Medical Coding and Billing Articles
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recent articles
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August 10th, 2020
Coding Injections for Pain Management
| Published August 10th, 2020
Coding for pain management can get confusing. How many injections, the location, and when to use a modifier are all common questions. This article will cover some of the most common injections used in pain management.
Trigger Point Injections
Trigger point injections are reported by how many muscles are treated using an ...
August 10th, 2020
Modifier 50 — Four "Must Know" Tips For Getting Paid
| Published August 10th, 2020
Modifiers added to an HCPCS or CPT© code alters the code description, providing clarity about the service for proper claim processing and reimbursement. Here are four things you must know about modifier 50 to ensure proper payment. - Modifiers are either informational or payment related. Informational modifiers provide additional...
August 5th, 2020
Coding with PCS When There is No Code
| Published August 5th, 2020
ICD-10-PCS covers ALMOST everything! But not quite! What if a body system does not contain a body part for toes or fingers? What about an elbow? When it does not cover what you are looking for, where do you turn? To the guidelines, of course! There are ICD-10-PCS guidelines just as ...
July 28th, 2020
OIG Report Highlights Need to Understand Guidelines
| Published July 28th, 2020
A new OIG report once again highlights the necessity for organizations to fully understand requirements for reporting services and having proper documentation. The types of problems addressed in this report are ongoing issues for multiple types of services and specialties and for many different payers.
July 21st, 2020
Office of Inspector General Says Medicare Advantage Organizations are Denying Services Inappropriately
| Published July 21st, 2020
We attended the recent virtual RISE National Conference and had the opportunity to listen to presenters share their knowledge about risk adjustment and HCC reporting and data validation. Among the presenters were representatives from the Office of Inspector General (OIG), who presented findings from encounter data from 2012-2016. They began ...
July 20th, 2020
New Grouper Added for Skilled Nursing
| Published July 20th, 2020
The additional grouper for Skilled Nursing, sometimes referred to as (PDPM), is used for classifying SNF patients in a covered Part A stay.
This grouper is included with our Home Health Grouper.
Current groupers/calculators include:
Home Health PDGM (Patient-Driven Grouping Model)
Skilled Nursing Facility PDPM (Patient-Driven Payment Model)
What is it?
According to CMS, In ...
July 15th, 2020
Use the Correct Diagnosis Codes and Revenue Codes to Get Paid for PAD Rehab
| Published July 15th, 2020
The initial treatment in rehabilitation for patients suffering from Intermittent Claudication (IC) is Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD). Rehabilitation using SET involves the use of intermittent walking exercise, which alternates periods of walking to moderate-to-maximum claudication, with rest.
When reporting 93668 for peripheral arterial disease rehabilitation the following ...
July 14th, 2020
Are NCCI Edits Just for Medicare?
| Published July 14th, 2020
The National Correct Coding Initiative (NCCI) edits were developed by CMS to help promote proper coding and control improper coding that leads to incorrect payments with part B claims. It is important to understand that NCCI edits do not include every possible code combination or every type of un-bundling combination. With that ...
July 14th, 2020
New Name Same Great Product! "HCC Plus"
| Published July 14th, 2020
July 9th, 2020
Payment Adjustment Rules for Multiple Procedures and CCI Edits
| Published July 9th, 2020
Surgical and medical services often include work that is required to be done prior to a procedure and post-procedure. When there are multiple procedures done by the same physician, group, or another qualified healthcare professional on the same day, the pre and post work is only required once. Therefore, CMS ...
July 8th, 2020
New ABN Form is Here
| Published July 7th, 2020 - Last Review/Update July 8th, 2020
The anticipated changes to the Advanced Beneficiary Notice of Non-coverage (ABN) Form (CMS-R-131) have arrived. This important form is issued to the patient or client by providers, physicians, practitioners, and suppliers in situations where Medicare payment is expected to be denied.
You can begin using the new ABN immediately if you so wish. However, it becomes mandatory on August 31, 2020.
July 1st, 2020
Understanding UCR Inpatient Fees used on DRGs
| Published July 1st, 2020
June 29th, 2020
HCPCS Codes Were NOT all Created for the Same Purpose
| Published June 29th, 2020
Have you ever wondered why you were unable to find a particular product/code with our DMEPOS search? When looking for HCPCS Level II codes, there are several kinds of codes and not all HCPCS codes were created for the same purpose. If you are searching for a certain HCPCS product ...
June 29th, 2020
Additional COVID-19 Testing Codes Announced
| Published June 29th, 2020
New coronavirus antigen testing codes announced. These are effective immediately.
June 18th, 2020
CMS- Reminder COVID Assessment and Specimen Collection
| Published June 18th, 2020
On March 1, 2020, new codes and rules were released to bill for COVID-19 symptom and exposure assessments, as well as specimen collection. CMS has recently sent out reminders on billing for these services, the proper use of the CS modifier on claims, and how they are handling denials due ...
June 16th, 2020
Should I Bill Dental or Medical?
| Published June 16th, 2020
While you likely find yourself focusing on fewer patients and more on emergency care, it’s a good time to understand how medical billing can allow patients with active infection in the oral cavity to seek the treatment they need.
Forms need to be filled out correctly, and you must carefully follow ...
June 15th, 2020
Newest Launch - We Now Have Outpatient Facility Pricing!
| Published June 15th, 2020
Our newest feature launch offers UCR pricing for Outpatient Facility. We recently released pricing information based on databases of insurance claims from private-sector health care providers.Usual, customary, and reasonable charges (UCR) are medical fees used when there are no contractual pricing agreements and are used by certain healthcare plans and third-party payers to generate ...
June 16th, 2020
Medical Necessity using Soap can prevent a future audit!
| Published June 15th, 2020 - Last Review/Update June 16th, 2020
Medical Necessity using Soap can prevent a future audit!
How Do I Correctly Document all my notes on every patient regardless of the insurance I am billing?
Medically necessary care is the reasonable and essential diagnostic, preventive, and treatment services (including supplies, appliances, and devices) and follow-up care as determined by qualified ...
June 10th, 2020
MEGA - NCCI Edit Changes - WHO Knew?
| Published June 10th, 2020
There was no huge announcement when CMS released new files in April. The files that were released on April 7, 2020, actually replaced files to update the NCCI edits on Procedure to Procedure (PTP) edits and Medically Unlikely Edits (MUE). The updated files included;
291,902 Deleted Procedure to Procedure (PTP) edits
197 Deleted Medically Unlikely ...
June 4th, 2020
Proposed Risk Adjustment Changes
| Published June 4th, 2020
On June 2, 2020, HHS published two proposed changes to the Risk Adjustment Data Validation (RADV) protocols for HHS-Operated Risk Adjustment Programs.
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