factors

A conversion factor is a dollar amount that is applied to an adjusted Relative Value Unit (RVU) to arrive at a fee. Conversion factors can be based on a geographic location as well as a national level. The article contains information from the Veterans Administration about how they create their geographically-adjusted 80th percentile conversion factors.

Medicare Fee Schedule Information

Telehealth Policies in the Post-Pandemic Era

by  Kate Choi

Earlier this month, the Centers for Medicare & Medicaid Services (CMS) released its proposed Physician Fee Schedule for 2025 . A major component of the proposed rule is the telehealth policies, particularly given that major Medicare telehealth waivers are set to expire at the end of 2024. CMS has...

Where are UCR Fees Located in Find-A-Code?

by  Wyn Staheli, Director of Content - innoviHealth

UCR fees can be found in several places within Find-A-Code. The most commonly used place is found in the Fees section of the individual code. When you are on the code information page for a specific code, scroll down to the fees section and click on the bar titled “Fees” (as shown below) to open this section:

Does the Pro Fee Calculator Include UCR Fees?

by  Wyn Staheli, Director of Content - innoviHealth

Find-A-Code’s Pro Fee Calculator is an easy-to-use tool for calculating fees for CPT and HCPCS codes. Need to apply modifiers or additional units? The Pro Fee calculator can do this and much more. Check it out.


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