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News and Important Information2019 Coding and Reimbursement Tip Sheet for Transition from Pediatric to Adult Health Care Neonate Coding When Child is Transferred (2019/01/17) Code SetsCPT CodesCPT Procedure Codes ICD-10-CM CodesICD-10-CM Diagnosis Codes Find-A-Code's Tools & ResourcesClick-A-Dex™Click-A-Dex™ Index Search Tool Build-A-CodeStep-by-step coding from all major code sets. NCCI Edits ValidatorValidate using NCCI edits for errors in code selection. Pro-Fee CalculatorVerify Medicare Reimbursement and UCR Fees for Professional Services Commercial Payer PoliciesView Clinical Indications for Medical necessity on procedures, Suggested Code Selection to assist your clinical judgment includes citations. Find-A-NPI™Find-A-NPI™ Fast Provider Lookup Additional Links and ResourcesDrugs and Biologicals Pub-100 Ch 17Drugs and Biologicals Pub-100 Ch 17 Commonly Administered Pediatric VaccinesAmerican Academy of Pediatrics Billing Requirements for OPPSBilling Requirements for OPPS Providers with Multiple Service Locations Select the title to see a summary and a link to the full article. November 12th, 2019 HIPAA Final Rule Eliminates HPID and OEID| Published November 12th, 2019 Final rule eliminates the requirement for health plans to obtain a unique health plan identifier (HPID) and also eliminates the voluntary use of the other entity identifier (OEID). This change becomes effective December 27, 2019. November 11th, 2019 And Then There Were Fees...| Published November 11th, 2019 Find-A-Code offers fees and pricing for just about everything, this article will address two of some of the most common payment systems with CMS. (OPPS) -Outpatient Medicare Outpatient Prospective Payment System. (MPFS)- Medicare Physician Fee Schedule The Fees section on each code page is determined on the type of services... October 21st, 2019 VA- Reasonable Charges Rules, Notices, & Federal Register| Published October 21st, 2019 October 18th, 2019 Medically Unlikely Edits (MUEs): Unlikely, But Not Always Impossible| Published October 18th, 2019 - Last Review/Update October 23rd, 2019 Medically Unlikely Edits (MUEs) were created by the Centers for Medicare & Medicaid Services (CMS) to help lower the error rate for paid Part B claims. MUEs are the maximum units of a HCPCS or CPT code that a provider would bill under most circumstances for the same patient on ... October 15th, 2019 CMS says Codes are on the Move!| Published October 15th, 2019
Have you noticed your LCDs are missing something? CMS is moving codes out of LCDs and into Billing and Coding Articles. MACs began moving ICD-10-CM, CPT/HCPCS, Bill Type, and Revenue codes in January 2019, and will continue through January 2020. Therefore, if there is an LCD with its codes removed, you will find ... October 11th, 2019 Why is HIPAA So Important?| Published October 11th, 2019 - Last Review/Update October 15th, 2019 Why is HIPAA So Important?
Some may think that what they do to protect patient information may be a bit extreme. Others in specialty medical fields and research understand its importance a little more. Most of that importance lies in the information being protected. Every patient has a unique set of ... October 7th, 2019 Hypertension & ICD-10| Published October 7th, 2019 Hypertensive Diseases and ICD-10. Helps and examples for these codes. October 1st, 2019 2020 Official ICD-10-CM Coding Guideline Changes Are Here!| Published October 1st, 2019 It’s that time of year for offices to get ready for the ICD-10-CM code revisions. As part of that process, it’s also good to know what is going on with the ICD-10-CM Official Guidelines for Coding and Reporting. In the examples listed below, strikeout text is deleted and highlighted text ... October 1st, 2019 Federal Workers Compensation Information| Published October 1st, 2019
When federal employees sustain work-related injuries, it does not go through state workers compensation insurance. You must be an enrolled provider to provide services or supplies. The following are some recommended links for additional information about this program.
Division of Federal Employees' Compensation (DFEC) website
Division of Federal Employees' Compensation (DFEC) provider ... October 1st, 2019 Do ICD-10 Updates Have Your Heart Beating Irregularly? Check Out the New Atrial Fibrillation Codes| Published October 1st, 2019 Atrial fibrillation (AF) is the most common type of abnormal heart rhythm (arrhythmia). It is caused by a disorder in the heart’s electrical system. AF is the result of abnormal contractions of the atria (upper two chambers of the heart) causing them to quiver and beat out of sync with ... October 1st, 2019 The New ICD-10-CM Code Updates Are Here — Are You Ready?| Published October 1st, 2019 Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99)
A small revision in the description changed[STEC] to (STEC) for B96.21, B96.22, B96.23. Remember, in the instructional guidelines, ( ) parentheses enclose supplementary words not included in the description (or not) and [ ] brackets enclose synonyms, alternative wording, or explanatory phrases.
