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Viewing:  Nov 22, 2017

Medical Coding and Billing Articles

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Medicare Diabetes Prevention Program (MDPP) Expanded Model Information

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Diabetes treatment places an ever-increasing strain on the resources of the U.S. healthcare system. CMS estimated that in 2016 alone, Medicare incurred an additional $42 billion in costs due to the number of beneficiaries with diabetes. The best way to keep these costs down in the future is by preventing ...

Tags:  Payer: CMS|Medicare    Topic: Medicare    Topic: Payment Models   

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Understanding ASC Pricing

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ASCs (Ambulatory Surgical Centers) have a separate fee schedule with a base allowed amount that is adjusted for each state using Core Based Statistical Areas (CBSA). Under the ASC payment system, Medicare pays facilities for specific ASC covered surgical procedures, however, there are only certain types of procedures that are eligible for payment ...

Tags:  Topic: Coding    Topic: Medicare    Topic: Reimbursement   

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Average Wholesale Price (AWP)

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Clinical Drug Information, LLC Average Wholesale Price (AWP) is intended only to be used by Clinical Drug Information, LLC customers. While many use this information as a price index, the Clinical Drug Information, LLC AWP does not represent an average of wholesale prices from any group of transactions in the ...

Tags:  Topic: Billing    Topic: Fees    Topic: NDC - National Drug codes   

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Medicare Offering FREE Resources- Educate Beneficiaries About the New Medicare Cards

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Medicare is offering FREE resources to help you notify patients about the new Medicare cards. MLN connects newsletter announced the following. "CMS is starting to conduct a major education campaign about the new card for people with Medicare. Help alert your patients by displaying a poster in your office and giving your patients tear-off sheets or fliers. Register ...

Tags:  Topic: CPT Coding   

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Dental providers and Medicare

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Even if a dental provider is not participating in Medicare but still wants to treat Medicare patients, unless the provider actually opts out, they are still restricted to a limiting charge in most states.  This means you cannot balance bill a Medicare Beneficiary anything more than 115 percent of the Medicare non-par ...

Tags:  Specl: Dental   

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Escharotomy Procedural Cross-Walking CPT to ICD-10-PCS

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An Escharotomy is used for "local treatment of burned surface" per the AMA Guidelines, when incisions are performed on the burn site. Notice, when cross-walking 16035 or 16036 to inpatient codes, Find-A-Code crosswalks lead to Body System H, Operation 8 - Division of the skin, and Operation N - Release of the skin. A division or release of the skin would be a ...

Tags:  Specl: Dermatology|Plastic Surgery    Specl: Emergency Medicine    Topic: CPT Coding    Topic: ICD10PCS Coding   

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Q/A: Physical Exam for Military (Specifically Feet)

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Q: We had a patient come to our podiatry clinic to get a physical for her feet to qualify for ROTC activities. They came back clear of any deformities, defects, etc. Our scribes listed this visit diagnosis as Z00.00 (Encounter for general adult medical examination without abnormal findings) which seems correct ...

Tags:  Specl: Podiatry    Specl: Primary Care|Family Care    Topic: Billing    Topic: ICD10CM Coding   

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Four Final Rules Affecting CMS Payments for 2018

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It’s a season for changes. CMS just finalized four rules which directly impact the following payment systems: Physician Fee Schedule Final Policy, Payment, and Quality Provisions for CY 2018 Hospital OPPS and ASC Payment System and Quality Reporting Programs Changes for 2018 HHAs: Payment Changes for 2018 Quality Payment Program Rule for Year 2 This ...

Tags:  Topic: CPT Coding    Topic: Fees    Topic: Modifier Coding    Topic: Quality Payment Program   

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Patient Relationship Codes

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Section 1848(r)(4) of MACRA requires that claims submitted for items and services furnished by a physician or applicable practitioner on or after January 1, 2018, include codes for the following: care episode groups patient condition groups patient relationship categories Previously, CMS decided to use procedure code modifiers to report patient relationship codes on Medicare ...

Tags:  Topic: Billing    Topic: Compliance    Topic: Modifier Coding    Topic: Quality Payment Program   

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New Payment Rulings Could Affect You

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Fall has always been the season for CMS fee changes and on November 2, 2017, CMS announced the finalization of four rules which directly impact the following payment systems: Physician Fee Schedule Final Policy, Payment, and Quality Provisions for CY 2018 Hospital OPPS and ASC Payment System and Quality Reporting Programs Changes ...

