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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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November 24th, 2020
How Might the New 2021 E/M Guideline Changes Impact Risk Adjustment?
| Published November 24th, 2020
While provider organizations are busy learning the new E/M guideline changes being implemented January 1, 2021, Medicare Advantage Organizations (MAOs) are contemplating how the documentation changes for these services may impact risk adjustment coding. To be clear, the new E/M guidelines only pertain to Office and Other Outpatient E/M Services ...
November 18th, 2020
How to Search Find-A-Code for Medicare Policies and Guidelines — LCDs, NCDs and Articles —
| Published November 18th, 2020
Help for Searching Find-A-Code when searching for Medicare Policies and Guidelines — LCDs, NCDs and/or Articles.
November 18th, 2020
Cross-A-Code Instructions in Find-A-Code
| Published November 18th, 2020
Cross-A-Code is a tool found in Find-A-Code which helps you to locate codes in other code sets that help you when submitting a claim.
November 12th, 2020
COVID Vaccine Codes Announced
| Published November 11th, 2020 - Last Review/Update November 12th, 2020
On November 10, 2020, the American Medical Association (AMA) announced the addition of two new codes which will be used for the new COVID-19 vaccines along with 4 new administration codes to be used when reporting the administration of these vaccines.
November 5th, 2020
Locating Periodontal Disease in ICD-10-CM
| Published November 5th, 2020
When coding a diagnosis for periodontal disease, keep in mind there are more options than just chronic or acute. To get started, look at chapter 11, Diseases of the digestive system (K00-K95). Looking at this section a little further, you can see this is where the oral cavity is coded ...
November 5th, 2020
Are You Aware of the 2021 Star Rating System Updates?
| Published November 5th, 2020
Each year the Centers for Medicare & Medicaid Services (CMS) publishes the Star Ratings System Updates for Medicare Advantage (Part C) and Medicare Prescription (Part D). This rating system was developed to help beneficiaries identify and select the health plans that best meet their needs, specifically addressing main issues:
Quality of ...
November 4th, 2020
Staging and Grading Periodontitis
| Published November 4th, 2020
We now understand periodontitis may present itself as a manifestation of systemic diseases in fact; according to DeltaDental, research shows that more than 90 percent of all systemic diseases have oral manifestations, including swollen gums, mouth ulcers, dry mouth, and excessive gum problems. Some of these diseases include:
Diabetes
Leukemia
Oral cancer
Pancreatic cancer
Heart ...
October 28th, 2020
Incident To
| Published October 28th, 2020
Just about any large clinic you visit will have non-physician practitioners, or NPPs. These will include physician assistants, nurse practitioners, and clinical nurses for example. Practices and clinics can bill under the NPPs if they are credentialed with the payer, but the reimbursement is only 85% of the fee schedule. There ...
October 27th, 2020
OIG – Fraud and Abuse Study with COVID-19 Testing
| Published October 27th, 2020
According to the Office of Inspector General (OIG), “The coronavirus disease 2019 (COVID-19) pandemic has led to an unprecedented demand for diagnostic laboratory testing to determine whether an individual has the virus. Beyond the COVID-19 tests, laboratories can also perform add-on tests, for example, to confirm or rule out diagnoses ...
October 26th, 2020
Delving Into the 360 Assessment Fraud Complaint
| Published October 26th, 2020
The Department of Justice is pursuing claims of healthcare fraud against Cigna Health-Spring Medicare Advantage plan based on how they used data from their 360 Program in 2012. A review of the allegations may help other payers avoid similar accusations.
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