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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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May 17th, 2022
Understanding the Basics of Reporting Mammography Services
| Published May 17th, 2022
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.
May 13th, 2022
The Conundrum Presented by Outpatient Surgeries
| Published May 13th, 2022
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...
May 11th, 2022
How Would Your Organization Defend This Auditing Accusation?
| Published May 11th, 2022
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.
May 11th, 2022
HHS’s New Mental Health and Substance Use Disorder Benefit Resources Will Help People Seeking Care to Better Understand Their Rights
| Published May 11th, 2022
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
May 10th, 2022
DMEPOS Items: Medical Record Documentation
| Published May 10th, 2022
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 ...
May 10th, 2022
Recent AMA Study Finds Half of Black Women Have High Blood Pressure
| Published May 10th, 2022
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...
May 9th, 2022
Making the Case for Clean Claims
| Published May 9th, 2022
Medicare providers are your claims clean? Federal regulations mandate that 90 percent of “clean claims” must be paid to healthcare providers within 30 days. But what if the payor doesn’t pay within 30 days? What if your claims are unclean? The problem is – who determines what a...
May 9th, 2022
Moving to Medical Decision-Making as the Key Component
| Published May 5th, 2022 - Last Review/Update May 9th, 2022
Office billing is now based solely on either MDM or total time. Last week, I declared that it is my opinion that medical decision-making (MDM) should always be one of the components that contributes to selecting (or perhaps, demonstrating) the appropriate level of service (LOS) for the professional...
May 3rd, 2022
Minor Procedures Get a Major Sting in the 2021 CERT Report
| Published May 3rd, 2022
The 2021 Comprehensive Error Rate Testing report provides important lessons on exactly what errors are being found during chart reviews and how provider organizations can be proactive in their approach to quality documentation that not only supports the services provided to the patient but allows the providers to work in an environment of knowing what must be documented to support what they submit to the payer.
May 2nd, 2022
Continuous Glucose Monitors (CGMs) -- New Codes
| Published May 2nd, 2022
New codes for continuous glucose monitors (CGMs) became effective on April 1, 2022. The following information is excerpted from MLN Matters MM12564 regarding CGMs. Be sure to review this information and implement policies to ensure accurate reporting/billing.
On December 28, 2021, we published the Medicare DMEPOS final rule in the Federal Register. This addressed the ...
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