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June 27th, 2017
Modifier JW With Drug Codes
By Find-A-Code | Published June 27th, 2017
Modifier JW
In the past, some Medicare Administrative Contractors have required providers to report wasted drugs with modifier JW (Drug amount discarded/not administered to any patient). Use of the modifier was at the contractor’s discretion, and some contractors told providers not to report it. But effective January 1, 2017, all providers ...
By Chris Woolstenhulme, CPC, CMRS | Published June 20th, 2017
Due to the cost and refills that is required with portable oxygen systems separate payment classes were added in 2007 for oxygen generating portable equipment. Each year, Payment Classes for Oxygen Generating Portable Equipment, Stationary Oxygen Contents, and Portable Oxygen Contents, are adjusted to make additional payment classes for oxygen ...
CMS Overpaid Providers $729 Million in Incentive Payments
By Chris Woolstenhulme, CPC, CMRS | Published June 16th, 2017
Medicare paid hundreds of millions in electronic health record incentive payments that did not comply with federal requirements according to the OIG. The OIG estimated CMS inappropriately paid $729,424,395 to EPs who did not meet the requirements for meaningful use.
Eligible professional’s (EP’s) are physicians, dentists, podiatrists, optometrists or chiropractors, if ...
Negotiating Free Rent – For Medical Professional Tenants
By Jeff Grandfield and Dale Willerton – The Lease Coach | Published June 15th, 2017
Free rent is just one negotiable factor in a commercial lease. To be clear, free rent is a period of time where you are not paying the Base or Minimum Rent (but are, typically, paying your Operating Costs) and you are open for business. Many medical professional tenants confuse this ...
By Chris Woolstenhulme, CPC, CMRS | Published May 25th, 2017
Do you need help with cases and calculating groups of Risk Scores?
Per customers request, Find-A-Code now offers BULK entry for calculating for Risk Scores. The HCC Risk tool offers two options for calculating risk scores, we now offer a BULK calculation for cases or the calculation for a single enrollee.
To use the BULK calculation for cases
Create ...
By Chris Woolstenhulme, CPC, CMRS | Published May 25th, 2017
Risk Adjustments are used to access an illness or severity and comparing classifications of diseases using diagnosis codes.
Find-A-Code gives you the ability to search for risk codes used for calculations on an individual code or calculator for a group of codes to quickly calculate a risk score.
Keep in mind prior ...
Prescribers, including dentists, who write prescriptions for Part D drugs are to be enrolled in an approved status or validly opted out with Medicare, in order for their patients’ prescriptions to be covered under Medicare Part D.
Full enforcement of Part D prescriber enrollment requirement will begin on January 1, 2019. ...
By Chris Woolstenhulme, CPC, CMRS | Published April 24th, 2017
Medicare has given the option for participation in the Quality Payment Program offering two tracks you can choose from as well as the option to pick your pace. You can choose to start anytime between January 1 and October 2, 2017:
Advanced Alternative Payment Models (APMs) or
The Merit-based Incentive Payment System ...
Office of Inspector General (OIG) - Compliance Program Guidance
By Chris Woolstenhulme, CPC, CMRS | Published April 14th, 2017
The compliance program guidance documents are listed below.
09-30-2008Supplemental Compliance Program Guidance for Nursing Facilities (73 Fed.Reg. 56832; September 30, 2008)
Compliance Program Guidance for Nursing Facilities (65 Fed. Reg. 14289; March 16, 2000)
11-28-2005Draft Compliance Program Guidance for Recipients of PHS Research Awards (70 Fed.Reg. 71312; November 28, 2005)
NSTC Launches Government-Wide Initiative ...
By Chris Woolstenhulme, CPC, CMRS | Published April 14th, 2017
The Office of Inspector General (OIG) has the responsibility to identify and detect fraud, waste, and abuse for the United States Department of Health and Human Services (HHS) (also known as the Health Department). The mission of the U.S. Department of Health and Human Services is to enhance and protect ...
Definitions for Character #3 of PCS Codes Medical and Surgical Root Operations
By Chris Woolstenhulme, CPC, CMRS | Published April 12th, 2017
Character #3 of PCS codes Medical and Surgical Root operations definitions
Alteration
Modifying the anatomic structure of a body part without affecting the function of the body part
Bypass
Altering the route of passage of the contents of a tubular body part
Change
Taking out or off a device from a body part, and putting back an ...
On February 3, 2017, the Department of Justice (DOJ) issued a Final Rule to increase the civil monetary penalties assessed under the False Claims Act (FCA), due to inflation for the year 2017, to an all-time high of $10,957 (minimum) to $21,916 (maximum). Thirty years ago, in 1986, Congress amended the False ...
Q: I have recently hired a new staff person. We have conducted training and I feel like she is a great addition to my practice. However, a couple of the basic job duties and required procedures we have in place aren't being done as efficiently as they had been with ...
Expect the biggest set of CCI changes you’ll see in 2014 to take effect on Jan. 1, as the edits are synched up to CPT® and HCPCS code changes that start next year. There are 61,120 new edit pairs coming next year, along with 13,107 deletions and 137 modifier changes....
The final sub-component of Medical Decision Making is the Risk of Significant Complications, Morbidity and/or Mortality. The following is the official Evaluation and Management Table of Risk. The level is selected by choosing one element from three criteria (Presenting Problem, Diagnostic Procedures Ordered, and Management Options), with the highest level selected ...
Tags: Specl: All Specialties Topic: E+M Documentation and Coding
Newly Revised "Common Procedure Codes" section in the 2016 ChiroCode DeskBook
By Evan M. Gwilliam, DC MBA BS CPC CCPC NCICS CPC-I CCCPC MCS-P CPMA | Published March 29th, 2017
The force used to create a degree of tension of soft tissues and/or to allow for separation between joint surfaces. The degree of traction is controlled through the amount of force (pounds) allowed, duration (time), and angle of pull (degrees) using mechanical means. Terms often used in describing pelvic/cervical traction ...
Caution needs to be observed when reporting post-operative pain management (POPM). In accordance with NCCI edits policies, postoperative pain management is considered bundled in the surgical code(s). There are only a few instances where it may be billed separately.
Medicare Global Surgery Rules prevent separate payment for postoperative pain management when ...
Tags: Specl: Anesthesia|Pain Management Specl: General Surgery Topic: CPT Coding
Double Dipping in the History of the Evaluation and Management Note
By Aimee Wilcox, MA, CST, CCS-P, CPMA | Published March 3rd, 2017
There are many rules and guidelines a coder must be aware of when it comes to appropriately selecting an Evaluation and Management (EM) code and avoiding doubling dipping is one of them. Double dipping occurs when the same information is used in more than one of the subcomponents of history.
The subcomponents of history include:
Chief Complaint ...
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