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Medical Coding and Billing Articles

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Double Dipping in the History of the Evaluation and Management Note

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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 ...

Tags:  Loc: All Locations    Payer: All Payers    Specl: All Specialties    Topic: Auditing    Topic: Coding    Topic: Compliance    Topic: CPT Coding    Topic: Documentation    Topic: E+M Documentation and Coding    Topic: Fraud   

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How to Properly Report Prolonged Evaluation and Management Services

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Have you ever had a patient take more time with the provider than they were scheduled for? Do you understand which codes to report and the rules that govern them to allow for better reimbursement? Prolonged Service codes were created just for that reason but you must carefully follow the documentation ...

Tags:  Loc: All Locations    Payer: All Payers    Specl: All Specialties    Topic: CPT Coding   

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Auditing Prolonged Evaluation and Management Services

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At times, there are patients who require prolonged face-to-face time with the provider to discuss or be counseled about their condition, plan of care, risks, complications, alternative therapies, or other medical issues. When E/M services go wild, taking significantly longer than the typical time associated with it, that direct face-to-face ...

Tags:  Loc: All Locations    Payer: All Payers    Specl: All Specialties    Topic: CPT Coding    Topic: E+M Documentation and Coding   

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Dental Providers- So what are ICD 10 codes?

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What has been your definition so far when asked about how they are different? What does an ICD-10 code look like? How does an ICD-10 code work?  Have you seen commercials about medical coding schools and wonder if the profession is right for you? With the field expected to grow faster ...

Tags:  Specl: Dental    Topic: Billing    Topic: ICD10CM Coding   

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Elderly Abuse Discovered by the OIG - Early Alert

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The OIG sent out an early alert in an effort to create awareness to potential abuse or neglect of Medicare Beneficiaries in skilled nursing facilities. The OIG identified 134 Medicare beneficiaries whose injuries may have been the result of potential abuse or neglect. The beneficiaries reported were treated at the ...

Tags:  Specl: Primary Care|Family Care    Specl: Skilled Nursing   

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Quality Measures for Chiropractic - 2017

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Performance Measurement Codes for Chiropractic: Although there are hundreds of Performance Measurement (PM) services and events, only two may be reported for chiropractors for the 2017 reporting year. Pain Assessment and Follow-Up 131 ENCOUNTER: 90791, 90792, 92002, 92004, 92012, 92014, 92507, 92508, 92526, 96116, 96118, 96150, 96151, 97161, 97162, 97163, 97164, 97165, 97166, 97167, ...

Tags:  Topic: CDT (Dental) Codes    Topic: CPT Coding    Topic: HCPCS Coding    Topic: Quality Payment Program   

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Funding Extended for Veterans Choice Program

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The Veterans Choice Program, created in 2014, was part of the solution to the extensive waiting times found in the VA system. The program allowed veterans to meet their health care needs from private health care providers. Though the “sunset” of the program was avoided earlier in the year, the ...

Tags:  Payer: VA - Veterans Administration    Specl: All Specialties    Topic: Insurance   

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VA Patient-Centered Community Care and Veterans Choice Program: Worth it for Providers?

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As the opportunities for providers outside the VA system expand in order to meet demand, you may be interested in offering services to veterans and the VA, if you are not already. With overwhelming bipartisan support, the opportunities are not likely to abate, but are those opportunities worth it for ...

Tags:  Payer: VA - Veterans Administration    Specl: All Specialties    Topic: Insurance   

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The First Phone Call to Your Office

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The telephone has a huge impact on your practice.  The very first phone call to your office will be the beginning of the patient relationship to the practice, and if not handled correctly may potentially be the last.  https://www.dentalcare.com/en-us/practice-management/scripting/use-a-telephone-script-scripting-conversations Chose your words carefully. https://www.dentalcare.com/en-us/practice-management/scripting/raise-the-energy-level-with-a-power-words-list Welcome:  https://www.dentalcare.com/en-us/practice-management/scripting/dental-scripts-scripting-the-patient-welcome Scheduling. It shapes everyone’s day and has a direct ...

