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August 20th, 2019
Are You Aware of Medicare Advantage Plans Timely Filing Rules?
Published August 20th, 2019|
The Medicare Fee for Service (FFS) program (Traditional or Original Medicare) has a timely filing requirement; a clean claim for services rendered must be received within one year of the date of service or risk payment denial. As any company who has billed Medicare services can attest, the one-year timely filing ...
August 13th, 2019
How to Properly Report Prolonged Evaluation and Management Services
Published August 13th, 2019|
Have you ever had a patient take more time with the provider than they were scheduled for? Do you understand which codes to report and the rules that govern them to allow for better reimbursement? Prolonged Service codes were created just for that reason but you must carefully follow the documentation ...
June 17th, 2019
Extrapolation Policies Apply to RAD-V Audits
Published June 17th, 2019|
Risk Adjustment is a program that was implemented to identify and support Medicare beneficiaries with health conditions, illnesses, or injuries that put them at risk of death or organ system/bodily function failure. Through Risk Adjustment (RA), Medicare ensures their beneficiaries are being followed at least annually for any healthcare conditions ...
June 13th, 2019
What Medical Necessity Tools Does Find-A-Code Offer?
Published June 13th, 2019|
Find-A-Code is a great resource for individuals working in all aspects of healthcare, from providers and ancillary staff to the attorneys and payers who assess and critique the documentation supporting the services performed. When recently asked what tools Find-A-Code has to help support medical necessity, our response was, "We provide many resources ...
May 29th, 2019
Noting "Noncontributory" for Past Medical, Family, Social History - Is It Acceptable?
Published May 29th, 2019 - Last Review/Update June 4th, 2019|
Is "noncontributory" really an unacceptable word to describe a patient whose family history doesn't have any bearing on the condition being evaluated and treated today?
April 23rd, 2019
Let's Talk High Risk E/M Services
Published April 23rd, 2019|
Have you ever assigned a high-complexity E/M code (e.g., 99205, 99215, 99223, 99233, 99245, etc.) and wondered if it would stand up to further scrutiny? Well, let’s take a closer look at the requirements for reporting high-level E/M services. Both the American Medical Association and Medicare-published E/M Guidelines agree that a ...
April 23rd, 2019
What is Medical Necessity and How Does Documentation Support It?
Published April 23rd, 2019|
We recently fielded the question, “What is medical necessity and how do I know if it's been met?" The AMA defines medical necessity as: It is important to understand that while the AMA provides general guidance on what they consider medically necessary services, these particular coding guidelines are generic and may be ...
March 21st, 2019
The Impact of Medical Necessity on High Level E/M Services
Published March 21st, 2019|
I was recently asked the question, "Does 99233 require documentation of a past medical, family, and/or social history (PFSH)?" The quick answer is, "it depends." Code 99233 has the following minimal component requirement: Subsequent inpatient E/M encounters can meet the code level requirement either by component scoring & medical necessity or time & medical necessity. ...
March 18th, 2019
How to Report Imaging (X-Rays) of the Thumb
Published March 18th, 2019|
If you've ever taken piano lessons, you know that the thumb is considered the first finger of the hand. Anatomically, it is also referred to as the first phalanx (finger). However, when you are coding an x-ray of the thumb, images are captured of the thumb, hand, wrist, and all ...
March 1st, 2019
Understanding NCCI Edits
Published March 1st, 2019|
Medicare creates and maintains the National Correct Coding Initiative (NCCI) edits and NCCI Policy Manual, which identify code pair edits. When performed on the same patient, on the same day, and by the same provider, the secondary code is considered an integral part of the primary code, and payment for ...
February 14th, 2019
Proposed Rule: Expanded Telemedicine Benefits for Medicare Advantage Beneficiaries
Published February 14th, 2019|
Telemedicine continues its rise, with new technologies allowing for better communication and access to more aspects of healthcare than ever before. Each year Medicare has made strides, albeit small strides, in their telemedicine coverage while commercial payers continue to make great strides, constantly improving and expanding telemedicine service offerings to ...
