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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July 19th, 2021
Chronic Pain Coding Today & in the Future
| Published July 19th, 2021
Properly documenting and coding chronic pain can be challenging. As is commonly the case with many conditions, over the years, there has been a shift in the identification of different types of pain, including chronic pain. Understanding where we are now and where we are going will help your organization prepare for the future by changing documentation patterns now.
July 15th, 2021
How Does Global and Professional Direct Contracting (GPDC) Affect Risk Adjustment?
| Published July 15th, 2021
CMS recently announced the 53 Direct Contracting Entities (DCEs) that will be participating in the April 1, 2021 through December 31, 2021 Global and Professional Direct Contracting (GPDC) Model. Among those participating is Clover Health Partners, who runs an in-home primary care program that has the potential to help Medicare ...
July 14th, 2021
How to Properly Assign ICD-10-CM Codes for Pain
| Published July 14th, 2021
Pain is a common diagnosis among all specialties so it should not be surprising to find there are 162 ICD-10-CM codes for reporting it and over 80 mentions in the ICD-10-CM Official Guidelines for Coding and Reporting which describe when certain types of pain should be reported and how the codes should be sequenced.
July 13th, 2021
Will CMS Allow Medicare Advantage Organizations to Risk Adjust from Audio-Only Encounters?
| Published July 13th, 2021
While audio-only telehealth services became a covered benefit during the PHE, CMS put limitations on using the data from those encounters for risk adjustment scoring. Medicare Advantage (MA) plans cannot use the information from these encounters to be scored for risk adjustment; however, it can be used for risk adjustment scoring of ACA plans.
June 29th, 2021
Compliance in the Dental Office or Small Practice
| Published June 29th, 2021
If your practice does not already have a compliance program in place, you will want to get started after reading this article. We have uncovered some important findings with the Office of Inspector General (OIG) in dental practices you need to be aware of. A compliance program offers standard procedures to follow, ...
June 23rd, 2021
UCR Anesthesia Fee Calculations and Base Units - Now Available!
| Published June 23rd, 2021
As per customer request, Find-A-Code now offers UCR Anesthesia Fee Calculations along with CMS and ASA. The anesthesia fee calculations can be found under the Fees section of the code and under the Anesthesia Fee Information.
Time units are computed by dividing the reported anesthesia time by 15 minutes (17 minutes / 15 minutes = 1.13 units).
NOTE: Always ...
June 22nd, 2021
Important Changes to Shared/Split Services
| Published June 16th, 2021 - Last Review/Update June 22nd, 2021
Reporting of split (or shared) services has always been wrought with the potential for incorrect reporting when the fundamental principles of the service are not understood. A recent CMS publication about these services further complicates the matter.
June 7th, 2021
Understanding Non-face-to-face Prolonged Services (99358-99359) in 2021
| Published June 3rd, 2021 - Last Review/Update June 7th, 2021
Due to the extensive changes in office or other outpatient services (99202-99215), there are many questions which still need to be answered, one of which is related to the prolonged services without face-to-face contact. This article explores the question regarding the appropriate use of codes 99358/99359 and how to report it.
June 2nd, 2021
Managed Care Organizations Use CMS Tools to Identify Outliers
| Published June 1st, 2021 - Last Review/Update June 2nd, 2021
Managed Care Organizations (MCOs) include risk-adjusted plans whose funding is based on the health status of their beneficiaries. Government-funded MCOs use CMS information to search for suspected cases of fraud and abuse.
June 1st, 2021
Chronic Care Management Services
| Published June 1st, 2021
This article discusses some of the different Chronic Care Management (CCM) Services found in both the CPT and HCPCS code sets. CCM is not the same as Case Management Services in that case management has to do with “coordinating, managing access to, initiating, and/or supervising'' patient healthcare services whereas CCM services also require the patient to have a condition(s) which is expected to last at least a year or until their death.
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