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Viewing:  Feb 21, 2017

Medical Coding and Billing Articles

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Telehealth Psychiatric Service

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Telehealth (also known as telemedicine) is playing an ever increasing roll in the reimbursement process. Internet services continue to expand and many insurance payers/providers are now covering (paying for) telehealth services. Telepsychiatry (providing behavioral health services in a telehealth environment) has been highly successful because video conferencing makes providing psych ...

Tags:  Specl: Behavioral Health|Psychiatry|Psychology    Topic: Coding    Topic: CPT Coding    Topic: HCPCS Coding    Topic: Modifier Coding    Topic: Reimbursement    Topic: Technology   

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Diagnostic Criteria for Behavioral Health

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In order to arrive at a diagnosis and check for related complications, a healthcare provider needs to evaluate the patient condition. This may include: History: This can include the patient's personal history as well as that of the patient's family. Physical exam: The healthcare provider will try to rule out physical problems ...

Tags:  Specl: Behavioral Health|Psychiatry|Psychology    Topic: Coding   

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CMS Issues Proposed Rule to Increase Patients’ Health Insurance Choices for 2018

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The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule for 2018, which proposes new reforms that are critical to stabilizing the individual and small group health insurance markets to help protect patients.

Tags:  Payer: CMS|Medicare    Topic: Insurance   

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Podiatry Class Findings

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The following modifiers are required when reporting medically necessary routine foot care services per Medicare guidelines: Q7: One Class A finding Q8: Two Class B findings Q9: One Class B and two Class C findings Appropriate: With foot care (podiatry) codes to indicate covered foot care Inapproriate: With any code not related to foot care When the foot ...

Tags:  Payer: CMS|Medicare    Specl: Podiatry    Topic: Modifier Coding   

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Medicare Conversion Factor

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In April of 2015, the Sustainable Growth Rate (SGR) formula which is used to calculate the Medicare Physician Fee Schedule (MPFS) Conversion Factor was repealed as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The conversion factor will increase by 0.5% each year until 2019 and ...

Tags:  Specl: All Specialties    Topic: Fees    Topic: Medicare   

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Medicaid EHR Incentive

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The Medicare and Medicaid incentive programs are different. The Medicare EHR incentive program has been incorporated into the new Quality Payment Program (QPP). However, providers may be unaware that there is still a Medicaid EHR incentive program. The time period for signing up for the Medicaid EHR incentive program ended in 2016. ...

Tags:  Payer: AMC|Medicaid    Specl: All Specialties    Topic: EHR    Topic: Medicaid   

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Medicare Revises their Appeals Process

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On January 17, 2017, a Final Rule was published in the Federal Register outlining changes to the Medicare Appeals process in an order to streamline procedures and reduce the current backlog of appeals at the third and fourth levels of appeal. This new policy takes effect on March 20, 3017. ...

Tags:  Specl: All Specialties    Topic: Appeals    Topic: Medicare   

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Quality Reporting is not Just for CMS

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If you thought that quality reporting is just for CMS, you are wrong. Other payers recognize the need to establish quality metrics.

Tags:  Topic: Fees    Topic: Quality Payment Program   

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Psychotherapy Notes Provision of HIPAA

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Of special interest to all behavioral health practitioners (both Covered Entities and NON-covered entities) is HIPAA's provision for psychotherapy notes. The privacy rule recognizes that psychotherapy notes need more protection than other types of PHI. Even if you are not a covered entity, we recommend understanding and implementing office procedures ...

Tags:  Specl: Behavioral Health|Psychiatry|Psychology    Topic: HIPAA   

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Medicare Coverage of Behavioral Health Services

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Tags:  Specl: Behavioral Health|Psychiatry|Psychology    Topic: CPT Coding    Topic: ICD9 Coding    Topic: Medicare   

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A Must Have for Every Dental Office!