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Looking at Site Selection Variables – For Chiropractic Tenants

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When you’re looking for the right property for your new chiropractic practice or wish to expand or move your practice, having a checklist of desirable criteria can help you stay on track. As The Lease Coach, we appreciate and applaud tenants who provide a detailed checklist of what they are looking for in each location. You should weigh many demographic aspects when considering leasing a location in a certain area or territory. Just because you’ve found a new property with space for lease doesn’t mean the demographics will fit your ideal criteria. As a chiropractic tenant, the following points will be specifically important to you when searching:

Tags:  Topic: Misc   

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Medicare Announces New Cards to Be Issued

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Identity theft has become a major problem in the United States. As a prevention measure, the Centers for Medicare& Medicaid Services (CMS) is readying a fraud prevention initiative that removes Social Security numbers from Medicare cards to help combat identity theft, and safeguard taxpayer dollars.   Personal identity theft affects a large ...

Tags:  Topic: Medicare   

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TCM, CCM, and Clinical Staff Members

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When auditing Transitional Care Management (TCM) and Chronic Care Management (CCM) services, you may come into a situation where services are performed by clinical staff members. What constitute as a clinical staff member, and are they allowed to perform such services? What if they are not licensed? CMS is vague about ...

Tags:  Topic: Auditing   

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The Importance of Time, Timelines, and Timing with Your Commercial Lease – For Medical Professional Tenants

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 Readers of our new book, Negotiating Commercial Leases & Renewals FOR DUMMIES, will learn (in part) that the leasing process can take differing amounts of time, depending on whether you’re opening your first or fifth location. You can discover a lot during your first few lease deals that you can ...

Tags:  Topic: Practice Management   

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If It’s Not a Consultation, What Is It?

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You thought you had a consultation supported in your documentation, and now you find out that you cannot bill the consultation codes (99241-99245, 99251- 99255). So, what are the top reasons for a consultation not to be supported? If the payer does not support these codes If the documentation does not support ...

Tags:  Topic: Auditing    Topic: CPT Coding    Topic: Modifier Coding   

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Case Law Update: Just Because HIPAA Does Not Provide a Private Right of Action, Doesn't Mean that Other Avenues Exist

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    August 4, 2017 Case Law Update: Just Because HIPAA Does Not Provide a Private Right of Action, Doesn't Mean that Other Avenues Exist   Simply stated, the Health Information Portability and Accountability Act (HIPAA) does not provide a private cause of action[1]. And, prior to the 2009 passage of the Health Information Technology ...

Tags:  Topic: HIPAA   

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United HealthCare Ending Consultation Reimbursements: Effective October 1st, 2017

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While Medicare discontinued payment allowance for consultation services (ranges 99241-99245 and 99251-99255) in January 2010, many commercial carriers have continued to cover these services. United Healthcare is now joining Medicare's opinion on consultation services. In the June 2017 edition of the United HealthCare Bulletin, United Healthcare has announced that effective October ...

Tags:  Topic: CPT Coding    Topic: E+M Documentation and Coding   

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Transparency and Fees

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More than any other industry, healthcare is almost notorious for its lack of price transparency. While patients generally know how much their copay will be and certainly how much their final bill turns out to be, few hospitals and practices publish the actual costs of their services prior to those ...

Tags:  Specl: Dental    Topic: Fees    Topic: Practice Management   

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Chart Auditing For Beginners

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In the new year, have you found yourself in the new role of performing internal chart audits for your organization? Are you often finding yourself saying "Now What?!" First, take a deep breath and start with the basics. In this week's tip, I will review the very basic tips and ...

Tags:  Topic: Auditing   

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Injury, Poisoning, and Certain Other Consequences of External Causes (S00-T88)

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There is important information that must be included when documenting injuries and external cause codes in ICD-10-CM. There are expanded sections on poisonings and toxins making it more convenient to code, as ICD-10-CM is very specific. When using a code from Chapter 19 (Injury, Poisoning and Certain other Consequences of External ...

Tags:  Topic: ICD10CM Coding   

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Do Other States Lower Payments for Crowns by Delta or Blue Cross?

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Question: A subscribers from the State of Michigan has asked this: Has anyone from other states seen the fees for crowns lowered by Delta or Blue Cross? Answer: First look at your contracts, and see if there is anything in it that allows for fees to be lowered. Next, look up your ...

Tags:  Specl: Dental    Topic: CDT (Dental) Codes    Topic: CPT Coding   

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Past Articles

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Articles: ICD-10

Articles: Medical Coding

Articles: Medical Billing

Articles: Medical Billing and Coding (General)


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