Chapter 2: ... September 30th, 2019 CMS and HHS Tighten Enrollment Rules and Increase Penalties| Published September 30th, 2019 This ruling impacts what providers and suppliers are required to disclose to be considered eligible to participate in Medicare, Medicaid, and Children's Health Insurance Program (CHIP). The original proposed rule came out in 2016 and this final rule will go into effect on November 4, 2019.
There have been known problems ... September 30th, 2019 Vaccine Administration - When The Right Vaccine Code is Not Enough| Published September 30th, 2019 Understanding how to apply immunization administration codes properly will support correct reimbursement for vaccinations. Reporting the right vaccine code alone is not enough to guarantee proper billing. The majority of the time, providers can charge for the vaccine/product as well as the administration of the vaccine; always consult your payer ... August 20th, 2019 Are You Aware of Medicare Advantage Plans Timely Filing Rules?| Published August 20th, 2019 The Medicare Fee for Service (FFS) program (Traditional or Original Medicare) has a timely filing requirement; a clean claim for services rendered must be received within one year of the date of service or risk payment denial.
As any company who has billed Medicare services can attest, the one-year timely filing ... August 16th, 2019 Medical ID Theft| Published August 16th, 2019 - Last Review/Update August 20th, 2019 Medical ID Theft
"So, do you guys think you can do something with that?" John asked angrily at our first meeting with him in August 2017 as he slammed a stack of medical bills, EOBs and collection letters - three inches high - down in front of my partner and I. ... August 13th, 2019 How to Properly Report Prolonged Evaluation and Management Services| Published August 13th, 2019 Have you ever had a patient take more time with the provider than they were scheduled for? Do you understand which codes to report and the rules that govern them to allow for better reimbursement?
Prolonged Service codes were created just for that reason but you must carefully follow the documentation ... August 9th, 2019 The OIG Work Plan: What Is It and Why Should I Care?| Published August 9th, 2019 - Last Review/Update August 14th, 2019 The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ... July 26th, 2019 Anthem is Changing their Timely Filing Requirements for All Plans, Including Medicare Advantage| Published July 26th, 2019 - Last Review/Update August 8th, 2019 Anthem has been very busy sending out notices stating that, beginning October 1, 2019, all timely filing deadlines for claims will be 90 days. We've seen this letter, or something very similar, sent to doctors and other healthcare providers from California to Kentucky.
In their notice, Anthem states:
"Effective for all commercial ... July 22nd, 2019 Are These Problems Hurting Your Practice?| Published July 22nd, 2019 There are many things that can be missed when trying to run an effective and profitable practice. This article covers some important tasks that are often overlooked such as not reviewing your payer contracts or failing to check eligibility. July 12th, 2019 5 Ways to Minimize HIPAA Liabilities| Published July 12th, 2019 - Last Review/Update July 30th, 2019 Last year was historic for HIPAA enforcement. The HHS Office of Civil Rights collected a record $23.5 million in settlements and judgments against providers guilty of HIPAA violations. To avoid becoming part of that unwanted statistic, it’s important to pay extra close attention to five key areas of HIPAA vulnerability.