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Don’t let managed dental plans sneak up on you! Announcing InstaCode's 2017 Reimbursement Guide for Dental with Medical crosswalks. We are excited to introduce a truly unique product that will be even more beneficial to the financial health of your practice. Some of the new features include: CDT, CPT, ICD-10-CM and HCPCS CDT to CPT ...

Tags:  Specl: Dental   

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Code Sets - Health Care Provider Taxonomy Code Set Link

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Every Provider needs to know their Health Care Provider Taxonomy Codes. The Taxonomy Codes define the provider type, classification, and area of specialization. We have provided a link and instructions to help you locate your code.

Tags:  Payer: CMS|Medicare    Specl: All Specialties    Topic: Medicare    Topic: Practice Management    Topic: Taxonomy Code Sets   

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HIPAA Exempt Offices (Paper)

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It is a common misconception that every doctor’s office is (or must become) a HIPAA covered entity; however, the list of those who still qualify for exemption from HIPAA is rapidly shrinking. There are exceptions to the HIPAA requirements; if a practice sends or receives no transactions electronically, it is ...

Tags:  Topic: HIPAA   

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OSHA Compliance

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OSHA is a requirement for healthcare offices. Here are a few basic tips and links for helpful information.

Tags:  Topic: OSHA   

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Anesthesia Code Changes in 2017- Epidural Steroid Injections (ESI)

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Pay close attention to the new 2017 Anesthesia codes there are a few notable changes.  There is a new code set for Epidural Steroid Injections (ESI). The difference in the new codes set has a clear distinction on a single injection or a catheter placement for continuous infusion/intermittent bolus and if ...

Tags:  Specl: Anesthesia|Pain Management    Topic: CPT Coding   

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Mammography Codes Changed in 2017

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Pay careful attention to the mammography code changes for 2017. The following codes have been Deleted: 77055  Mammography; unilateral 77056  Mammography; bilateral 77057  Screening mammography, bilateral (2-view study of each breast) Below are the Replacement Codes:  77065 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral 77066 Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral 77067 Screening ...

Tags:  Specl: Interventional Radiology    Topic: CPT Coding   

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New and Deleted Drug Screen codes for 2017

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Deleted Codes for Drug Screening, the following codes are no longer valid for services performed on or after January 01, 2017. Deleted Codes for 2017 80300   Drug screen, any number of drug classes from Drug Class List A; any number of non-TLC devices or procedures, (eg, immunoassay) capable of being read by direct optical ...

Tags:  Specl: All Specialties    Topic: CPT Coding   

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New and Deleted Angioplasty Codes for 2017

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The following codes have been Deleted as of January 01, 2017 35450   Transluminal balloon angioplasty, open; renal or other visceral artery 35452   Transluminal balloon angioplasty, open; aortic 35458   Transluminal balloon angioplasty, open; brachiocephalic trunk or branches, each vessel 35460   Transluminal balloon angioplasty, open; venous 35471   Transluminal balloon angioplasty, percutaneous; renal or visceral artery 35472   Transluminal balloon angioplasty, percutaneous; aortic 35475   Transluminal balloon angioplasty, percutaneous; ...

Tags:  Specl: Cardiology|Vascular    Topic: CPT Coding   

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Virtual Groups and MIPS

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During the comment period of the MIPS Proposed Rule (Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models), there were some concerns about NPI and TIN usage for MIPS reporting for smaller organizations. The following statements are from the MIPS Final ...

Tags:  Payer: CMS|Medicare    Topic: Medicare    Topic: Quality Payment Program   

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Moderate Sedation Code Changes for 2017

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One of the significant code changes for 2017 included Moderate sedation services. Codes 99143-99145 and 99148-99150 are no longer active codes in 2017.  The moderate sedation codes have been replaced with six new codes 99151-99157.  For example:  Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of ...

Tags:  Specl: Anesthesia|Pain Management    Topic: CPT Coding   

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Articles: ICD-10

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Articles: Medical Billing and Coding (General)


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