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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May 26th, 2022
Preventive Medicine Versus E&M Codes: The Same-Day Coding Dilemma
| Published May 26th, 2022
Choosing a proper office visit code can become confusing unless one understands the rules separating preventive medicine and evaluation and management (E&M) coding. Problem-oriented E&M services, office, and other outpatient visit codes 99202-99215 (along with hospital, observation, and consultative encounters) are for patients who present with signs, symptoms,...
May 26th, 2022
Care Management Billing
| Published May 26th, 2022
Chronic Care Management (CCM) is taking off, and with new codes and rules, it can get confusing. According to CMS, here are a few guidelines to help you with concurrent billing of CCM services.
You can’t report complex CCM and non-complex CCM for the same patient in a calendar month
Don‘t report ...
May 24th, 2022
CMS Claims Risk Adjustment Overpayments Commonly Include 10 Specific Diseases
| Published May 24th, 2022
There are many lessons that can be learned from a single OIG audit report. In this recently-published OIG report, several of the most common documentation and coding errors are pointed out in relation to reporting HCCs for risk adjusted plans. Take a few minutes to review the report and see if improvements within your own organization can be made from what you learn.
May 23rd, 2022
How Would Your Organization Defend This Auditing Accusation?
| Published May 23rd, 2022
The Office of Inspector General (OIG) is always working on audits in a pursuit of accurate reporting and reimbursement. A recently published OIG audit report can provide great information on how to protect providers and risk adjustment payers from serious financial losses by showing exactly what the OIG is looking for and how the payer (or provider) may have defended their coding choices. In this article, you will see how the OIG audited the HCC for major depressive disorder and what Anthem did to defend its reporting.
May 19th, 2022
Methadone Take-Home Flexibilities Extension Guidance
On March 16, 2020, SAMHSA issued an exemption to Opioid Treatment Programs (OTPs) whereby a state could request “a blanket exception for all stable patients in an OTP to receive 28 days of Take-Home doses of the patient’s medication for opioid use disorder.” States could also “request up to 14 days of Take-Home medication for those patients who are less stable but who the OTP believes can safely handle this level of Take-Home medication.”
The exemption will carry on effective upon the expiration of the COVID-19 Public Health Emergency, subject to conditions listed in this article.
May 17th, 2022
Understanding the Basics of Reporting Mammography Services
| Published May 17th, 2022
How familiar are you with the coding and documentation requirements for screening and diagnostic mammography? What is diagnostic digital breast tomosynthesis and can you bill for it? This article review the basics of reporting screening, diagnostic, and digital breast tomosynthesis.
May 13th, 2022
The Conundrum Presented by Outpatient Surgeries
| Published May 13th, 2022
Do you keep them under inpatient status? Or do you bring them in as outpatients and just keep them overnight? For our Medicare populations, in all of our organizations, the ability to follow the CPT code of the applicable surgical procedure is the determining factor to bill inpatient...
May 11th, 2022
HHS’s New Mental Health and Substance Use Disorder Benefit Resources Will Help People Seeking Care to Better Understand Their Rights
| Published May 11th, 2022
New Resources to Help People Seeking Care to Understand and Access Protections Offered Under the Parity Law for Mental Health and Substance Use Disorder Benefits
May 10th, 2022
DMEPOS Items: Medical Record Documentation
| Published May 10th, 2022
According to MLN Connects 2022-04-21 MLNC, "For Medicare to cover any Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) item, the patient’s medical record must include enough documentation to justify the need for:
Type and quantity of items ordered
Frequency of use (or replacement if applicable)
The medical record should include the patient’s ...
May 10th, 2022
Recent AMA Study Finds Half of Black Women Have High Blood Pressure
| Published May 10th, 2022
Hypertension among Black Americans is among the highest in the world. Currently, the American Medical Association (AMA) is working to achieve optimal health for all. To do that, they need to work at the community level to bring health equity to minority communities in the U.S. A recent...
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