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Medical Coding and Billing Articles

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A Coder’s Insight into Diagnosis Coding

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To assign an accurate diagnosis code, you need the most specific ICD-9- CM code available for a documented condition and the same will be true when ICD-10 becomes our coding system. Now is the time, if you haven’t already, to look at how you chooseyour codes and to work with ...

Tags:  Topic: CPT Coding    Topic: Denial Management    Topic: Diagnosis Coding    Topic: Procedure Coding   

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So How Do I Get Paid for This? APC, OPPS, IPPS, DRG?

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You know how to find a procedure code and you may even know how to do the procedure, but where does the reimbursement come from?  It seems to be a mystery to many of us, so let's clear up some common confusion and review some of the main reimbursement systems.  One of the ...

Tags:  Topic: Facilities    Topic: Fees    Topic: Hospital    Topic: Payment Models   

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Attention Chiropractors!

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Find-A-Code has created a TOPIC page specifically for Chiropractors. Check it out! We have simplified your search with Articles, Tips, Webinars, and Tools all in one place for your convenience. Be sure to visit us today. Simply go to Findacode.com then hover over TOPICS at the top of the page, then select Chiropractic. ...

Tags:  Specl: Chiropractic   

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Are You Aware of Medicare Advantage Plans Timely Filing Rules?

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The Medicare Fee for Service (FFS) program (Traditional or Original Medicare) has a timely filing requirement; a clean claim for services rendered must be received within one year of the date of service or risk payment denial. As any company who has billed Medicare services can attest, the one-year timely filing ...

Tags:  Loc: All Locations    Payer: All Payers    Payer: CMS|Medicare    Specl: All Specialties    Topic: Appeals    Topic: Billing    Topic: Coding    Topic: Compliance    Topic: CPT Coding    Topic: Denial Management    Topic: Insurance    Topic: Medicare    Topic: Medicare Secondary Payer    Topic: Payer Guidelines    Topic: Practice Management    Topic: Reimbursement   

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A Step by Step Guide to Medical Billing

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The next 4 weeks we will be providing you with a step by step guide to why medical billing is now part of our Dental future. Dental surgery is performed to treat various conditions of the teeth, jaws, and gums. Surgical procedures that dentists perform include dental implants, treatment for temporomandibular ...

Tags:  Specl: Dental    Specl: Oral and Maxillofacial Surgery   

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Understanding Payment Indicators

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Understanding how payment works with Medicare payment indicators and the impact a modifier has on payment is vital to pricing. Even if you are not billing Medicare, most carriers follow Medicare's policies for participating and non-participating rules.  Here is an article from Regence on their policy statement, describing the rules ...

Tags:  Topic: Coding    Topic: CPT Coding    Topic: Facilities    Topic: Modifier Coding   

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Medical ID Theft

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Medical ID Theft "So, do you guys think you can do something with that?" John asked angrily at our first meeting with him in August 2017 as he slammed a stack of medical bills, EOBs and collection letters - three inches high - down in front of my partner and I. ...

Tags:  Specl: Acupuncture|Alternative    Specl: Allergy|Immunology    Specl: Ambulance    Specl: Anesthesia|Pain Management    Specl: Behavioral Health|Psychiatry|Psychology    Specl: Billing    Specl: Cardiology|Vascular    Specl: Chiropractic    Specl: Dental    Specl: Dermatology|Plastic Surgery    Specl: Emergency Medicine    Specl: Endocrinology    Specl: ENT|Otolaryngology    Specl: Gastroenterology    Specl: General Surgery    Specl: Home Health|Hospice    Specl: Internal Medicine    Specl: Interventional Radiology    Specl: Neurology|Neurosurgery    Specl: Obstetrics|Gynecology    Specl: Ophthalmology    Specl: Optometry    Specl: Oral and Maxillofacial Surgery    Specl: Orthopedics    Specl: Pediatrics    Specl: Physical Medicine|Physical Therapy    Specl: Pulmonology    Specl: Radiology    Specl: Rheumatology    Specl: Skilled Nursing    Specl: Urology|Nephrology   

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How to Properly Report Prolonged Evaluation and Management Services

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Have you ever had a patient take more time with the provider than they were scheduled for? Do you understand which codes to report and the rules that govern them to allow for better reimbursement? Prolonged Service codes were created just for that reason but you must carefully follow the documentation ...

Tags:  Loc: All Locations    Payer: All Payers    Specl: All Specialties    Specl: Behavioral Health|Psychiatry|Psychology    Topic: Billing    Topic: Coding    Topic: CPT Coding    Topic: E+M Documentation and Coding    Topic: Procedure Coding   

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Healthcare Common Procedure Coding System (HCPCS)

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There are three main code sets and Healthcare Common Procedure Coding System (HCPCS), is the third most common code set used. They are often called Level II codes and are used to report non-physician products supplies and procedures not found in CPT, such as ambulance services, DME, drugs, orthotics, supplies, ...

Tags:  Topic: CDT (Dental) Codes    Topic: Denial Management    Topic: Diagnosis Coding    Topic: DME    Topic: HCPCS Coding   

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Will Medicare Change Their Rules Regarding Coverage of Services Provided by a Chiropractor?

