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Recent articles:Click on the title to see the article summary and a link to the full article. April 26th, 2018 Documenting DMEs| Published April 26th, 2018 As per MLN MM8304,
This article is based on Change Request (CR) 8304, which instructs DME MACs to implement requirements, which are effective July 1, 2013, for detailed written orders for face-to-face encounters conducted by the physician, PA, NP or CNS for certain DME items as defined in 42 CFR 410.38(g).
Due to concerns ... Tags: Specl: All Specialties Topic: DME Topic: HCPCS Coding Topic: Medicare April 20th, 2018 The PSAVE Pilot Program: Should You Self-Audit Your Medicare Claims?| Published April 20th, 2018 - Last Review/Update April 25th, 2018 As the Medicare program has grown, the Centers for Medicare and Medicaid Services (CMS) has employed a variety of different claims audit mechanisms to better ensure that the Medicare Trust Fund is protected from waste, fraud and abuse.... Tags: Payer: CMS|Medicare Specl: All Specialties Topic: Auditing Topic: Compliance Topic: Fraud April 19th, 2018 Proper Record Keeping and Documentation| Published April 19th, 2018
Proper record keeping and documentation is not only essential for today’s dental practitioner, but is also required by law. Moreover, correct, current and accurate records directly enhance patient care by enabling the dentist to plan treatments, monitor progress, and provide essential notations. Clear and concise treatment plans, medical alerts, and ... Tags: Specl: Dental Topic: Billing Topic: Documentation Topic: Practice Management April 19th, 2018 Coverage Criteria for Nonwearable Automatic Defibrillators| Published April 19th, 2018
According to Noridian and CGS Administrators LCD L33690, a nonwearable automatic defibrillator (E0617) is covered for beneficiaries in two circumstances. They meet either (1) both criteria A and B or (2) criteria C, described below:
The beneficiary has one of the following conditions (1-8):A documented episode of cardiac arrest due to ventricular fibrillation, not due to a ... Tags: Topic: DME Topic: HCPCS Coding Topic: LCDs and NCDs April 16th, 2018 Indications for Serotypes A and B Botulinum Toxins| Published April 16th, 2018
According to Novitas LCD L27476, the following indications apply:
1. Blepharospasm and strabismus2. Spastic dystonia or focal dystonias to relieve pain, to assist posturing and walking, to increase range of motion, to assist in the outcome of physical therapy, and/or to reduce spasm thus allowing adequate perineal hygiene.3. Spasmodic dysphonia4. Achalasia and cardiospasm when ... Tags: Topic: HCPCS Coding Topic: Medicare Topic: Pharmaceutical April 12th, 2018 Billing Nutrition Counseling in a Chiropractic Setting| Published April 12th, 2018
Billing nutrition counseling services may not be as straight-forward as you might think. Some providers mistakenly choose Medical Nutrition Therapy (MNT) codes (97802-97804, G0270, G0271) because it states nutrition therapy in the title. However, according to CPT guidelines, when MNT assessment and/or intervention is performed by a physician or qualified healthcare professional ... Tags: Specl: Chiropractic Topic: CPT Coding Topic: HCPCS Coding Topic: ICD9 Coding Topic: Modifier Coding Topic: Procedure Coding April 12th, 2018 Dentists Submitting Claims to Medicare| Published April 12th, 2018 When a Dental provider is treating a Medicare Beneficiary, it is important to get a copy of the Medicare card to verify the patient's medical benefits, provider eligibility and claims address/submission prior to submitting a claim. CMS is in the process of changing Medicare Policy Numbers, so you may see ... Tags: Specl: Dental Topic: Billing Topic: Practice Management April 12th, 2018 Use it or Lose it - How We Can Help!| Published April 12th, 2018 If you don’t use the correct information or document the proper information and submit a medical claim you will lose! You will lose reimbursement, could be excluded from participating in Federal Health Care programs, you could possibly lose your license and family time. The government has every tool they need, you ... Tags: Topic: Practice Management April 12th, 2018 Billing Nutrition Counseling| Published April 12th, 2018 Billing nutrition counseling services may not be as straight-forward as you might think. Some providers mistakenly choose Medical Nutrition Therapy (MNT) codes (97802-97804, G0270, G0271) because it states nutrition therapy in the title. However, according to CPT guidelines, when MNT assessment and/or intervention is performed by a physician or qualified healthcare professional who may report evaluation and management ... Tags: Specl: All Specialties Topic: CPT Coding Topic: HCPCS Coding Topic: ICD9 Coding Topic: Modifier Coding Topic: Procedure Coding April 9th, 2018 Using Pulmonary Stress Tests| Published April 9th, 2018
As per Palmetto GBA LCD L33444, exercise testing is done to evaluate functional capacity and to assess the severity and type of impairment of existing as well as undiagnosed conditions. The pulmonary stress test will be considered medically necessary for these conditions:INDICATIONS:Evaluation of exercise tolerance• Determination of functional impairment or capacity • ... Tags: Topic: CPT Coding April 9th, 2018 Coverage Criteria for Peripheral Venous Examinations| Published April 9th, 2018
According to National Government Services LCD L33627, indications for venous examinations are separated into three major categories: deep vein thrombosis (DVT), chronic venous insufficiency, and vein mapping. Studies are medically necessary only if the patient is a candidate for anticoagulation, thrombolysis or invasive therapeutic procedure(s).