Take ... July 5th, 2019 Helping Others Understand How to Apply Incident to Guidelines| Published July 5th, 2019 - Last Review/Update July 16th, 2019 Over the past few months, I have worked with different organizations that have been misinterpreting the "incident to" guidelines and, in return, have been billing for services rendered by staff that are not qualified to perform the services per AMA and CPT. What I found within the variances is that ... June 27th, 2019 2018 Medicare Improper Payment Report Shows Slight Improvement but There's Still Work to be Done| Published June 27th, 2019 - Last Review/Update July 8th, 2019 The Medicare Improper Payment Report for 2018 is not a measurement of fraud. Rather, it is an estimate of the claims paid by Medicare which did not meet Medicare coverage, coding, and billing rules. The estimated Medicare FFS payment accuracy rate (claims paid correctly) from July 1, 2016 through June 30, 2017, was 91.9 percent. ... June 21st, 2019 Small Breaches Can Be Subject to Large Penalties| Published June 21st, 2019 - Last Review/Update June 27th, 2019 Small Breaches Can Be Subject to Large Penalties
We may have heard about the large fines issued by the Office for Civil Rights (OCR) against big organizations like Anthem or the University of Texas MD Anderson Cancer Center. These organizations have been in the news due to privacy breaches that constituted violations ... June 18th, 2019 How to Properly Report Monitoring Patients Taking Blood-thinning Medications| Published June 18th, 2019 - Last Review/Update June 19th, 2019 Codes 93792 and 93792, which were added effective January 1, 2019, have specific guidelines that need to be followed. This article provides some guidance and tips on properly reporting these services. June 17th, 2019 Extrapolation Policies Apply to RAD-V Audits| Published June 17th, 2019 Risk Adjustment is a program that was implemented to identify and support Medicare beneficiaries with health conditions, illnesses, or injuries that put them at risk of death or organ system/bodily function failure. Through Risk Adjustment (RA), Medicare ensures their beneficiaries are being followed at least annually for any healthcare conditions ... June 14th, 2019 A United Approach| Published June 14th, 2019 - Last Review/Update June 18th, 2019 A United Approach
As auditors, we all have a different perspective when evaluating documentation. It would be unreasonable to think that we all view things the same way. In my opinion, differing perspectives are what makes a great team because you can coalesce on a particular chart, work it through and ... June 13th, 2019 What Medical Necessity Tools Does Find-A-Code Offer?| Published June 13th, 2019 Find-A-Code is a great resource for individuals working in all aspects of healthcare, from providers and ancillary staff to the attorneys and payers who assess and critique the documentation supporting the services performed. When recently asked what tools Find-A-Code has to help support medical necessity, our response was, "We provide many resources ... June 6th, 2019 How to Code Ophthalmologic Services Accurately| Published June 6th, 2019 - Last Review/Update June 11th, 2019 Have you ever tried to quickly recall the elements required to support a comprehensive ophthalmologic exam versus an intermediate one? Make coding decisions quickly by creating a cheat sheet containing vital information that allows you to quickly select the right code.
According to Article A19881 which was published in 2004 and ... May 29th, 2019 Noting "Noncontributory" for Past Medical, Family, Social History - Is It Acceptable?| Published May 29th, 2019 - Last Review/Update June 4th, 2019 Is "noncontributory" really an unacceptable word to describe a patient whose family history doesn't have any bearing on the condition being evaluated and treated today? May 21st, 2019 RT and LT Modifier Usage Change (effective 2019-03-01)| Published May 21st, 2019 According to Noridian Medicare, there are new changes required when reporting the RT and LT modifier(s). In the past, it was appropriate to bill the RT and LT modifier on the same line when it was required for certain HCPCS codes. Noridian released a publication stating claims reported with RT/LT on the same ... May 17th, 2019 An Update on the DHS OIG's Effort to Combat Fraud & Abuse| Published May 17th, 2019 - Last Review/Update May 21st, 2019 An Update on the DHS OIG's Effort to Combat Fraud & Abuse
Every year, the Department of Health and Human Services (DHS) Office of Inspector General (OIG) is required by law to release a report detailing the amounts deposited and appropriated to the Medicare Trust Fund, and the source of such ... April 29th, 2019 Medicare Revises Their Appeals Process| Published April 29th, 2019 On April 12, 2019, Medicare announced that there will be some changes to their appeals process effective June 13, 2019. According to the MLN Matters release (see References), the following policy revisions in the Medicare Claims Processing Manual (MCPM), Chapter 29 are taking place:
The policy on use of electronic signatures
Timing ... April 26th, 2019 Medicare Revises Their Appeals Process| Published April 26th, 2019 There are policy revisions in the Medicare Claims Processing Manual (MCPM), Chapter 29 taking place June 13, 2019. This will give you a heads up on those changes. April 23rd, 2019 Let's Talk High Risk E/M Services| Published April 23rd, 2019 Have you ever assigned a high-complexity E/M code (e.g., 99205, 99215, 99223, 99233, 99245, etc.) and wondered if it would stand up to further scrutiny? Well, let’s take a closer look at the requirements for reporting high-level E/M services.
