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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July 1st, 2020

Understanding UCR Inpatient Fees used on DRG's

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 1st, 2020

tags Specl: Skilled Nursing Topic: Care Coordinator Topic: Fees Topic: Hospital Topic: Payment Models Topic: Practice Management

June 29th, 2020

HCPCS Codes Were NOT all Created for the Same Purpose

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 29th, 2020

Have you ever wondered why you were unable to find a particular product/code with our DMEPOS search? When looking for HCPCS Level II codes, there are several kinds of codes and not all HCPCS codes were created for the same purpose. If you are searching for a certain HCPCS product ...

tags Topic: CDT (Dental) Codes Topic: DME Topic: HCPCS Coding

June 29th, 2020

Additional COVID-19 Testing Codes Announced

By Wyn Staheli, Director of Research | Published June 29th, 2020

New coronavirus antigen testing codes announced. These are effective immediately.

tags Topic: Code Updates Topic: Coding Topic: COVID-19 Topic: CPT Coding Topic: Procedure Coding

June 23rd, 2020

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

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 23rd, 2020

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: CPT Coding Topic: ICD10CM Coding

June 23rd, 2020

Are NCCI Edits Just for Medicare?

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 23rd, 2020

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: Coding Topic: CPT Coding Topic: Modifier Coding Topic: MUE - Medical Unlikely Edit

June 18th, 2020

CMS- Reminder COVID Assessment and Specimen Collection

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 18th, 2020

On March 1, 2020, new codes and rules were released to bill for COVID-19 symptom and exposure assessments, as well as specimen collection. CMS has recently sent out reminders on billing for these services, the proper use of the CS modifier on claims, and how they are handling denials due ...

tags Topic: COVID-19 Topic: CPT Coding

June 17th, 2020

Payment Adjustment Rules for Multiple Procedures and CCI Edits

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 17th, 2020

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 Topic: CPT Coding Topic: Denial Management Topic: Modifier Coding Topic: Practice Management

June 16th, 2020

Should I Bill Dental or Medical?

By Christine Taxin | Published June 16th, 2020

While you likely find yourself focusing on fewer patients and more on emergency care, it’s a good time to understand how medical billing can allow patients with active infection in the oral cavity to seek the treatment they need. Forms need to be filled out correctly, and you must carefully follow ...

tags Specl: Dental Specl: Oral and Maxillofacial Surgery

June 15th, 2020

Newest Launch - We Now Have Outpatient Facility Pricing!

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 15th, 2020

Our newest feature launch offers UCR pricing for Outpatient Facility. We recently released pricing information based on databases of insurance claims from private-sector health care providers.Usual, customary, and reasonable charges (UCR) are medical fees used when there are no contractual pricing agreements and are used by certain healthcare plans and third-party payers to generate ...

tags Specl: Skilled Nursing Topic: Billing Topic: Care Coordinator Topic: CPT Coding Topic: Fees Topic: Physician Billing Topic: Practice Management Topic: Reimbursement

June 16th, 2020

Medical Necessity using Soap can prevent a future audit!

By Christine Taxin | Published June 15th, 2020 - Last Review/Update June 16th, 2020

Medical Necessity using Soap can prevent a future audit! How Do I Correctly Document all my notes on every patient regardless of the insurance I am billing? Medically necessary care is the reasonable and essential diagnostic, preventive, and treatment services (including supplies, appliances, and devices) and follow-up care as determined by qualified ...