Since the signs and symptoms of ... Tags: Topic: CPT Coding Topic: HCPCS Coding April 9th, 2018 CMS Compliance Guidelines Focused Trainings| Published April 9th, 2018 Since the publication of the Compliance Program Guidelines in 2012, the Medicare Part C & D Oversight and Enforcement Group, Division of Compliance Enforcement, has presented a series of focused trainings for the industry on the application of the seven elements of an effective compliance program. These trainings are designed ... Tags: Payer: CMS|Medicare Topic: Compliance April 4th, 2018 What Do Patients Expect in 2018?| Published April 4th, 2018 - Last Review/Update April 12th, 2018 Evolutions in technology continue to merge with a trend toward consumerism in healthcare. As a result, patients are expecting a different kind of experience in managing their healthcare.... Tags: Topic: Billing Topic: Practice Management Topic: Technology March 29th, 2018 Medicare Telemedicine Changes for 2018| Published March 29th, 2018
Find-A-Code presented a webinar on “Coding and Auditing Telemedicine Services,” on March 29, 2018, which did not include the new and updated CMS information published in the MNL Matters Number: MM10393 on January 2, 2018. New and exciting changes were introduced in this article, which is addressed below.
Originating Site Fee
Each ... Tags: Loc: All Locations Payer: All Payers Payer: CMS|Medicare Specl: All Specialties Topic: CPT Coding Topic: HCPCS Coding Topic: Modifier Coding Topic: TeleMedicine March 27th, 2018 Maximizing Resources for ICD-10 Coding Audits| Published March 27th, 2018 - Last Review/Update April 12th, 2018 From internal reviews to external inpatient coding audits, healthcare organizations nationwide are revisiting tried-and-true audit practices with ICD-10 coding quality in mind.... Tags: Topic: Auditing Topic: ICD10CM Coding Topic: ICD10PCS Coding March 26th, 2018 Avoiding D9 Denials| Published March 26th, 2018
The following is according to WPS.
Please make sure what is bold below is entered verbatim on the second line of the "Remarks" section. This should be the only thing on the second line of remarks:
Patient control nbr - If you are changing or adding a patient control number
Admission hour - If you are changing or adding the admission ... Tags: Topic: Billing Topic: Claims Processing Topic: Denial Management Topic: UB04 Form and Coding March 26th, 2018 Documentation for Evaluation and Management (E/M) Services| Published March 26th, 2018
According to WPS, when billing or coding for E/M services you should follow a few guidelines.
Documentation must support the level of service billed and the medical necessity for the level billed. Below are additional tips for services which commonly incur CERT error findings for insufficient documentation.
Critical Care Visits
Clear indication of patient ... Tags: Topic: CPT Coding Topic: Documentation Topic: E+M Documentation and Coding March 26th, 2018 Q/A: Which Modifiers to Use When Billing 44005 and 36556 Together| Published March 26th, 2018 - Last Review/Update April 11th, 2018 I have a denial for 44005 and 36556 being billed together. I added modifiers 51, 59, and Q6 to 36556 but I am afraid it will deny again? Tags: Specl: Cardiology|Vascular Specl: Gastroenterology Specl: General Surgery Topic: CPT Coding Topic: Modifier Coding March 21st, 2018 Medicare Beneficiary Identifier (MBI) Beginning April 1, 2018 (This is Not a Joke)| Published March 21st, 2018 The law requires the Centers for Medicare & Medicaid Services (CMS) to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A new unique Medicare number will replace the current Health Insurance Claim Number (HICN) on the new Medicare cards. The new cards will be mailed in... Tags: Payer: CMS|Medicare March 21st, 2018 Q/A: Billing for GI Anesthesia| Published March 21st, 2018 - Last Review/Update March 27th, 2018 Medicare’s policy requires the use of a different code when a screening colonoscopy becomes a diagnostic procedure requiring you to bill with CPT code 00811 when treating a Medicare Beneficiary. Tags: Payer: CMS|Medicare Specl: Gastroenterology Topic: CPT Coding Topic: Modifier Coding |
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