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Medical Coding and Billing Articles

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Attention Providers - Please Make Time to Read this Letter

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In an effort to show CMS is committed to changing the rules to accommodate their providers CMS released a letter to Doctors of Medicare Beneficiaries. The letter offers encouragement and a promise to reduce the burden of unnecessary rules and requirements. The letter states “President Trump has made it clear that ...

Tags:  Payer: CMS|Medicare    Topic: Compliance   

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Patients Over Paperwork?! We have Great News!

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Spend more time with patients and less time documenting? Great Concept! Document meaningful information? Sound good? CMS is proposing just that! CMS released a new proposal July 12, 2018, focused on streamlining clinician billing and expanding access to high-quality care. The goal is to improve and restore the doctor-patient relationship, modernize Medicare ...

Tags:  Payer: CMS|Medicare    Topic: Documentation    Topic: TeleMedicine   

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CMS Proposed New E/M Codes for Podiatry

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According to CMS changes are coming for E/M codes.  A recent proposal from CMS stated: "The E/M visit code set is outdated and needs to be revised and revalued." Since podiatry tends to furnish a lower level of E/M visits, CMS is proposing new G-codes to report E/M office/outpatient visits. The proposed ...

Tags:  Payer: CMS|Medicare    Specl: Podiatry    Topic: CPT Coding    Topic: E+M Documentation and Coding    Topic: ICD9v3 Coding   

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Understanding the Level of Preventative Services (Grades and Suggestions)

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It is essential for providers, clinicians, and other users to understand the importance of providing preventative services.  The U.S. Preventative Services Task Force (USPSTF) has recommendations and has applied Grade Definitions as a suggested resource to imply the significance and strength of preventative services.  The following definitions apply to recommendations ...

Tags:  Topic: Preventive Medicine   

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Dual Medicare-Medicaid Billing Problems

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It is important to keep in mind that Medicaid is run at a state level so there can be some differences when it comes to coverage. However, the rules regarding balance billing of covered services is set at the federal level. The law states (emphasis added): A state plan must provide ...

Tags:  Payer: AMC|Medicaid    Payer: CMS|Medicare    Topic: Claims Processing    Topic: Compliance    Topic: Medicaid    Topic: Medicare   

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ESRD Claims Error: Transitional Drug Adjustment Add-On Payment Adjustment

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Medicare sent out a news release to inform of incorrect reimbursement and correction. "End Stage Renal Disease (ESRD) claims are incorrectly reimbursed if they: Are eligible for Transitional Drug Adjustment Add-On Payment Adjustment and Contain non-covered charges After we fix the system on January 1, 2019, your Medicare Administrative Contractor will mass adjust claims ...

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Documentation: Face to Face for Home Health Certification

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As a physician, you are responsible for providing appropriate, accurate supporting documentation of your face-to-face encounters (FTF) with your patients regarding home health care. Analysis of the recent errors identified by the Comprehensive Error Rate Testing (CERT) Review Contractor shows a continuing increase in denials related to documentation for the FTF. The ...

Tags:  Specl: All Specialties    Topic: Documentation    Topic: HCPCS Coding    Topic: Practice Management   

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WHO Said ICD-11 is Coming Soon

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Sooner or later ICD-11 will be released, and it sounds like it will be sooner than later. WHO released the news on June 18, 2018. The World Health Organization stated “ICD-11 will be presented at the World Health Assembly in May 2019 for adoption by Member States, and will come ...

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Small Practices are Affected by MIPS Increased Thresholds

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We recently heard about a small practice that had been faithfully submitting all the required “G” codes for the Quality Payment Program (QPP) only to discover that for 2018 they are excluded from MIPS because the low volume threshold increased from $30,000 in Part B allowed charges or 100 Part ...

Tags:  Topic: Quality Payment Program   

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How Does the Physician Compare Website Affect You?

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The physician compare website may not be working quite the way you think it is. Not all providers will have rankings showing up for them. Physician compare lists basic information, but quality measure information was not added until this year (2018) and not all quality measures are included in the ...

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

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Workers Compensation Links by State

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The Money in MIPS

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Seema Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS), recently announced that 91% participated in the first year of the Quality Payment Program (QPP), barely squeaking by their goal of 90%....