Both the American Medical Association and Medicare-published E/M Guidelines agree that a ... April 23rd, 2019 Coverage for Hearing Aids and Auditory Implants| Published April 23rd, 2019 For hearing impairment, Medicare is firm in its stance on when it will and will not cover hearing correction. In the PUB 100-02 Medicare Benefit Policy Manual, Chapter 16, Medicare cites the Social Security Act by explaining:
"..."hearing aids or examination for the purpose of prescribing, fitting, or changing hearing aids" ... April 23rd, 2019 What is Medical Necessity and How Does Documentation Support It?| Published April 23rd, 2019 We recently fielded the question, “What is medical necessity and how do I know if it's been met?"
The AMA defines medical necessity as:
It is important to understand that while the AMA provides general guidance on what they consider medically necessary services, these particular coding guidelines are generic and may be ... April 8th, 2019 Prepayment Review Battle Plan| Published April 8th, 2019 Any type of payer review can create some headaches for providers and cause problems for a healthcare office. Even for a practice that has taken administrative steps to try and prevent a prepayment review, it can still happen. A prepayment review means that you must include documentation WITH your claim. ... April 1st, 2019 Q/A: Can I Tell a Medicare Patient Which Option to Check on the ABN?| Published April 1st, 2019 - Last Review/Update April 2nd, 2019 Question
My patient seemed confused about which of the options they should check. Can I just tell them which one they should check?
Answer
No! That could be construed as coercion. The official instructions state “Under no circumstances can the notifier decide for the beneficiary which of the 3 checkboxes to select.”
Now, this ... March 27th, 2019 Pain Codes in ICD-10-CM| Published March 27th, 2019 When coding with ICD-10-CM, pain codes can be found in different sections:
The Body System affected or site-specific pain codes, such as Low Back Pain M54.5, can be found in Chapter 13. Diseases of the Musculoskeletal system (M00-M99). Other examples might be ocular pain H57.1, found in Chapter 7. Diseases of ... March 25th, 2019 Clearing Up Some Medicare Participation Misunderstandings| Published March 25th, 2019 - Last Review/Update April 2nd, 2019 Even though we may think we truly understand what it means to be a participating provider, Medicare doesn’t quite work the way that other insurance plans do. Far too many providers do not understand the difference and get into hot water. To further complicate matters, the rules are different for ... March 22nd, 2019 Q/A: How do we Know Which Codes a Payer Will Allow?| Published March 22nd, 2019 How do we know which codes a payer will allow?
The best way to determine the codes (CPT, ICD-10-CM and HCPCS) allowed by a payer is to review their payer policy. While it is good to know the official guidelines (e.g., ICD-10-CM Official Guidelines for Coding and Reporting, AMA Guidelines, Medicare ... March 21st, 2019 The Impact of Medical Necessity on High Level E/M Services| Published March 21st, 2019 I was recently asked the question, "Does 99233 require documentation of a past medical, family, and/or social history (PFSH)?"
The quick answer is, "it depends."
Code 99233 has the following minimal component requirement:
Subsequent inpatient E/M encounters can meet the code level requirement either by component scoring & medical necessity or time & medical necessity. ... March 18th, 2019 How to Report Imaging (X-Rays) of the Thumb| Published March 18th, 2019 If you've ever taken piano lessons, you know that the thumb is considered the first finger of the hand. Anatomically, it is also referred to as the first phalanx (finger). However, when you are coding an x-ray of the thumb, images are captured of the thumb, hand, wrist, and all ... March 7th, 2019 Q/A: Can you Help me Understand the New Medicare Insurance Cards?| Published March 7th, 2019 As many of you are aware, CMS began issuing new Medicare identification cards last year which required the replacement of social security numbers with a new Medicare Beneficiary Identifier (MBI). All cards have now been mailed out and patient's should have the new cards when they come in. Currently, we are in the transition period until January 2020. March 4th, 2019 Answers to Your Auditing & Compliance Questions| Published March 4th, 2019 - Last Review/Update March 7th, 2019 National Alliance of Medical Auditing Specialists (NAMAS) hosts a forum where auditing and compliance professionals can get answers to their questions, and exchange information with other professionals across the country. Recently, we've received the following question regarding fracture care that we'd like to share below.
