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Medical Coding and Billing Articles

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Modifier JW With Drug Codes

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Modifier JW In the past, some Medicare Administrative Contractors have required providers to report wasted drugs with modifier JW (Drug amount discarded/not administered to any patient). Use of the modifier was at the contractor’s discretion, and some contractors told providers not to report it. But effective January 1, 2017, all providers ...

Tags:  Topic: HCPCS Coding    Topic: Modifier Coding   

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Changes with DME

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Due to the cost and refills that is required with portable oxygen systems separate payment classes were added in 2007 for oxygen generating portable equipment. Each year, Payment Classes for Oxygen Generating Portable Equipment, Stationary Oxygen Contents, and Portable Oxygen Contents, are adjusted to make additional payment classes for oxygen ...

Tags:  Topic: HCPCS Coding   

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Got Drugs? Got Pricing?

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Tags:  Specl: All Specialties    Topic: Pharmaceutical    Topic: Practice Management   

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CMS Overpaid Providers $729 Million in Incentive Payments

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Medicare paid hundreds of millions in electronic health record incentive payments that did not comply with federal requirements according to the OIG.  The OIG estimated CMS inappropriately paid $729,424,395 to EPs who did not meet the requirements for meaningful use. Eligible professional’s (EP’s) are physicians, dentists, podiatrists, optometrists or chiropractors, if ...

Tags:  Topic: OIG   

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Negotiating Free Rent – For Medical Professional Tenants

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Free rent is just one negotiable factor in a commercial lease. To be clear, free rent is a period of time where you are not paying the Base or Minimum Rent (but are, typically, paying your Operating Costs) and you are open for business. Many medical professional tenants confuse this ...

Tags:  Topic: Practice Management   

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Bulk Risk Scores

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Do you need help with cases and calculating groups of Risk Scores? Per customers request, Find-A-Code now offers BULK entry for calculating for Risk Scores.  The HCC Risk tool offers two options for calculating risk scores, we now offer a BULK calculation for cases or the calculation for a single enrollee. To use the BULK calculation for cases Create ...

Tags:  Topic: Risk Adjustment   

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Risk Adjustment Calculator

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Risk Adjustments are used to access an illness or severity and comparing classifications of diseases using diagnosis codes. Find-A-Code gives you the ability to search for risk codes used for calculations on an individual code or calculator for a group of codes to quickly calculate a risk score.  Keep in mind prior ...

Tags:  Topic: ICD10CM Coding    Topic: Risk Adjustment   

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Deadline

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Prescribers, including dentists, who write prescriptions for Part D drugs are to be enrolled in an approved status or validly opted out with Medicare, in order for their patients’ prescriptions to be covered under Medicare Part D. Full enforcement of Part D prescriber enrollment requirement will begin on January 1, 2019. ...

Tags:  Specl: Dental    Topic: CPT Coding   

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The Quality Payment Programs

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Medicare has given the option for participation in the Quality Payment Program offering two tracks you can choose from as well as the option to pick your pace. You can choose to start anytime between January 1 and October 2, 2017: Advanced Alternative Payment Models (APMs) or The Merit-based Incentive Payment System ...

Tags:  Topic: Medicare   

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Office of Inspector General (OIG) - Compliance Program Guidance

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The compliance program guidance documents are listed below. 09-30-2008Supplemental Compliance Program Guidance for Nursing Facilities (73 Fed.Reg. 56832; September 30, 2008) Compliance Program Guidance for Nursing Facilities (65 Fed. Reg. 14289; March 16, 2000) 11-28-2005Draft Compliance Program Guidance for Recipients of PHS Research Awards (70 Fed.Reg. 71312; November 28, 2005) NSTC Launches Government-Wide Initiative ...

Tags:  Topic: Compliance    Topic: CPT Coding    Topic: OIG   

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The Office of Inspector General (OIG)

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The Office of Inspector General (OIG) has the responsibility to identify and detect fraud, waste, and abuse for the United States Department of Health and Human Services (HHS) (also known as the Health Department). The mission of the U.S. Department of Health and Human Services is to enhance and protect ...

Tags:  Topic: OIG   

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Definitions for Character #3 of PCS Codes Medical and Surgical Root Operations

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Character #3 of PCS codes Medical and Surgical Root operations definitions Alteration Modifying the anatomic structure of a body part without affecting the function of the body part   Bypass Altering the route of passage of the contents of a tubular body part   Change Taking out or off a device from a body part, and putting back an ...

Tags:  Topic: Hospital    Topic: ICD10PCS Coding   

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False Claim Penalties Increase Again

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On February 3, 2017, the Department of Justice (DOJ) issued a Final Rule to increase the civil monetary penalties assessed under the False Claims Act (FCA), due to inflation for the year 2017, to an all-time high of $10,957 (minimum) to $21,916 (maximum). Thirty years ago, in 1986, Congress amended the False ...

Tags:  Specl: All Specialties    Topic: Compliance   

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Less Efficiency with New Employee - What to do?

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Q:  I have recently hired a new staff person.  We have conducted training and I feel like she is a great addition to my practice.  However, a couple of the basic job duties and required procedures we have in place aren't being done as efficiently as they had been with ...

Tags:  Topic: Admin   

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2014 brings big volume of changes to CCI edits

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Expect the biggest set of CCI changes you’ll see in 2014 to take effect on Jan. 1, as the edits are synched up to CPT® and HCPCS code changes that start next year. There are 61,120 new edit pairs coming next year, along with 13,107 deletions and 137 modifier changes....

Tags:  Topic: Coding    Topic: CPT Coding   

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National Association of Chiropractic Attorneys (NACA) Directory

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National Association of Chiropractic Attorneys (NACA) Directory Listed by state

Tags:  Specl: Chiropractic    Topic: Practice Management   

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E/M Table of Risk

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The final sub-component of Medical Decision Making is the Risk of Significant Complications, Morbidity and/or Mortality. The following is the official Evaluation and Management Table of Risk. The level is selected by choosing one element from three criteria (Presenting Problem, Diagnostic Procedures Ordered, and Management Options), with the highest level selected ...

Tags:  Specl: All Specialties    Topic: E+M Documentation and Coding   

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Newly Revised "Common Procedure Codes" section in the 2016 ChiroCode DeskBook

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The force used to create a degree of tension of soft tissues and/or to allow for separation between joint surfaces. The degree of traction is controlled through the amount of force (pounds) allowed, duration (time), and angle of pull (degrees) using mechanical means. Terms often used in describing pelvic/cervical traction ...

Tags:  Topic: CPT Coding    Topic: HCPCS Coding   

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Acute Postoperative Pain Management

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Caution needs to be observed when reporting post-operative pain management (POPM). In accordance with NCCI edits policies, postoperative pain management is considered bundled in the surgical code(s). There are only a few instances where it may be billed separately. Medicare Global Surgery Rules prevent separate payment for postoperative pain management when ...

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

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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:  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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Articles: ICD-10

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Articles: Medical Billing and Coding (General)


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