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Medical Facilities & Organizations

articles, webinars, links, files and other resources related to coding, reimbursement and compliance for medical facilities and organizations

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recent articles

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November 12th, 2019

HIPAA Final Rule Eliminates HPID and OEID

By Wyn Staheli, Director of Research | Published November 12th, 2019

Final rule eliminates the requirement for health plans to obtain a unique health plan identifier (HPID) and also eliminates the voluntary use of the other entity identifier (OEID). This change becomes effective December 27, 2019.

tags Specl: All Specialties Topic: HIPAA

November 11th, 2019

And Then There Were Fees...

By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published November 11th, 2019

Find-A-Code offers fees and pricing for just about everything, this article will address two of some of the most common payment systems with CMS. (OPPS) -Outpatient Medicare Outpatient Prospective Payment System. (MPFS)- Medicare Physician Fee Schedule The Fees section on each code page is determined on the type of services...

tags Payer: CMS|Medicare Specl: All Specialties Topic: CMS1500 Topic: Fees Topic: UB04 Form and Coding

November 3rd, 2019

Are you providing TMD treatment and having a hard time receiving payment from Medical? Take a look at the law for your state!

By Christine Taxin | Published November 3rd, 2019 - Last Review/Update November 7th, 2019

TM TREATMENT AND THIRD PARTY INSURANCE COVERAGEMinnesota, in 1987, became the first state to adopt legislation requiring health insurance policies issued within the state to include coverage for the diagnosis and treatment of temporomandibular (TMD) joint disorders and craniomandibular (CMD) disorders on the same basis as other joint disorders. At ...

tags Loc: Arkansas Loc: California Loc: Florida Loc: Georgia Loc: Illinois Loc: Kentucky Loc: Maryland Loc: Minnesota Loc: Mississippi Loc: Nevada Loc: New Mexico Loc: North Carolina Loc: North Dakota Loc: Tennessee Loc: Texas Loc: Vermont Loc: Virginia Loc: Washington Loc: West Virginia Loc: Wisconsin Specl: Dental Specl: Oral and Maxillofacial Surgery

October 22nd, 2019

VA: How UCR Charges are Determined

By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published October 22nd, 2019

How does the VA determine charges billed to third party payers for Veterans with private health insurance? According to the VA. "38 C.F.R 17.101 stipulates the basic methodology by which VA bills third party insurance carriers. In order to generate a charge for medical services, VA establishes reasonable charges for five ...

tags Payer: VA - Veterans Administration Topic: Fees

October 21st, 2019

VA- Reasonable Charges Rules, Notices, & Federal Register

By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published October 21st, 2019

tags Payer: All Payers Payer: VA - Veterans Administration Specl: All Specialties Topic: Fees Topic: Reimbursement Topic: UB04 Form and Coding

October 18th, 2019

Medically Unlikely Edits (MUEs): Unlikely, But Not Always Impossible

By Namas | Published October 18th, 2019 - Last Review/Update October 23rd, 2019

Medically Unlikely Edits (MUEs) were created by the Centers for Medicare & Medicaid Services (CMS) to help lower the error rate for paid Part B claims. MUEs are the maximum units of a HCPCS or CPT code that a provider would bill under most circumstances for the same patient on ...

tags Specl: All Specialties Specl: Billing Topic: CPT Coding Topic: Modifier Coding

October 16th, 2019

ICD-10 Appendix E

By Find-A-Code | Published October 16th, 2019

Z00.00 Z01.20 Z02.3 Z03.810 Z34.00 Z38.4 Z51.11 Z52.4 Z00.01 Z01.21 Z02.4 Z03.818 Z34.01 Z38.5 Z51.12 Z52.5 Z00.110 Z01.30 Z02.5 Z03.89 Z34.02 Z38.61 Z52.000 Z52.6 Z00.111 Z01.31 Z02.6 Z04.1 Z34.03 Z38.62 Z52.001 Z52.810 Z00.121 Z01.411 Z02.71 Z04.2 Z34.80 Z38.63 Z52.008 Z52.811 Z00.129 Z01.419 Z02.79 Z04.3 Z34.81 Z38.64 Z52.010 Z52.812 Z00.2 Z01.42 Z02.81 Z04.41 Z34.82 Z38.65 Z52.011 Z52.813 Z00.3 Z01.810 Z02.82 Z04.42 Z34.83 Z38.66 Z52.018 Z52.819 Z00.5 Z01.811 Z02.83 Z04.6 Z34.90 Z38.68 Z52.090 Z52.89 Z00.70 Z01.812 Z02.89 Z04.71 Z34.91 Z38.69 Z52.091 Z76.1 Z00.71 Z01.818 Z02.9 Z04.72 Z34.92 Z38.7 Z52.098 Z76.2 Z00.8 Z01.82 Z03.6 Z04.8 Z34.93 Z38.8 Z52.10 Z99.12 Z01.00 Z01.83 Z03.71 Z04.9 Z38.00 Z39.0 Z52.11 Z01.01 Z01.84 Z03.72 Z31.81 Z38.01 Z39.1 Z52.19 Z01.10 Z01.89 Z03.73 Z31.82 Z38.1 Z39.2 Z52.20 Z01.110 Z02.0 Z03.74 Z31.83 Z38.2 Z42.1 Z52.21 Z01.118 Z02.1 Z03.75 Z31.84 Z38.30 Z42.8 Z52.29 Z01.12 Z02.2 Z03.79 Z33.2 Z38.31 Z51.0 Z52.3 ...

tags Topic: ICD10CM Coding

October 15th, 2019

Now That is Fraud! Genetic Testing "Public alert"

By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published October 15th, 2019

Genetic testing is becoming very popular. In fact, so popular you might see it in places you would not expect such as a community event, fairs or any event happening in your community. Some labs may even offer FREE screening for genetic testing. Watch for FREE screening announcements or advertisements ...

tags Payer: CMS|Medicare Specl: Laboratory|Pathology Topic: Fraud Topic: OIG

October 15th, 2019

CMS says Codes are on the Move!

By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published October 15th, 2019

Have you noticed your LCDs are missing something? CMS is moving codes out of LCDs and into Billing and Coding Articles. MACs began moving ICD-10-CM, CPT/HCPCS, Bill Type, and Revenue codes in January 2019, and will continue through January 2020. Therefore, if there is an LCD with its codes removed, you will find ...

tags Payer: CMS|Medicare Specl: All Specialties Topic: LCDs and NCDs

October 11th, 2019

Why is HIPAA So Important?

By Namas | Published October 11th, 2019 - Last Review/Update October 15th, 2019

Why is HIPAA So Important? Some may think that what they do to protect patient information may be a bit extreme. Others in specialty medical fields and research understand its importance a little more. Most of that importance lies in the information being protected. Every patient has a unique set of ...

tags Payer: CMS|Medicare Specl: All Specialties Topic: HIPAA Topic: Practice Management

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