Q: I recently noticed CPT 26600, ... March 4th, 2019 UnitedHealthcare to Discontinue Coverage of Consultations| Published March 4th, 2019 - Last Review/Update March 7th, 2019 In United Healthcare's March provider bulletin, they announced that beginning on June 1, 2019, they will be phasing out coverage of consultation services (99241-99255). March 1st, 2019 Understanding NCCI Edits| Published March 1st, 2019 Medicare creates and maintains the National Correct Coding Initiative (NCCI) edits and NCCI Policy Manual, which identify code pair edits. When performed on the same patient, on the same day, and by the same provider, the secondary code is considered an integral part of the primary code, and payment for ... February 14th, 2019 Proposed Rule: Expanded Telemedicine Benefits for Medicare Advantage Beneficiaries| Published February 14th, 2019 Telemedicine continues its rise, with new technologies allowing for better communication and access to more aspects of healthcare than ever before. Each year Medicare has made strides, albeit small strides, in their telemedicine coverage while commercial payers continue to make great strides, constantly improving and expanding telemedicine service offerings to ... February 12th, 2019 Coding Medicare Initial Preventive Physical Exams (IPPE)| Published February 12th, 2019 The Medicare Initial Preventive Physical Exam (IPPE), also commonly referred to as the “Welcome to Medicare Physical”, may seem daunting to many, but when broken out to identify the requirements is fairly straightforward.
Purpose
An IPPE helps the Medicare beneficiary (the patient) get to know their healthcare provider at a time when they ... February 7th, 2019 Q/A: Do Digital X-rays Have Their Own Codes?| Published February 7th, 2019 - Last Review/Update February 8th, 2019 Question
Are you aware if digital x-ray of the spine requires a different code than plain x-ray? If so, where can I find the information specific to digital x-ray codes?
Answer
There are no separate codes for digital x-rays. However, there may be modifiers that are required to be submitted with the usual ... February 1st, 2019 Attestations Teaching Physicians vs Split Shared Visits| Published February 1st, 2019 - Last Review/Update February 7th, 2019 Physicians often use the term "attestation" to refer to any kind of statement they insert into a progress note for an encounter involving work by a resident, non-physician practitioner (NPP), or scribe. However, for compliance and documentation purposes, "attestation" has a specific meaning and there are distinct requirements for what ... January 28th, 2019 Q/A Neonate Coding When Child is Transferred (2019/01/17)| Published January 28th, 2019 Codapedia Forum - Questions & Answers
Q/A: Neonatologist was at the birth of a very critical child, she billed 99468 and then it was decided to transfer the child to another facility, she also billed 99291 and 99292 x 3. Her time was denied, how should she have billed for the initial ... January 28th, 2019 Empowering Medicare Beneficiaries| Published January 28th, 2019 - Last Review/Update January 29th, 2019 BLOG: CMS announced a NEWS release today making it easier to help Medicare Beneficiaries access cost and quality information. CMS announced, "Today, the Centers for Medicare & Medicaid Services (CMS) launched a new app that gives consumers a modernized Medicare experience with direct access on a mobile device to some of ... January 28th, 2019 2018 Salary Survey| Published January 28th, 2019 - Last Review/Update January 29th, 2019 NAMAS needs your help in capturing salary information for 2018 and developing standards for the industry. This is the information that YOU as an auditor need to share with your employer!
Everyone who participates will be entered into a drawing for a chance to win one of many prizes! One winner ... January 25th, 2019 Medical Necessity vs. Documentation for Inpatient Services| Published January 25th, 2019 - Last Review/Update January 29th, 2019 Auditing the documentation of inpatient and observation E/M services can often be challenging. Many of the notes we are provided for review include so much information that the note feels like a short novel instead of documentation for one date of service. This over-documentation can make it difficult to see ... January 23rd, 2019 Everything You need to Know about Drugs| Published January 23rd, 2019 We have it all! Search our WK Drug Database for drugs and pharmaceuticals. When it comes to support and guidance the WK Drug Database offers a paramount search and is conveniently presented in one place.
Pricing
GPIs
NDCs
Billing Codes
Indications/Diseases
Packaging Information
Active and Inactive
and more...
Additionally, learn more about drugs and pharmaceuticals that can be used to detect, treat, or monitor ... January 23rd, 2019 How to Report Co-Surgeons Using Modifier 62| Published January 23rd, 2019 Modifier 62 is appended to surgical claims to report the need for the skills of two surgeons (co-surgeons) to perform a procedure, with each surgeon performing a distinct part of the same procedure, during the same surgical session.
