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Recent articles:Click on the title to see the article summary and a link to the full article. May 21st, 2019 RT and LT Modifier Usage Change (effective 2019-03-01)| Published May 21st, 2019 According to Noridian Medicare, there are new changes required when reporting the RT and LT modifier(s). In the past, it was appropriate to bill the RT and LT modifier on the same line when it was required for certain HCPCS codes. Noridian released a publication stating claims reported with RT/LT on the same ... Tags: Specl: All Specialties Specl: Dermatology|Plastic Surgery Specl: Orthopedics Specl: Physical Medicine|Physical Therapy Specl: Podiatry May 17th, 2019 An Update on the DHS OIG's Effort to Combat Fraud & Abuse| Published May 17th, 2019 - Last Review/Update May 21st, 2019 An Update on the DHS OIG's Effort to Combat Fraud & Abuse
Every year, the Department of Health and Human Services (DHS) Office of Inspector General (OIG) is required by law to release a report detailing the amounts deposited and appropriated to the Medicare Trust Fund, and the source of such ... Tags: Specl: All Specialties Topic: Billing Topic: Fraud Topic: OIG May 14th, 2019 Spotlight: QPro Blogs| Published May 14th, 2019
Look for important tips and updates for the medical industry on the QPro Blog!
The link to the blog is available from the Medical page under the Industries tab.
Use the search bar to look up topics and specialties.
View the blogs page here.
... Tags: May 13th, 2019 Q/A: Two Payers Both Paid the Claim. Who Gets the Refund?| Published May 13th, 2019 Question
We have a personal injury situation where we submitted a claim was sent to the patient's auto policy carrier who refused payment. We then submitted it to her other insurance. Eventually, both companies paid her claims. Her auto paid at full value, and her secondary paid at a reduced rate ... Tags: Topic: Billing Topic: Compliance Topic: Practice Management May 13th, 2019 Prioritize Your Patient's Financial Experience| Published May 13th, 2019 For many years, the ChiroCode DeskBook has emphasized the need for providers to firmly establish the patient’s financial responsibility through clear communication. We even created a “Patient Financial Responsibility Acknowledgment Form” to help providers with this process. Lately, the lack of pricing transparency has been in the news and even ... Tags: Topic: Billing Topic: Collections Topic: Practice Management May 13th, 2019 Electrical Stimulation and Electromagnetic Therapy Devices| Published May 13th, 2019 - Last Review/Update May 20th, 2019 Electrical Stimulation and Electromagnetic Therapy Devices can be used for pain, muscle atrophy, help spinal cord injuries, treat symptoms caused by other medical conditions and can be used in the treatment of wounds. This Regence BC/BS article lists codes and devices and gives guidance on coding from Medicare Advantage viewpoint. Tags: Loc: Idaho Loc: Oregon Loc: Utah Loc: Washington Payer: BC|BS Specl: Anesthesia|Pain Management Specl: Chiropractic Specl: Neurology|Neurosurgery Specl: Physical Medicine|Physical Therapy Topic: Billing Topic: Coding Topic: CPT Coding Topic: DME Topic: Documentation Topic: HCPCS Coding Topic: ICD9 Coding Topic: Payer Guidelines Topic: Supply Coding May 8th, 2019 Facts on Procedure Codes| Published May 8th, 2019
There are two levels of codes used for services and procedures:
Level I Codes are used for Services and Procedures provided by physicians.
5 digit numerical code, example, 99213 - Office or other outpatient visits
Level II Codes are used to bill Medical equipment supplies and transport services.
4 digit Alpha/Numerical code example, ... Tags: Topic: CPT Coding Topic: HCPCS Coding May 7th, 2019 Documentation of E/M services for Neurology (Don't Forget the Cardiology Element)| Published May 7th, 2019
According to Neurology Clinical Practice and NBIC, the neurologic exam is commonly lacking in documentation due to the extensive requirements needed to capture the appropriate revenue.
With the lack of precise documentation, it results in a lower level of E/M than that which is more appropriate, which can cost a physician a lot ... Tags: Specl: Neurology|Neurosurgery Topic: CPT Coding May 6th, 2019 HIPAA Violation Penalties Revised| Published May 6th, 2019 On April 30, 2019 The Department of Health and Human Services (HHS) announced that “HHS will apply a different cumulative annual CMP limit for each of the four penalties tiers in the HITECH Act.” Unlike other notices which require a proposed rule with a comment period, this notice will take ... Tags: Topic: HIPAA May 6th, 2019 Q/A: If Orthopedic Tests are Negative, do You List Them in Your Treatment Notes?| Published May 6th, 2019 Question: If orthopedic tests are negative, do you need to still list them in your treatment notes?
