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Medical Coding and Billing Articles

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Join QPro Today and Get Certified

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Join QPro Today and Get Certified! To have a credential in the medical profession shows you have met a minimum standard for professional and ethical standards. Often employers prefer to hire staff that will be involved with any type of patient information such as coding, to show proof they have met certain ...

Tags:  Loc: All Locations    Specl: All Specialties    Topic: Professional Licensing|Certification   

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2018 Rules for 95251 and Other CGM Codes

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The CPT description of 95251 does not include an assessment of the patient or indicate a plan of care for the patient. The CPT description for code 95251 indicates an analysis, interpretation and report of a minimum of 72 hours of data collected from a CGM device. An appropriate CGM ...

Tags:  Topic: Coding    Topic: CPT Coding    Topic: Documentation    Topic: E+M Documentation and Coding    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: All Specialties    Specl: Behavioral Health|Psychiatry|Psychology    Topic: Compliance    Topic: HIPAA   

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Keys to Successful Claims Filing

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There are many factors that can contribute to your success in filing claims and getting reimbursed.  The information below is from the CMS website. Completing Item 12, Patient's or Authorized Person's Signature, on the CMS-1500 form for a non-assigned claim A signature on file (SOF) indicates the supplier has obtained the beneficiary's one-time authorization on ...

Tags:  Topic: HCPCS Coding   

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Pricing for ASC’s and APC’s

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For Medicare purposes, an Ambulatory Surgical Center Resources (ASC) is a distinct entity that operates exclusively to furnish surgical services to patients who do not require hospitalization and in which the expected duration of services does not exceed 24 hours following admission. ASC payment groups determine the amount that...

Tags:  Topic: CPT Coding    Topic: Fees    Topic: Hospital    Topic: Practice Management   

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PSAVE Pilot Program - What Does it Mean to You?

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Noridian's pilot program Provider Self-Audit with Validation and Extrapolation (PSAVE) has been extended which means that it has been successful for the payer, which means that they are saving money. Historically, when a pilot program is proven to be successful, it isn’t too long before other MACs follow. Before signing up to participate, providers need to carefully evaluate the program. Are the benefits worth the costs?

Tags:  Specl: All Specialties    Topic: Compliance    Topic: Medicare    Topic: Reimbursement   

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Importance of Depression Screenings

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Why would a chiropractor be concerned about depression screenings when you aren’t trained to be a mental health provider? The answer lies in patient outcomes. Many quality care organizations recommend depression screenings for patients with a chronic condition. According to The National Institute of Mental Health, “People with other chronic ...

Tags:  Specl: Chiropractic    Topic: CPT Coding    Topic: HCPCS Coding    Topic: Procedure Coding   

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Using Modifiers 96 and 97

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The Affordable Care Act (ACA) requires coverage of certain essential health benefits (EHBs), two of which are rehabilitative and habilitative services and devices. Since the ACA did not define these terms or specify coverage requirements, it is left up to individual states to create benchmark plans to determine coverage requirements. ...

Tags:  Topic: Billing    Topic: CPT Coding    Topic: HCPCS Coding    Topic: Modifier Coding    Topic: Procedure Coding   

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BREAKING NEWS: CMS Proposes to Change E&M Coding

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On July 16th 2018, anyone subscribed to the CMS Quality Payment Program received an e-mail containing a letter to doctors from Seem Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS). There are some widespread changes proposed in this letter of which you need to be aware. Where ...

Tags:  Specl: All Specialties    Topic: CPT Coding   

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QPro’s First Annual QPro Con

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 Date: October 9-10   Time: 9-3 MST   QPro Con is featuring a virtual event with keynote speakers and experts with years of hands-on experience in the healthcare industry. Stay ahead of the changes and keep informed of important information that affects the healthcare community.      Attendees receive 12 FREE CEUs with the purchase ...

Tags:  Topic: ICD10CM Coding   

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Using Modifiers

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Modifiers offer supplemental information and provide additional details without changing the procedure codes definition and are always two digits. Modifiers are required for proper billing and at times used with NCCI edits, however, two or more NCCI -associated modifiers on the same line will be denied. In addition, NCCI modifiers ...

Tags:  Topic: Billing    Topic: Modifier Coding   

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Provide Proof of a Qualified Professional with QPro Certifications!

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QPro - Announces the Launch of an Innovative Testing Site! Innovation is paving the way once again! Unlike other certification bodies, QPro does not certify the ability to pass a test but instead verifies members qualifications are proven. Test online using real-life coding resources and coding books commonly used in the office setting. Who can Benefit ...

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CMS Proposes Changes to Evaluation & Management Requirements

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It is no secret that providers have long argued that E/M coding is burdensome and does not truly reflect the services provided. This fact is acknowledged by CMS with the following statement "Prior attempts to revise the E/M guidelines were unsuccessful or resulted in additional complexity due to lack of ...

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

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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.   For ...

Tags:  Topic: Auditing    Topic: CPT Coding   

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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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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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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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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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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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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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