Aetna Articles and Resources
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by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Have you had a chance to review the new ICD-10-CM codes for FY 2022? Did you know that many payers do not want to see unspecified codes when there is a possibility for better data? How adept are you at assigning and sequencing COVID-19 codes? Take a minute to review 5 of the major changes to the FY2022 ICD-10-CM code updates and claim your chance to watch our most recent webinar where we review the newest code updates.
Sep 29th, 2021
Injection Services
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Injection Service Codes
Injection service codes, are reported under administration of vaccines/toxoids, using 96372, 90460, 90461, 90471, 90472, 0001A, 0002A, 0003A, 0011A, 0012A, 0021A, 0022A, 0031A, 0041A, and 0042A.
Other injections services include:
Non-antineoplastic hormonal therapy injections – 96372
Anti-neoplastic nonhormonal injection therapy 96401
Anti-neoplastic hormonal injection therapy- 96402
Allergen immunotherapy - 95115-95117
According to CMS, do ...
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
As the OIG has published their intent to further investigate the 9.5% of improper payments based on incorrect ICD-10-CM code assignation, they implore Managed Care Organizations (MCOs) to begin employing some of the CMS tools and data analytic programs used to help identify outliers.
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Between June 2019 and June 2020, the United States saw a total of 107,750 deaths from COVID-19. The spread of this virus was so extraordinary that it led President Trump to declare a public health emergency, and we watched as individual states began implementing laws and regulations to limit social interaction ...
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Question: I am in an ENT office as part of a large clinic with separate practices including audiology, CT, and allergy, all billing under the same TAX ID. Sometimes tests are ordered which are done in other departments that my office does not bill for, would those be considered an outside source?
Answer: This is a great question and one that has been asked by many coders and auditors.
Mar 18th, 2021
How Reporting E/M Based on Time May Lose Money
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Just like math teachers who require students to show their work so they can see how the student reached their answer, providers are also required to "show their work" through the documentation process in the medical record. By the time a provider has reviewed the patient's subjective complaints (i.e., patient's ...
Apr 20th, 2020
Dismal OIG Report on Telemedicine
by Wyn Staheli, Director of Content - innoviHealth
Providers need to understand the rules for reporting telemedicine services. A recent OIG report shows that this is not the case. What problems are being found in documentation claims? As providers are expanding their telehealth offerings, now is the time to understand the potential pitfalls since disallowed amounts will be taken back.
Apr 15th, 2020
CMS Temporarily Suspends Contract-Level RADV Audits
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
The Centers for Medicare and Medicaid Services (CMS) is suspending contract-level RADV audits, related to the payment year 2015 and will not initiate any new ones until after the public health emergency has ended. Any documentation already submitted will be reviewed as usual.
Apr 15th, 2020
New CPT® Codes Approved for COVID-19 Antibody Identification
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
On April 10, 2020, the American Medical Association approved and published a revision of code 86318 and added two new codes 86328 and 86769 for reporting Coronavirus [COVID-19] antibody testing.
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Do you still find yourself searching the internet for an ICD10 code? Medical coders often type into their search engine, what is the ICD10 code for ... and a specific diagnosis code, to avoid repeatedly dragging out the incredibly large ICD10 codebook. Ironically, some of the most commonly searched ICD10 diagnoses include: ...
by Aubrie Rowley
The current coronavirus pandemic refers to COVID-19, a novel or new type of coronavirus known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The first victim of the virus was identified in Wuhan, Hubei, China at the end of 2019. There is no immunization available to prevent it from spreading and ...
Feb 10th, 2020
A 2020 Radiology Coding Change You Need To Know
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
The radiology section of the 2020 CPT© has 1 new, 18 revised, and 14 deleted codes. Interestingly, six of the 14 deleted codes were specific to reporting single-photon computerized tomographic (SPECT) imaging services of the brain, heart, liver, bladder, and others. If your organization reports radiology services, it is...
Jan 30th, 2020
Medicare Announces Coverage of Acupuncture Services
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
On January 21, 2020, a CMS Newsroom press-release read,
This new announcement is both exciting and refreshing. Acupuncture, a key component of traditional Chinese medicine and most commonly used to treat pain, is now being officially recognized by Medicare and several other large payers as a covered, alternative treatment option for ...
Oct 21st, 2019
VA- Reasonable Charges Rules, Notices, & Federal Register
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Atrial fibrillation (AF) is the most common type of abnormal heart rhythm (arrhythmia). It is caused by a disorder in the heart’s electrical system. AF is the result of abnormal contractions of the atria (upper two chambers of the heart) causing them to quiver and beat out of sync with ...
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
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 ...
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
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 ...
by NAMAS
Anthem has been very busy sending out notices stating that, beginning October 1, 2019, all timely filing deadlines for claims will be 90 days. We've seen this letter, or something very similar, sent to doctors and other healthcare providers from California to Kentucky.
In their notice, Anthem states:
"Effective for all commercial ...
Jun 17th, 2019
Extrapolation Policies Apply to RAD-V Audits
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
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 ...
Jun 13th, 2019
What Medical Necessity Tools Does Find-A-Code Offer?
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
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 ...
Select the title to see a summary and a link to the full webinar information. some webinars require a subscription to view.
Jun 17th, 2019
Telehealth Policies for Medicare and Commercial Payers
Telehealth Policies for Medicare and Commercial Payers
CPT Coding
Coding
Denial Management
Documentation
Insurance
Payer Guidelines
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Commercial Payer Policies
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