Answer: Yes. Any tests which are performed by a healthcare provider, regardless of the result, should be documented in the patient record. This record is the only way that a reviewer or another provider ... Tags: Specl: Orthopedics Topic: Documentation May 1st, 2019 Spotlight: UCR and Workers Comp Fees| Published May 1st, 2019 Access Usual, Customary, and Reasonable (UCR) rates and National Unadjusted Workers Compensation rates for your geographic area! Rates are displayed in a table as well as a graph for comparison with Medicare billed and Medicare allowed. UCR and Workers Comp Fees are available as an add on to any subscription... Tags: Topic: Workers Compensation May 1st, 2019 Spotlight: ASA Crosswalk| Published May 1st, 2019 Crosswalk from CPT Anesthesia codes (00100-01999) to Surgery and Procedure Codes! Let's look at anesthesia code 00100 as an example. The ASA Crosswalks are available under the Cross-A-Code bar. Click to expand. Look for the ASA CROSSWALK or ASA Reverse CROSSWALK bar. You will also see the CMS and ASA... Tags: Topic: CPT Coding May 1st, 2019 Spotlight: Anatomy Images| Published May 1st, 2019 When viewing CPT codes, Find-A-Code offers detailed anatomy images and tables to help with coding.
For example 28445 offers a table with information to assist classification of gustilo fractures:
Click on the image preview from the code information page to expand the image.
Tags: Topic: CPT Coding May 1st, 2019 Spotlight: Printing Additional Code Information| Published May 1st, 2019 Did you know you can print the information from Find-A-Code's code information pages?
Click the Printer icon on any code information page.
You can check/unckeck the boxes at the top to select what information you want to print:
It's that easy!
Tags: April 29th, 2019 Medicare Revises Their Appeals Process| Published April 29th, 2019 On April 12, 2019, Medicare announced that there will be some changes to their appeals process effective June 13, 2019. According to the MLN Matters release (see References), the following policy revisions in the Medicare Claims Processing Manual (MCPM), Chapter 29 are taking place:
The policy on use of electronic signatures
Timing ... Tags: Payer: CMS|Medicare Specl: All Specialties Topic: Appeals Topic: Billing Topic: Medicare April 29th, 2019 Q/A: I’m Being Audited? Is There a Documentation Template I can use?| Published April 29th, 2019 Question: Our Medicare contractor is auditing claims with 98942. Do you have any suggestions for a template for documentation to warrant the use of 98942?
Answer: When you submit a claim with code 98942 you are stating that you have determined that it was medically necessary to adjust all 5 of ... Tags: Specl: Chiropractic Topic: Auditing Topic: Compliance Topic: CPT Coding April 26th, 2019 Medicare Revises Their Appeals Process| Published April 26th, 2019 There are policy revisions in the Medicare Claims Processing Manual (MCPM), Chapter 29 taking place June 13, 2019. This will give you a heads up on those changes. Tags: Payer: CMS|Medicare Specl: All Specialties Topic: Appeals April 24th, 2019 Biofeedback - Is it Medically Necessary?| Published April 24th, 2019
Biofeedback is used for many reasons, and most commonly used for pain management. Each payer should be consulted with to verify coverage when treating with Biofeedback to verify if the treatment is considered experimental or investigational.
The majority of payers will list Biofeedback on an exclusions list. Others such as BC ... Tags: Specl: Behavioral Health|Psychiatry|Psychology Topic: CPT Coding Topic: HCPCS Coding April 23rd, 2019 OIG Announces New Review For Medicare Part B Payments for Podiatry and Ancillary Services| Published April 23rd, 2019 Due to prior OIG work identifying inappropriate payments for podiatrists and ancillary services, the OIG announced in Feb 2019 they will begin a new review starting in 2020. The OIG stated they will review Medicare Part B payments to determine if medical necessity is supported in accordance with Medicare requirements.
Part of the ... Tags: Specl: Podiatry Topic: Compliance Topic: OIG April 23rd, 2019 Let's Talk High Risk E/M Services| Published April 23rd, 2019 Have you ever assigned a high-complexity E/M code (e.g., 99205, 99215, 99223, 99233, 99245, etc.) and wondered if it would stand up to further scrutiny? Well, let’s take a closer look at the requirements for reporting high-level E/M services.
Both the American Medical Association and Medicare-published E/M Guidelines agree that a ... Tags: Loc: All Locations Payer: All Payers Specl: All Specialties Topic: Assessment Tools Topic: Auditing Topic: Billing Topic: Compliance Topic: CPT Coding Topic: Documentation Topic: E+M Documentation and Coding Topic: Guidelines and Manuals |
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