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Two separate pieces of legislation introduced in the House of Representatives (H.R. 2883 and H.R. 3654) have the potential to change some of Medicare’s policies regarding doctors of chiropractic. Find out what these two bills are all about and how they could affect Medicare policies.

Tags:  Payer: CMS|Medicare    Specl: Chiropractic    Topic: Compliance    Topic: CPT Coding   

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Q/A: I Billed 2 Units of L3020 and Claim was Denied. Why?

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Question: We billed 2 units of L3020 but were denied for not using the right modifiers. What should we do? Answer: Rather than submitting two units of the L3020 to indicate that the patient one orthotic for each foot, you would need to use modifiers identifying left foot and right foot. Appropriate coding ...

Tags:  Topic: HCPCS Coding    Topic: Modifier Coding   

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The OIG Work Plan: What Is It and Why Should I Care?

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The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ...

Tags:  Specl: Acupuncture|Alternative    Specl: All Specialties    Specl: Allergy|Immunology    Specl: Ambulance    Specl: Anesthesia|Pain Management    Specl: Behavioral Health|Psychiatry|Psychology    Specl: Billing    Specl: Cardiology|Vascular    Specl: Chiropractic    Specl: Dental    Specl: Dermatology|Plastic Surgery    Specl: Emergency Medicine    Specl: Endocrinology    Specl: ENT|Otolaryngology    Specl: Gastroenterology    Specl: General Surgery    Specl: Home Health|Hospice    Specl: Internal Medicine    Specl: Interventional Radiology    Specl: Laboratory|Pathology    Specl: Neurology|Neurosurgery    Specl: Obstetrics|Gynecology    Specl: Oncology|Hematology    Specl: Ophthalmology    Specl: Optometry    Specl: Oral and Maxillofacial Surgery    Specl: Orthopedics    Specl: Pediatrics    Specl: Physical Medicine|Physical Therapy    Specl: Podiatry    Specl: Primary Care|Family Care    Specl: Pulmonology    Specl: Radiology    Specl: Rheumatology    Specl: Skilled Nursing    Specl: Urology|Nephrology    Topic: Compliance    Topic: Medicaid    Topic: Medicare    Topic: OIG   

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CMS Proposes to Reverse E/M Stance to Align with AMA Revisions

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On July 29, 2019, CMS released their proposed rule for the Medicare Physician Fee Schedule for 2020. Last year’s final rule “finalized the assignment of a single payment rate for levels 2 through 4 office/outpatient E/M visits beginning in CY 2021.” It also changed some of the documentation requirements (e.g., ...

Tags:  Topic: CPT Coding    Topic: E+M Documentation and Coding    Topic: HCPCS Coding    Topic: Procedure Coding   

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Q/A: What if my Patient Refuses to Fill out the Outcome Assessment Questionnaire?

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Question: What if my Medicare patient refuses to fill out the outcome assessment questionnaire? Answer: Inform the patient that Medicare requires that you demonstrate functional improvement in order for them to determine if the care is medically necessary. In other words, they may have to pay for the care out of pocket if ...

Tags:  Specl: Chiropractic    Topic: Assessment Tools    Topic: Documentation   

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The Slippery Slope For CDI Specialists

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Who knew that when Jack & Jill when up the hill to fetch a pail of water, they would have to ensure that in order to keep the level of water the same on the way back down, they would need to both support the pail.  Many of you in this industry are ...

Tags:  Payer: CMS|Medicare    Specl: Billing    Topic: Auditing    Topic: Medicare   

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The Role of Chiropractic in Value Based Payment Systems

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Chiropractic care can play a valuable role in overall patient health. It is important to realize that chiropractors can effectively participate in Medicare's new value based payment systems. Read about one organization who has made this transition.

Tags:  Specl: Chiropractic    Topic: Health Care Reform    Topic: Practice Management   

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Q/A: How do I Bill Mobile Clinic Services?

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Question: I have a part time mobile clinic. I travel to treat patients at their homes. Are there special considerations when billing for these encounters?

Tags:  Specl: Chiropractic    Topic: Billing    Topic: Coding   

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Anthem is Changing their Timely Filing Requirements for All Plans, Including Medicare Advantage

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Anthem has been very busy sending out notices stating that, beginning October 1, 2019, all timely filing deadlines for claims will be 90 days. We've seen this letter, or something very similar, sent to doctors and other healthcare providers from California to Kentucky. In their notice, Anthem states: "Effective for all commercial ...

Tags:  Payer: Aetna    Payer: CMS|Medicare    Specl: All Specialties    Topic: Claims Processing   

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Tips to Preventing Audits

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There is an ever-increasing number of dental claims that have come under scrutiny for fraud. One such payer, Aetna, is actively pursuing dental fraud by employing their special investigative units (SIUs) to identify and investigate providers who demonstrate unusual coding and billing practices. When payers identify the activities they deem ...

Tags:  Specl: Dental    Specl: Oral and Maxillofacial Surgery    Topic: Auditing   

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Q/A: What do I Need to Document for Periodic Adjustments on a Medicare Patient?

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Question: What type of documentation is required for a Medicare patient with degenerative joint disease who get adjusted once or twice a month for occasional flare-ups of the D. J. D. region? The noted adjustments give good relief of the patient's symptoms. Answer: There is no question that these adjustments would be considered ...

Tags:  Specl: Chiropractic    Topic: Documentation    Topic: Medicare   

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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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