Topics & Specialty Resources

articles, webinars, tips, links and other resources for medical coding, reimbursement and compliance

Facilities & Organizations - ACOs, Hospitals, etc.Payers - Medicare, Medicaid, BC/BS, Aetna, etc.Specialties - Cardiology, ENT, Family Practice, etc.States - State specific informationSubjects - Audits, E&M, HIPAA, Practice Management, etc.

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OIG Report Highlights Need to Understand Guidelines


A new OIG report once again highlights the necessity for organizations to fully understand requirements for reporting services and having proper documentation. The types of problems addressed in this report are ongoing issues for multiple types of services and specialties and for many different payers.

tags  Topic: Compliance    Topic: Documentation    Topic: OIG   

New Value-Based Payment Models for Primary Care (Primary Care First and Direct Contracting)


This article summarizes the new Medicare value-based payment models: Primary Care First and Direct Contracting.

tags  Payer: CMS|Medicare    Specl: Home Health|Hospice    Specl: Internal Medicine    Specl: Primary Care|Family Care    Topic: ACO - Accountable Care Organization   

Office of Inspector General Says Medicare Advantage Organizations are Denying Services Inappropriately


We attended the recent virtual RISE National Conference and had the opportunity to listen to presenters share their knowledge about risk adjustment and HCC reporting and data validation. Among the presenters were representatives from the Office of Inspector General (OIG), who presented findings from encounter data from 2012-2016. They began ...

tags  Payer: CMS|Medicare    Topic: Medicare    Topic: OIG    Topic: Risk Adjustment   

New Grouper Added for Skilled Nursing


The additional grouper for Skilled Nursing, sometimes referred to as (PDPM), is used for classifying SNF patients in a covered Part A stay. This grouper is included with our Home Health Grouper.  Current groupers/calculators include: Home Health PDGM (Patient-Driven Grouping Model) Skilled Nursing Facility PDPM (Patient-Driven Payment Model) What is it? According to CMS, In ...

tags  Specl: Home Health|Hospice    Specl: Skilled Nursing    Topic: Assessment Tools   

Use the Correct Diagnosis Codes and Revenue Codes to Get Paid for PAD Rehab


The initial treatment in rehabilitation for patients suffering from Intermittent Claudication (IC) is Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD).  Rehabilitation using SET involves the use of intermittent walking exercise, which alternates periods of walking to moderate-to-maximum claudication, with rest.   When reporting 93668 for peripheral arterial disease rehabilitation the following ...

tags  Specl: Cardiology|Vascular    Specl: Physical Medicine|Physical Therapy    Topic: Billing    Topic: Coding    Topic: CPT Coding    Topic: ICD10CM Coding   

Are NCCI Edits Just for Medicare?


The National Correct Coding Initiative (NCCI) edits were developed by CMS to help promote proper coding and control improper coding that leads to incorrect payments with part B claims. It is important to understand that NCCI edits do not include every possible code combination or every type of un-bundling combination. With that ...

tags  Specl: All Specialties    Specl: Anesthesia|Pain Management    Specl: Billing    Specl: Cardiology|Vascular    Specl: Dental    Specl: Dermatology|Plastic Surgery    Specl: Emergency Medicine    Specl: Endocrinology    Specl: ENT|Otolaryngology    Specl: Gastroenterology    Specl: General Surgery    Specl: Home Health|Hospice    Specl: Internal Medicine    Specl: Interventional Radiology    Specl: Laboratory|Pathology    Specl: Neurology|Neurosurgery    Specl: Obstetrics|Gynecology    Specl: Oncology|Hematology    Specl: Ophthalmology    Specl: Optometry    Specl: Oral and Maxillofacial Surgery    Specl: Orthopedics    Specl: Pain Management    Specl: Pediatrics    Specl: Physical Medicine|Physical Therapy    Specl: Podiatry    Specl: Primary Care|Family Care    Specl: Pulmonology    Specl: Radiology    Specl: Rheumatology    Specl: Skilled Nursing    Specl: Urology|Nephrology    Specl: xFAC Specialty Panel Admin    Topic: Auditing    Topic: Billing    Topic: Coding    Topic: CPT Coding    Topic: Modifier Coding    Topic: MUE - Medical Unlikely Edit   

New Name Same Great Product! "HCC Plus"


tags  Topic: Risk Adjustment   

Payment Adjustment Rules for Multiple Procedures and CCI Edits


Surgical and medical services often include work that is required to be done prior to a procedure and post-procedure. When there are multiple procedures done by the same physician, group, or another qualified healthcare professional on the same day, the pre and post work is only required once. Therefore, CMS ...

tags  Payer: CMS|Medicare    Topic: Billing    Topic: CPT Coding    Topic: Denial Management    Topic: Fees    Topic: Modifier Coding    Topic: Payer Guidelines    Topic: Practice Management   

New ABN Form is Here


The anticipated changes to the Advanced Beneficiary Notice of Non-coverage (ABN) Form (CMS-R-131) have arrived. This important form is issued to the patient or client by providers, physicians, practitioners, and suppliers in situations where Medicare payment is expected to be denied. You can begin using the new ABN immediately if you so wish. However, it becomes mandatory on August 31, 2020.

tags  Topic: ABN - Advanced Beneficiary Notice    Topic: HIPAA    Topic: Medicare    Topic: Practice Management   

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