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Medical Payers & Insurance Companies

articles, webinars, links, files and other resources related to coding, reimbursement and compliance for medical payers and insurance companies

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recent articles

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December 4th, 2019

Preview the PDGM Calculator for Home Health Today

By Wyn Staheli, Director of Research | Published December 4th, 2019

Until February 1, 2020, you can preview Find-A-Code's Patient-Driven Groupings Model (PDGM) home health payment calculator by going to https://www.findacode.com/tools/home-health/ .

tags Specl: Home Health|Hospice Topic: Fees

December 3rd, 2019

A 2020 Radiology Coding Change You Need To Know

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published December 3rd, 2019

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...

tags Loc: All Locations Payer: All Payers Specl: Billing Specl: Cardiology|Vascular Specl: Emergency Medicine Specl: Gastroenterology Specl: General Surgery Specl: Interventional Radiology Specl: Neurology|Neurosurgery Specl: Orthopedics Specl: Radiology Specl: Rheumatology Specl: Urology|Nephrology Topic: Auditing Topic: Coding Topic: CPT Coding Topic: Procedure Coding

December 3rd, 2019

Modifier 50 — Four "Must Know" Tips For Getting Paid

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published December 3rd, 2019

Modifiers added to an HCPCS or CPT© code alters the code description, providing clarity about the service for proper claim processing and reimbursement. Here are four things you must know about modifier 50 to ensure proper payment. - Modifiers are either informational or payment related. Informational modifiers provide additional...

tags Specl: All Specialties Topic: CPT Coding Topic: Modifier Coding Topic: Procedure Coding

December 3rd, 2019

Q/A: Can I Order a TENS unit for a Medicare Patient?

By Wyn Staheli, Director of Research | Published December 3rd, 2019 - Last Review/Update December 4th, 2019

Question Can a chiropractor order a TENS unit for a Medicare patient? We cannot order X-rays for a Medicare patient so I assume we cannot order a TENS unit either. Answer It’s not that you can’t order the TENS unit, it’s just that when it comes to doctors of chiropractic, Medicare only covers ...

tags Payer: CMS|Medicare Specl: Chiropractic Topic: Supply Coding

December 3rd, 2019

Answering the Question: Does my Insurance Cover Chiropractic Care?

By Wyn Staheli, Director of Research | Published December 3rd, 2019 - Last Review/Update December 4th, 2019

The question "Does my insurance cover chiropractic care" is the ongoing question chiropractic offices have struggled with for years. Unfortunately, when it comes to insurance, coverage often varies between payers — even varying between plans for a single payer so there isn't one easy answer.

tags Specl: Chiropractic Topic: Insurance

November 27th, 2019

"What is the ICD-10 code for...?" - Search Smarter With Find-A-Code Tools

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published November 27th, 2019 - Last Review/Update December 3rd, 2019

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: ...

tags Loc: All Locations Payer: All Payers Specl: All Specialties Topic: Auditing Topic: Billing Topic: Claims Processing Topic: Coding Topic: Compliance Topic: CPT Coding Topic: Diagnosis Coding Topic: ICD10CM Coding Topic: Practice Management Topic: Reimbursement Topic: Technology

November 25th, 2019

New Medicare Home Health Care Payment Grouper — Are You Ready?

By Wyn Staheli, Director of Research | Published November 25th, 2019

In 2020, Medicare will begin using a new Patient-Driven Groupings Model (PDGM) for calculating Medicare payment for home health care services. This is probably the biggest change to affect home health care since 2000.

tags Specl: Home Health|Hospice Topic: Fees

November 25th, 2019

Hypertension ICD-10-CM Code Reporting Table

By Wyn Staheli, Director of Research | Published November 25th, 2019

In ICD-10-CM, hypertension code options do not distinguish between malignant and benign or between controlled and uncontrolled. What is important for code selection is knowing if the hypertension is caused by or related to another condition. The following table shows some of these options.

tags Specl: All Specialties Specl: Anesthesia|Pain Management Specl: Neurology|Neurosurgery Specl: Obstetrics|Gynecology Specl: Ophthalmology Specl: Optometry Specl: Oral and Maxillofacial Surgery Topic: ICD10CM Coding

November 20th, 2019

VA: How UCR Charges are Determined

By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published November 20th, 2019

How does the VA determine charges billed to third party payers for Veterans with private health insurance? According to the VA. "38 C.F.R 17.101 stipulates the basic methodology by which VA bills third party insurance carriers. In order to generate a charge for medical services, VA establishes reasonable charges for five ...

tags Payer: VA - Veterans Administration Topic: Fees

November 19th, 2019

Q/A: How do I Code a Procedure for the Primary Insurance so the Secondary Can Get Billed?

By Wyn Staheli, Director of Research | Published November 19th, 2019

Question: How do you modify a code submitted to the primary insurance company to let them know it is not covered by them so you can bill to a secondary?

tags Specl: Chiropractic Topic: Billing Topic: Modifier Coding

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