Select the title to see a summary and a link to the full article.
November 20th, 2019
VA: How UCR Charges are Determined
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published November 20th, 2019
How does the VA determine charges billed to third party payers for Veterans with private health insurance?
According to the VA. "38 C.F.R 17.101 stipulates the basic methodology by which VA bills third party insurance carriers. In order to generate a charge for medical services, VA establishes reasonable charges for five ...
tags Payer: VA - Veterans Administration Topic: Fees
Q/A: Q/A: How do I Code a Procedure for the Primary Insurance so the Secondary Can Get Billed?
By Wyn Staheli, Director of Research | Published November 19th, 2019
Question: How do you modify a code submitted to the primary insurance company to let them know it is not covered by them so you can bill to a secondary?
Medical Insurance Coverage for TMJ Disorders (TMD)
By Christine Taxin | Published November 19th, 2019 - Last Review/Update November 20th, 2019
It is agreed that TMJ disorders should be covered by insurance. There are often questions whether it is covered by medical insurance or dental insurance and where the line is that separates coverage.Medical Insurance typically is the primary insurance for TMJ disorders. The reason is that joints are found anywhere ...
tags Specl: Billing Specl: Dental Specl: Oral and Maxillofacial Surgery Topic: Claims Processing
By Christine Taxin | Published November 18th, 2019
Documenting Medical NecessityTo receive reimbursement from medical insurers, you need to make a case that proves that dental surgery is necessary for the patient. To make your case, you need to explain your decision process in terms that a medical insurer can understand, using ICD-10 codes and CPT codes. These ...
tags Specl: Dental Specl: Oral and Maxillofacial Surgery Topic: Claims Processing Topic: CMS1500
By Wyn Staheli, Director of Research | Published November 12th, 2019
Final rule eliminates the requirement for health plans to obtain a unique health plan identifier (HPID) and also eliminates the voluntary use of the other entity identifier (OEID). This change becomes effective December 27, 2019.
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published November 11th, 2019
Find-A-Code offers fees and pricing for just about everything, this article will address two of some of the most common payment systems with CMS. (OPPS) -Outpatient Medicare Outpatient Prospective Payment System. (MPFS)- Medicare Physician Fee Schedule The Fees section on each code page is determined on the type of services...
tags Payer: CMS|Medicare Specl: All Specialties Topic: CMS1500 Topic: Fees Topic: UB04 Form and Coding
Are you providing TMD treatment and having a hard time receiving payment from Medical? Take a look at the law for your state!
By Christine Taxin | Published November 3rd, 2019 - Last Review/Update November 7th, 2019
TM TREATMENT AND THIRD PARTY INSURANCE COVERAGEMinnesota, in 1987, became the first state to adopt legislation requiring health insurance policies issued within the state to include coverage for the diagnosis and treatment of temporomandibular (TMD) joint disorders and craniomandibular (CMD) disorders on the same basis as other joint disorders. At ...
tags Loc: Arkansas Loc: California Loc: Florida Loc: Georgia Loc: Illinois Loc: Kentucky Loc: Maryland Loc: Minnesota Loc: Mississippi Loc: Nevada Loc: New Mexico Loc: North Carolina Loc: North Dakota Loc: Tennessee Loc: Texas Loc: Vermont Loc: Virginia Loc: Washington Loc: West Virginia Loc: Wisconsin Specl: Dental Specl: Oral and Maxillofacial Surgery
Medically Unlikely Edits (MUEs): Unlikely, But Not Always Impossible
By Namas | Published October 18th, 2019 - Last Review/Update October 23rd, 2019
Medically Unlikely Edits (MUEs) were created by the Centers for Medicare & Medicaid Services (CMS) to help lower the error rate for paid Part B claims. MUEs are the maximum units of a HCPCS or CPT code that a provider would bill under most circumstances for the same patient on ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published October 15th, 2019
Genetic testing is becoming very popular. In fact, so popular you might see it in places you would not expect such as a community event, fairs or any event happening in your community. Some labs may even offer FREE screening for genetic testing. Watch for FREE screening announcements or advertisements ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published October 15th, 2019
Have you noticed your LCDs are missing something? CMS is moving codes out of LCDs and into Billing and Coding Articles. MACs began moving ICD-10-CM, CPT/HCPCS, Bill Type, and Revenue codes in January 2019, and will continue through January 2020. Therefore, if there is an LCD with its codes removed, you will find ...
tags Payer: CMS|Medicare Specl: All Specialties Topic: LCDs and NCDs
By Namas | Published October 11th, 2019 - Last Review/Update October 15th, 2019
Why is HIPAA So Important?
Some may think that what they do to protect patient information may be a bit extreme. Others in specialty medical fields and research understand its importance a little more. Most of that importance lies in the information being protected. Every patient has a unique set of ...
tags Payer: CMS|Medicare Specl: All Specialties Topic: HIPAA Topic: Practice Management
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published October 10th, 2019
There are a few payers that have joined with CMS in discontinuing payment for consultation codes. Most recently, Cigna stated that, as of October 19, 2019, they will implement a new policy to deny the following consultation codes: 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254 and 99255.
United Healthcare announced they ...
tags Topic: CPT Coding Topic: E+M Documentation and Coding
Regence: Dental Procedures Under The BlueCard Program?
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published October 1st, 2019
This information can be found on Regence/Blue Cross Dental procedures explaining additional benefits for dental procedures. Regence currently does not offer dental benefits, however, there are times a patient can receive treatment with a Blue Cross provider and qualify under their medical benefits. In addition, Regence informs the providers to file these claims ...
tags Loc: All Locations Payer: BC|BS Specl: Dental Topic: Billing
2020 Official ICD-10-CM Coding Guideline Changes Are Here!
By Wyn Staheli, Director of Research | Published October 1st, 2019
It’s that time of year for offices to get ready for the ICD-10-CM code revisions. As part of that process, it’s also good to know what is going on with the ICD-10-CM Official Guidelines for Coding and Reporting. In the examples listed below, strikeout text is deleted and highlighted text ...
tags Specl: All Specialties Topic: Compliance Topic: ICD10CM Coding
By Wyn Staheli, Director of Research | Published October 1st, 2019
When federal employees sustain work-related injuries, it does not go through state workers compensation insurance. You must be an enrolled provider to provide services or supplies. The following are some recommended links for additional information about this program.
Division of Federal Employees' Compensation (DFEC) website
Division of Federal Employees' Compensation (DFEC) provider ...
Do ICD-10 Updates Have Your Heart Beating Irregularly? Check Out the New Atrial Fibrillation Codes
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published October 1st, 2019
Atrial fibrillation (AF) is the most common type of abnormal heart rhythm (arrhythmia). It is caused by a disorder in the heart’s electrical system. AF is the result of abnormal contractions of the atria (upper two chambers of the heart) causing them to quiver and beat out of sync with ...
tags Loc: All Locations Payer: All Payers Specl: Billing Specl: Cardiology|Vascular Specl: Emergency Medicine Specl: Endocrinology Specl: General Surgery Specl: Internal Medicine Specl: Interventional Radiology Specl: Laboratory|Pathology Specl: Oncology|Hematology Specl: Orthopedics Specl: Pediatrics Specl: Primary Care|Family Care Specl: Pulmonology Specl: Radiology Specl: Skilled Nursing Topic: Coding Topic: ICD10CM Coding
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