Medical Payers & Insurance Companies

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

Select a payers or insurance companies:

Aetna All Payers BC|BS CMS|Medicare Cigna Articles and Resources Health Net Kaiser Foundation Medicaid UnitedHealthcare Veterans Administration (VA)Workers Comp

suggest a resource

If you know of a resource that should be included here (links, data, etc.) please contact us.

recent articles

Select the title to see a summary and a link to the full article.

July 19th, 2021

Chronic Pain Coding Today & in the Future

By Wyn Staheli, Director of Research | Published July 19th, 2021

Properly documenting and coding chronic pain can be challenging. As is commonly the case with many conditions, over the years, there has been a shift in the identification of different types of pain, including chronic pain. Understanding where we are now and where we are going will help your organization prepare for the future by changing documentation patterns now.

tags Specl: All Specialties Topic: Diagnosis Coding Topic: ICD-11 Coding Topic: ICD10CM Coding

July 15th, 2021

How Does Global and Professional Direct Contracting (GPDC) Affect Risk Adjustment?

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published July 15th, 2021

CMS recently announced the 53 Direct Contracting Entities (DCEs) that will be participating in the April 1, 2021 through December 31, 2021 Global and Professional Direct Contracting (GPDC) Model. Among those participating is Clover Health Partners, who runs an in-home primary care program that has the potential to help Medicare ...

tags Loc: All Locations Payer: Medicare Advantage Plans Specl: Risk Adjustment|HCC Coding Topic: Risk Adjustment

July 14th, 2021

How to Properly Assign ICD-10-CM Codes for Pain

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published July 14th, 2021

Pain is a common diagnosis among all specialties so it should not be surprising to find there are 162 ICD-10-CM codes for reporting it and over 80 mentions in the ICD-10-CM Official Guidelines for Coding and Reporting which describe when certain types of pain should be reported and how the codes should be sequenced.

tags Specl: Acupuncture|Alternative Specl: Allergy|Immunology Specl: Anesthesia|Pain Management Specl: Behavioral Health|Psychiatry|Psychology Specl: Cardiology|Vascular 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: Rheumatology Specl: Risk Adjustment|HCC Coding Specl: Skilled Nursing Specl: Urology|Nephrology Topic: Diagnosis Coding Topic: ICD10CM Coding

July 13th, 2021

Will CMS Allow Medicare Advantage Organizations to Risk Adjust from Audio-Only Encounters?

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published July 13th, 2021

While audio-only telehealth services became a covered benefit during the PHE, CMS put limitations on using the data from those encounters for risk adjustment scoring. Medicare Advantage (MA) plans cannot use the information from these encounters to be scored for risk adjustment; however, it can be used for risk adjustment scoring of ACA plans.

tags Loc: All Locations Payer: All Payers Specl: Risk Adjustment|HCC Coding Topic: Risk Adjustment

June 29th, 2021

Compliance in the Dental Office or Small Practice

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 29th, 2021

If your practice does not already have a compliance program in place, you will want to get started after reading this article. We have uncovered some important findings with the Office of Inspector General (OIG) in dental practices you need to be aware of. A compliance program offers standard procedures to follow, ...

tags Specl: All Specialties Specl: Dental Topic: Claims Processing Topic: Compliance

June 23rd, 2021

UCR Anesthesia Fee Calculations and Base Units - Now Available!

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 23rd, 2021

As per customer request, Find-A-Code now offers UCR Anesthesia Fee Calculations along with CMS and ASA. The anesthesia fee calculations can be found under the Fees section of the code and under the Anesthesia Fee Information. Time units are computed by dividing the reported anesthesia time by 15 minutes (17 minutes / 15 minutes = 1.13 units). NOTE: Always ...

tags Payer: VA - Veterans Administration Specl: Anesthesia|Pain Management Topic: Billing Topic: Coding Topic: CPT Coding Topic: Fees Topic: Life Care Planners Topic: UB04 Form and Coding

June 22nd, 2021

Important Changes to Shared/Split Services

By Aimee Wilcox CPMA, CCS-P, CST, MA, MT and Wyn Staheli, Director of Content Research | Published June 16th, 2021 - Last Review/Update June 22nd, 2021

Reporting of split (or shared) services has always been wrought with the potential for incorrect reporting when the fundamental principles of the service are not understood. A recent CMS publication about these services further complicates the matter.

tags Topic: CPT Coding Topic: E+M Documentation and Coding Topic: Procedure Coding

June 7th, 2021

Understanding Non-face-to-face Prolonged Services (99358-99359) in 2021

By Aimee Wilcox CPMA, CCS-P, CST, MA, MT and Wyn Staheli, Director of Content Research | Published June 3rd, 2021 - Last Review/Update June 7th, 2021

Due to the extensive changes in office or other outpatient services (99202-99215), there are many questions which still need to be answered, one of which is related to the prolonged services without face-to-face contact. This article explores the question regarding the appropriate use of codes 99358/99359 and how to report it.

tags Specl: All Specialties Topic: CPT Coding Topic: E+M Documentation and Coding Topic: HCPCS Coding

June 2nd, 2021

Managed Care Organizations Use CMS Tools to Identify Outliers

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published June 1st, 2021 - Last Review/Update June 2nd, 2021

Managed Care Organizations (MCOs) include risk-adjusted plans whose funding is based on the health status of their beneficiaries. Government-funded MCOs use CMS information to search for suspected cases of fraud and abuse.

tags Loc: All Locations Payer: All Payers Payer: Medicare Advantage Plans Specl: Risk Adjustment|HCC Coding Topic: Auditing Topic: Coding Topic: Diagnosis Coding Topic: Documentation Topic: Fraud Topic: ICD10CM Coding Topic: Risk Adjustment

June 1st, 2021

Chronic Care Management Services

By Wyn Staheli, Director of Research | Published June 1st, 2021

This article discusses some of the different Chronic Care Management (CCM) Services found in both the CPT and HCPCS code sets. CCM is not the same as Case Management Services in that case management has to do with “coordinating, managing access to, initiating, and/or supervising'' patient healthcare services whereas CCM services also require the patient to have a condition(s) which is expected to last at least a year or until their death.

tags Specl: Behavioral Health|Psychiatry|Psychology Specl: Primary Care|Family Care Topic: CPT Coding Topic: HCPCS Coding Topic: Preventive Medicine Topic: Procedure Coding

Thank you for choosing Find-A-Code, please Sign In to remove ads.

MY NEWSLETTERS

FEES

FACILITY

RISK ADJUSTMENT