Tags:  Specl: Chiropractic    Topic: CPT Coding    Topic: Fees    Topic: Quality Payment Program   

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Payment Rulings and Small Provider Practices

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Fall has always been the season for CMS fee changes and on November 2, 2017, CMS announced the finalization of four rules which directly impact the following payment systems: Physician Fee Schedule Final Policy, Payment, and Quality Provisions for CY 2018 Hospital OPPS and ASC Payment System and Quality Reporting Programs Changes ...

Tags:  Topic: Fees    Topic: Quality Payment Program   

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How to Use Modifier Indicators with NCCI edits

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To verify if clinical circumstances might justify the use of a modifier when billing code pairs, look at the NCCI edits and the modifier indicator.  Medicare may have restrictions on the use of a modifier used to bypass an edit.  This important part of coding can alert a payer or ...

Tags:  Topic: Coding   

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Modifiers –Reimbursement or Informational?

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Modifiers are used to help describe the encounter, and used to further explain the procedure to the payer.  Modifiers will be used if the procedure does not fit or clearly explain the entire encounter.    There are two types of modifiers: Informational modifiers that do not impact reimbursement Pricing or Payment modifiers that ...

Tags:  Topic: CPT Coding    Topic: HCPCS Coding    Topic: Modifier Coding   

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Importance of Outcomes Measurements

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One important component of health care reporting is the utilization of quality measures which are typically classified into one of three broad categories: structure, process, or outcome. Structural measures define the healthcare provider’s capacity, systems, and processes (e.g., EHR use, ratio of providers to patients) Process measures indicate what providers do to ...

Tags:  Topic: Assessment Tools    Topic: Quality Payment Program   

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Does an Informed Consent Really Matter?

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Tags:  Topic: Practice Management   

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Speech-Language Pathology Services Policy from UniCare

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Medically Necessary: Rehabilitative speech-language pathology (SLP) services are considered medically necessary when ALL of the following criteria are met: The services are used in the treatment of communication impairment or swallowing disorders resulting from illness*, injury, surgery, or congenital abnormality; and Based on a plan of care, the therapy sessions achieve a specific ...

Tags:  Specl: Physical Medicine|Physical Therapy    Topic: CPT Coding    Topic: Documentation    Topic: HCPCS Coding    Topic: Procedure Coding   

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CMS Proposes to Revise Evaluation & Management Guidelines!!

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According to the recently released 2018 Physician Fee Schedule Proposed Rule, published in the Federal Register, dated July 21, 2017, the Centers for Medicare & Medicaid Services (CMS) acknowledges that the current Evaluation and Management (E/M) documentation guidelines create an administrative burden and increased audit risk for providers. In response, ...

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

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Q&A: Blue Cross Blue Shield Updating Their Policy on the Application of Therapies by a Chiropractic Assistant

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ChiroCode recently received the following inquiry: Blue Cross Blue Shield is updating their policy on the application of therapies by a chiropractic assistant. It is as follows: "Physical Therapy and Chiropractic Billing Guidelines Reminder Physician or Chiropractor “Incident To” Billing of Therapy Services (New) Beginning January 1, 2018, physicians and...

Tags:  Payer: BC|BS    Topic: CPT Coding   

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Come and Visit us at Codapedia!

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Codapedia is a new division of Find-a-Code where you can submit coding questions and reply to community coding questions.  Check out articles from prominent professionals in the healthcare community and join our coding forum.  Did we mention it's FREE? Of course,  codapedia is FREE! Search forum posts and articles for documentation, coding ...

Tags:  Topic: Codapedia   

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Summary of OIG Reports for Chiropractic

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The Office of the Inspector General was created to protect the integrity of the U.S. Department of Health and Human Services. They investigate fraud, waste, and abuse in HHS programs and make recommendations to various enforcement agencies. Every few years they investigate chiropractic services.  Here is a summary of the reports the ...

Tags:  Specl: Chiropractic    Topic: Compliance    Topic: CPT Coding    Topic: Medicare    Topic: OIG   

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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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