An easy way to explain this is to visualize a patient requiring cervical fusion where ... January 10th, 2019 Are You Protecting Your Dental Practice From Fraud?| Published January 10th, 2019
With the expansion of dental coverage through Medicaid and Medicare Advantage plans, an ever-increasing number of dental claims have come under scrutiny for fraud. One such payer, Aetna, is actively pursuing dental fraud by employing their special investigative units (SIUs) to identify and investigate providers who demonstrate unusual coding and ... January 4th, 2019 Nine New Codes for Fine Needle Aspirations (FNA) in 2019| Published January 4th, 2019 If your practice performs a lot of fine needle aspirations (FNA), you probably have the code options memorized (10021 without image guidance and 10022 with image guidance). However, the 2019 CPT codes now include nine (9) new FNA codes (10004-10012), one deleted FNA code (10022) and one revised FNA code ... January 3rd, 2019 Dry Needling| Published January 3rd, 2019 The correct coding of dry needling, also known as trigger point needling, has been a subject of confusion for quite some time. The American Chiropractic Association (ACA) and the American Physical Therapy Association (APTA) have been working together for several years to obtain appropriate codes to describe this service. In ... January 3rd, 2019 CMS Finalizes Major Changes to ACO Program| Published January 3rd, 2019 Back in August of 2018, as part of the Medicare Shared Savings Program (Shared Savings Program), CMS proposed some sweeping changes for Accountable Care Organizations (ACOs). There has been some controversy over these changes which require ACOs to move to two-sided models. In this Final Rule which was scheduled to be published in the Federal Register ... November 29th, 2018 Errors Billing Outpatient Services When Patient is also Inpatient| Published November 29th, 2018 The OIG recently reported that Medicare inappropriately paid acute-care hospitals for outpatient services provided to patients who were inpatients of another facility including long term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, and critical access hospitals. CMS suggests using the following resources to ensure compliance:
Medicare Inappropriately Paid Acute-Care Hospitals for ... November 28th, 2018 Q/A: Do Croft Guidelines Apply After Time has Passed Since the Accident?| Published November 28th, 2018 Question: Do the Croft Guidelines apply to a patient's condition immediately following the collision or are they applicable to a patient's state when they first come to see you? Whether that has been weeks or months since the collision without treatment? November 26th, 2018 Reciprocal Billing and Locum Tenens Arrangements Changes| Published November 26th, 2018 CMS has made changes to their payment policies for reciprocal billing arrangements and Fee-For-Time compensation arrangements (formerly referred to as locum tenens arrangements). Providers need to be aware of these changes and update their policies as appropriate. October 17th, 2018 Wolters Kluwer Drug Pricing| Published October 17th, 2018 Wolters Kluwer provides unit and package pricing for multiple drug price types: Average Wholesale Price (AWP), Wholesale Acquisition Cost (WAC), Direct Price (DP), Manufacturer's Suggested Wholesale Price (SWP), Centers for Medicare & Medicaid Services, Federal Upper Limit (CMS FUL), Average Average Wholesale Price (AAWP), Generic Equivalent Average Price (GEAP). Average... October 16th, 2018 Q/A: What Codes do I use for CLIA-Waived Tests?| Published October 16th, 2018 Question:
I am a certified DOT medical examiner and have applied to get my CLIA lab (waiver) for urinalysis, finger prick blood tests for A1c, cholesterol and glucose. I realize I cannot diagnose patients with these tests, but I am using them to make decisions in the DOT process and with ... September 12th, 2018 Join QPro Today and Get Certified| Published September 12th, 2018 Join QPro Today and Get Certified!
To have a credential in the medical profession shows you have met a minimum standard for professional and ethical standards.
Often employers prefer to hire staff that will be involved with any type of patient information such as coding, to show proof they have met certain ... August 31st, 2018 Finalized Confidentiality of Alcohol and Drug Abuse Patient Records Regulations| Published August 31st, 2018 In January, the U.S. Department of Health and Human Services (HHS) issued updates to the privacy regulations regarding the confidentiality of patient information of substance use disorder patients (42 CFR Part 2). This notice included references to better alignment with HIPAA regulations, but did state that Part 2 is more protective ... August 20th, 2018 PSAVE Pilot Program - What Does it Mean to You?| Published August 20th, 2018 Noridian's pilot program Provider Self-Audit with Validation and Extrapolation (PSAVE) has been extended which means that it has been successful for the payer, which means that they are saving money. Historically, when a pilot program is proven to be successful, it isn’t too long before other MACs follow. Before signing up to participate, providers need to carefully evaluate the program. Are the benefits worth the costs? August 16th, 2018 Medicare Timed Codes Guidelines| Published August 16th, 2018 Medicare's guidelines for reporting of timed codes is found in Medicare Claims Processing Manual Chapter 5, Section 20.2. Also known as the '8 minute' rule, it describes how to calculate time for appropriate reporting when more than one timed code is performed at the same time.