January 23rd, 2019
How to Report Co-Surgeons Using Modifier 62
Published January 23rd, 2019|
Modifier 62 is appended to surgical claims to report the need for the skills of two surgeons (co-surgeons) to perform a procedure, with each surgeon performing a distinct part of the same procedure, during the same surgical session. An easy way to explain this is to visualize a patient requiring cervical fusion where ...
January 4th, 2019
Nine New Codes for Fine Needle Aspirations (FNA) in 2019
Published January 4th, 2019|
If your practice performs a lot of fine needle aspirations (FNA), you probably have the code options memorized (10021 without image guidance and 10022 with image guidance). However, the 2019 CPT codes now include nine (9) new FNA codes (10004-10012), one deleted FNA code (10022) and one revised FNA code ...
January 3rd, 2019
New Genetic Test for Severe Inherited Conditions
Published January 3rd, 2019|
For 2019 a new code has been introduced (81443) which represents genetic testing for 15 genes associated with severe, inherited conditions. The results of this test may be used to identify carrier status during prenatal genetic counseling, confirm a clinical diagnosis, or identify at-risk family members for the following severe ...
November 7th, 2018
Q/A: What do I do When my State Doesn't Require Pre-certifications for PI, but the Payer in Another State Does?
Published November 7th, 2018 - Last Review/Update December 19th, 2018|
Question: In Pennsylvania for Personal Injury cases we do not need to go through specific care paths or get precertification in order to treat patients, however, in New Jersey (NJ), doctors that practice there are required to get that precertification. Our question is that when we bill a New Jersey auto ...
September 12th, 2018
Join QPro Today and Get Certified
Published September 12th, 2018|
Join QPro Today and Get Certified! To have a credential in the medical profession shows you have met a minimum standard for professional and ethical standards. Often employers prefer to hire staff that will be involved with any type of patient information such as coding, to show proof they have met certain ...
March 29th, 2018
Medicare Telemedicine Changes for 2018
Published March 29th, 2018|
Find-A-Code presented a webinar on “Coding and Auditing Telemedicine Services,” on March 29, 2018, which did not include the new and updated CMS information published in the MNL Matters Number: MM10393 on January 2, 2018. New and exciting changes were introduced in this article, which is addressed below. Originating Site Fee Each ...
February 1st, 2018
Don’t Be Hesitant About Collecting Co-Pays
Published February 1st, 2018|
If you are hesitant about collecting co-pays, consider that you may be paying interest on credit cards, property mortgages, and business loans. Each dollar that you do not collect in co-pays could have been used to pay down the practice debt. Without question, if you are having difficulty finding ways ...
January 23rd, 2018
NEW on Find-A-Code...National Coverage Determinations (NCDs)
Published January 23rd, 2018 - Last Review/Update January 25th, 2018|
Medicare limits its coverage of services to those considered to be reasonable and necessary for the diagnosis and treatment of an injury or illness based on coverage guidelines. National Coverage Determinations (NCDs) are created based on research, evidence-based processes, public participation, and other resources, and made available to the public. ...
September 14th, 2017
Double Dipping in the History of the Evaluation and Management Note
Published September 14th, 2017|
There are many rules and guidelines a coder must be aware of when it comes to appropriately selecting an Evaluation and Management (EM) code and avoiding doubling dipping is one of them. Double dipping occurs when the same information is used in more than one of the subcomponents of history. The subcomponents of history include: Chief Complaint ...
September 12th, 2017
Auditing Prolonged Evaluation and Management Services
Published September 12th, 2017 - Last Review/Update September 18th, 2017|
At times, there are patients who require prolonged face-to-face time with the provider to discuss or be counseled about their condition, plan of care, risks, complications, alternative therapies, or other medical issues. When E/M services go wild, taking significantly longer than the typical time associated with it, that direct face-to-face ...
February 1st, 2016
Will Incident-To in Your Organization Pass a Compliance Audit?
Published February 1st, 2016|
Practices that bill incident to services need to periodically audit compliance with Medicare and private payor guidelines to avoid potential denials or third-party audits.
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