Tags:  Topic: Practice Management    Topic: Quality Payment Program    Topic: Reimbursement   

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Home Oxygen Therapy -- CMN for Oxygen

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The Certificate of Medical Necessity (CMN) for Oxygen is a required form that helps to document the medical necessity for oxygen therapy. It also documents other coverage criteria for the oxygen use. For payment on a home oxygen claim, the information in the supplier’s records or the patient’s medical record must be substantiated with the information in the CMN.

Tags:  Payer: CMS|Medicare    Specl: Cardiology|Vascular    Specl: Emergency Medicine    Specl: Home Health|Hospice    Specl: Internal Medicine    Specl: Primary Care|Family Care    Topic: Billing    Topic: Coding    Topic: Compliance    Topic: DME    Topic: Documentation    Topic: HCPCS Coding    Topic: Medicare    Topic: Modifier Coding   

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Finalized Confidentiality of Alcohol and Drug Abuse Patient Records Regulations

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In January, the U.S. Department of Health and Human Services (HHS) issued updates to the privacy regulations regarding the confidentiality of patient information of substance use disorder patients (42 CFR Part 2).  This notice included references to better alignment with HIPAA regulations, but did state that Part 2 is more protective ...

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

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VA Expands Telehealth

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On May 11, 2018, the Department of Veterans Affairs (VA) released its final rule on the "Authority of VA Health Care Providers to Practice Telehealth." Effective June 11, 2018, VA providers will be able to provide telehealth services across state lines. This move will make it easier for veterans to obtain ...

Tags:  Payer: VA - Veterans Administration    Topic: Health Care Reform   

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Will Medicare's Proposed Reformations Affect Your Practice?

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Recently, Medicare's Innovation Center released an informal Request for Information (RFI) seeking input on several different system reformation proposals. As the market moves towards more value based payment systems, innovation and new models are being sought to both reduce costs and increase quality. This article outlines the ideas presented in the ...

Tags:  Topic: Health Care Reform    Topic: Medicaid    Topic: Medicare   

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Inappropriate Use of Units Costs Practice Over $800,000

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A recent OIG enforcement action emphasizes the need to understand the proper use of units. A healthcare provider in Connecticut improperly submitted multiple units for drug screening urine tests. The proper billing of units has proven to be problematic for more than just lab tests. Is your billing of drugs & biologicals, injections and timed codes appropriate?

Tags:  Topic: Auditing    Topic: Compliance    Topic: CPT Coding    Topic: HCPCS Coding    Topic: Procedure Coding    Topic: Supply Coding   

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Provider-Based Facilities and Split Billing Is Your Facility Being Reimbursed for All Work Performed?

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Are you stumped by billing guidelines for provider-based facilities? Who bills for what and why? Read on to hear how a little extra time and effort spent on researching split billing coding guidelines can greatly impact your facility, and even your budget ensuring reimbursement for all services performed...

Tags:  Topic: Auditing    Topic: CPT Coding   

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Three Ways Bundled Payments Can Be a Success

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Bundled payment models continue to attract interest for their potential benefits over traditional fee-for-service payment models. With bundled payments, also known as episode-based payments or packaged pricing, a group of providers is reimbursed based on a contracted price to cover all of the care and services related to a particular ...

Tags:  Topic: Billing    Topic: Practice Management   

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New on our TOPICS Page - "Preventive Medicine Coding and Billing Information"

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There is a lot of information available for you to utilize on our Topics pages. We have recently added a Preventative Medicine TOPICS page (under subjects), as per customers' request, for searching Preventative Codes. We're made it easy to locate services required under the Affordable Care Act for reporting preventive services. ...

Tags:  Topic: Preventive Medicine   

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Past Articles

Many of the following articles have been tagged with the tags shown above. These are displayed here again for historical purposes.

The following articles are published here and elsewhere on the Internet. If you would like to publish one of these articles on your website, please contact us and let us know which article you would like to publish and where you will be publishing it.

Articles: ICD-10

Articles: Medical Coding

Articles: Medical Billing

Articles: Medical Billing and Coding (General)


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