It should be noted that while ... August 15th, 2018 BREAKING NEWS: CMS Proposes to Change E&M Coding| Published August 15th, 2018 On July 16th 2018, anyone subscribed to the CMS Quality Payment Program received an e-mail containing a letter to doctors from Seem Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS). There are some widespread changes proposed in this letter of which you need to be aware.
Where ... July 12th, 2018 Q/A: Can You Swap Out 97140 with 97530?| Published July 12th, 2018 - Last Review/Update January 28th, 2019 Codes 97140 and 97530 are not interchangeable. See why. July 9th, 2018 Documentation: Face to Face for Home Health Certification| Published July 9th, 2018 As a physician, you are responsible for providing appropriate, accurate supporting documentation of your face-to-face encounters (FTF) with your patients regarding home health care.
Analysis of the recent errors identified by the Comprehensive Error Rate Testing (CERT) Review Contractor shows a continuing increase in denials related to documentation for the FTF. The ... June 22nd, 2018 Q/A: Do I Have a Patient with Part C sign an ABN if we are Out-of-Network?| Published June 22nd, 2018 - Last Review/Update January 28th, 2019 Do we need an ABN if the patient has Part C and we are out-of-network? Read More. June 14th, 2018 VA Expands Telehealth| Published June 14th, 2018 On May 11, 2018, the Department of Veterans Affairs (VA) released its final rule on the "Authority of VA Health Care Providers to Practice Telehealth." Effective June 11, 2018, VA providers will be able to provide telehealth services across state lines. This move will make it easier for veterans to obtain ... April 26th, 2018 Documenting DMEs| Published April 26th, 2018 As per MLN MM8304,
This article is based on Change Request (CR) 8304, which instructs DME MACs to implement requirements, which are effective July 1, 2013, for detailed written orders for face-to-face encounters conducted by the physician, PA, NP or CNS for certain DME items as defined in 42 CFR 410.38(g).
Due to concerns ... April 23rd, 2018 Q/A: Someone Broke into My Office. What do I do Now?| Published April 23rd, 2018 - Last Review/Update January 24th, 2019 My office was broken into last night. I use electronic health records, but we do store some protected health information for my patients in paper files. These files are not secured, so the burglars did have access to them. It did not appear that the files were touched as the burglars were looking for cash. What responsibilities to I have to my patients in a situation like this? Do I need to contact them and advise them that their PHI could have been compromised? April 20th, 2018 The PSAVE Pilot Program: Should You Self-Audit Your Medicare Claims?| Published April 20th, 2018 - Last Review/Update April 25th, 2018 As the Medicare program has grown, the Centers for Medicare and Medicaid Services (CMS) has employed a variety of different claims audit mechanisms to better ensure that the Medicare Trust Fund is protected from waste, fraud and abuse.... April 12th, 2018 Billing Nutrition Counseling| Published April 12th, 2018 Billing nutrition counseling services may not be as straight-forward as you might think. Some providers mistakenly choose Medical Nutrition Therapy (MNT) codes (97802-97804, G0270, G0271) because it states nutrition therapy in the title. However, according to CPT guidelines, when MNT assessment and/or intervention is performed by a physician or qualified healthcare professional who may report evaluation and management ... March 29th, 2018 Medicare Telemedicine Changes for 2018| Published March 29th, 2018 Find-A-Code presented a webinar on “Coding and Auditing Telemedicine Services,” on March 29, 2018, which did not include the new and updated CMS information published in the MNL Matters Number: MM10393 on January 2, 2018. New and exciting changes were introduced in this article, which is addressed below.
Originating Site Fee
Each ... March 13th, 2018 CPT Code for DOT exams| Published March 13th, 2018 - Last Review/Update January 31st, 2019 Question: I have a provider that provides Department of Transportation (DOT) exams. I have found ICD-10 code Z02.4 (encounter for examination for drivers license) but I am unsure which CPT Code to use. Would I still use 99203 or 99204? March 9th, 2018 Documentation for Ordering Oxygen Supplies and Equipment| Published March 9th, 2018 - Last Review/Update March 26th, 2018 The Medicare Learning Network provides guidance on required documentation for Ordering Oxygen Supplies and Equipment. March 9th, 2018 Documentation for Negative Pressure Wound Therapy| Published March 9th, 2018 - Last Review/Update March 27th, 2018 The Medicare Learning Network provides guidance on required documentation for negative pressure wound therapy. March 9th, 2018 Documentation for Surgical Dressings| Published March 9th, 2018 - Last Review/Update March 27th, 2018 The Medicare Learning Network provides guidance on required documentation for surgical dressings.
