Understanding how payment works with Medicare payment indicators and the impact a modifier has on payment is vital to pricing. Even if you are not billing Medicare, most carriers follow Medicare's policies for participating and non-participating rules. Here is an article from Regence ... Read More
Level II Coding Procedures called HCPCS or Level II codes.
There are three main code sets and the Healthcare Common Procedure Coding System (HCPCS) is the third most common code set used. They are often called Level II codes and are used to report non-physician products, supplies, and pro... Read More
CMS Proposes to Reverse E/M Stance to Align with AMA Revisions
By: Wyn Staheli, Director of ResearchPublished: August 6th, 2019
On July 29, 2019, CMS released their proposed rule for the Medicare Physician Fee Schedule for 2020. Last year’s final rule “finalized the assig... Read More
No single article could possibly cover all the possible problems that could be encountered in your practice. However, it’s always a good idea to pay attention to problems that others are encountering to try and keep them from happening to you. The skills that make an individual a good prov... Read More
ICD-10-CM codes represent the first line of defense when it comes to medical necessity. Correctly chosen diagnosis codes support the reason for the visit as well as the level of the E/M services provided. The issue of medical necessity is one of definitions and communication. What is obvious to th... Read More
It can be confusing to determine if a component or a particular feature is considered an integral part of an orthosis or if you can ask for separate payment. Obviously, the best way to determine that is to follow the specific payer's guidelines. The problem is that many payers don't have really good... Read More
May 06, 2019 - By Wyn Staheli, Director of Research
On April 30, 2019 The Department of Health and Human Services (HHS) announced that “HHS will apply a different cumulative annual CMP limit for each of the four penalties tiers in the HITECH Act.” Unlike other notices which require a proposed rule with a comment period, this notice will t... Read More
May 06, 2019 - By Wyn Staheli, Director of Research
On April 12, 2019, Medicare announced that there will be some changes to their appeals process effective June 13, 2019. According to the MLN Matters release (see References), the following policy revisions in the Medicare Claims Processing Manual (MCPM), Chapter 29 are taking place:... Read More
April 24, 2019 - By Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT
Find-A-Code is a great resource for individuals working in all aspects of healthcare, from providers and ancillary staff to the attorneys and payers who assess and critique the documentation supporting the services performed. When recently asked what tools Find-A-Code has to help support medica... Read More
April 18, 2019 - By Wyn Staheli, Director of Research
Question:
My patient seemed confused about which of the options they should check. Can I just tell them which one they should check?
Answer:
No! That could be construed as coercion. The official instructions state “Under no circumstances can the notifier decide for the beneficiary which of... Read More
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