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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Preventive Medicine Versus E&M Codes: The Same-Day Coding Dilemma

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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,...

tags  Topic: Coding    Topic: CPT Coding    Topic: E+M Documentation and Coding    Topic: Medicare    Topic: Practice Management    Topic: Preventive Medicine    Topic: Reimbursement   

Care Management Billing

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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 ...

tags  Topic: Billing    Topic: Care Management Services    Topic: Coding    Topic: CPT Coding    Topic: HCPCS Coding   

CMS Claims Risk Adjustment Overpayments Commonly Include 10 Specific Diseases

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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.

tags  Topic: Coding    Topic: CPT Coding    Topic: Documentation    Topic: ICD10CM Coding    Topic: Medicare    Topic: OIG    Topic: Risk Adjustment   

How Would Your Organization Defend This Auditing Accusation?

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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.

tags  Topic: Auditing    Topic: Coding    Topic: CPT Coding    Topic: Documentation    Topic: ICD10CM Coding    Topic: Medicare    Topic: OIG    Topic: Practice Management    Topic: Reimbursement    Topic: Risk Adjustment   

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.

tags  Topic: CPT Coding    Topic: Documentation    Topic: HCPCS Coding    Topic: ICD10CM Coding    Topic: Medicare    Topic: Modifier Coding    Topic: Practice Management    Topic: Social Determinants of Health (SDOH)    Topic: Substance Use Disorder   

Understanding the Basics of Reporting Mammography Services

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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.

tags  Specl: Oncology|Hematology    Specl: Radiology    Topic: Billing    Topic: Coding    Topic: CPT Coding    Topic: HCPCS Coding    Topic: ICD10CM Coding    Topic: Medicare    Topic: Modifier Coding    Topic: Preventive Medicine    Topic: Procedure Coding   

The Conundrum Presented by Outpatient Surgeries

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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...

tags  Topic: Admin    Topic: Billing    Topic: Coding    Topic: Hospital    Topic: Inpatient Coding    Topic: Medicare    Topic: Practice Management    Topic: Reimbursement   

HHS’s New Mental Health and Substance Use Disorder Benefit Resources Will Help People Seeking Care to Better Understand Their Rights

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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

tags  Specl: Behavioral Health|Psychiatry|Psychology    Specl: Primary Care|Family Care    Topic: Admin    Topic: Billing    Topic: CPT Coding    Topic: HCPCS Coding    Topic: ICD10CM Coding    Topic: Insurance    Topic: Medicare    Topic: Reimbursement    Topic: Training   

DMEPOS Items: Medical Record Documentation

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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 ...

tags  Topic: Auditing    Topic: Claims Processing    Topic: Denial Management    Topic: DME   

Recent AMA Study Finds Half of Black Women Have High Blood Pressure

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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...

tags  Topic: ICD10CM Coding    Topic: Medicare    Topic: Preventive Medicine   

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