March 9th, 2018 Documentation for Enteral Nutrition| Published March 9th, 2018 - Last Review/Update March 27th, 2018 The Medicare Learning Network provides guidance on required documentation for enteral nutrition. ... March 8th, 2018 Documentation for Home Blood Glucose Monitors (BGM)| Published March 8th, 2018 - Last Review/Update March 14th, 2018 The Medicare Learning Network provides guidance on how to Prevent Denials for Home Blood Glucose Monitors (BGM)... March 8th, 2018 Documentation for Therapeutic CGMs and Related Supplies| Published March 8th, 2018 - Last Review/Update March 14th, 2018 The Medicare Learning Network, provides coverage guidance on therapeutic CGMs and Related Supplies March 8th, 2018 Documentation for Bacterial Culture Lab Orders| Published March 8th, 2018 - Last Review/Update March 15th, 2018 The Medicare Learning Network provides guidance on delivering orders for bacterial culture laboratory tests... March 8th, 2018 Documentation and Orders for Respiratory Assistive Device| Published March 8th, 2018 - Last Review/Update March 27th, 2018 The Medicare Learning Network provides guidance on required documentation for a respiratory assistive device and ordering guidelines. March 8th, 2018 Documentation and Orders for Laboratory Tests| Published March 8th, 2018 - Last Review/Update March 27th, 2018 The Medicare Learning Network provides guidance on required documentation for ordering laboratory tests. March 8th, 2018 Documentation for Inpatient Rehabilitation Facilities| Published March 8th, 2018 - Last Review/Update March 27th, 2018 The Medicare Learning Network provides guidance on required documentation for Inpatient Rehabilitation Facilities (IRF). March 1st, 2018 New Bipartisian Budget Act of 2018 Provisions| Published March 1st, 2018 On February 9, 2018, the Bipartisan Budget Act of 2018 was signed into law. There were some changes which will affect Medicare payments. The following is a brief summary, for a more comprehensive summary see the References.
Therapy Caps: Some therapy caps (e.g., occupational, physical therapy, speech-language pathology) were discontinued. However, modifier KX will ... February 28th, 2018 Telemedicine Billing and Reimbursement| Published February 28th, 2018 The opportunities for providers who want to provide telemedicine continue to expand in all sectors of the healthcare market. Even the VA, long a symbol of a fossilized, bureaucratic healthcare entity, has begun to embrace this technology. Though most are familiar with what telemedicine is, many still have questions surrounding ... February 23rd, 2018 The Comprehensive Error Rate Testing Program| Published February 23rd, 2018 - Last Review/Update February 26th, 2018 With nearly a million physicians in this country, how do auditing organizations determine whom to audit? February 21st, 2018 No HCPCS Code Available? Now What?| Published February 21st, 2018 HCPCS level II codes classify products into categories for the purpose of claims processing. HCPCS level II codes are alphanumeric with a descriptive terminology that identifies the item or service used primarily for billing purposes.
There are several types of HCPCS level II codes such as:
Permanent National Codes
Dental Codes
Miscellaneous Codes
Temporary National ... February 5th, 2018 HIPAA Breach Settlements and Ransomware Attacks - Is Your Practice Secure?| Published February 5th, 2018 Two recent reports should make providers stop, take notice and make sure their practice's policies and procedures are up-to-date.
The first one involves a HIPAA Breach settlement of a company with facilities in several states. The OCR memo stated "In addition to a $3.5 million monetary settlement, a corrective action plan ... February 2nd, 2018 Scoring & Reporting Your Audit Findings| Published February 2nd, 2018 - Last Review/Update February 7th, 2018 This week we had a great question posted to our online forum, and I thought it would be a nice thought- provoking question for our auditing and compliance tip of the week. February 1st, 2018 Are Your Computers Vulnerable to Cyber Attacks?| Published February 1st, 2018 Healthcare providers must be vigilant in ensuring that software upgrades, also known as patches, are kept current. Failure to do so can lead to a HIPAA Security Breach with all its associated penalties. For example Windows XP no longer has security updates and should not be used in healthcare settings.
On ... February 1st, 2018 OIG Reviews Medicare Advantage Claims| Published February 1st, 2018 On January 16, 2018, the OIG released a report of their findings on claims data for Medicare Advantage plans. While it appears that there were not significant issues, they did find that:
"Types of potential errors included inactive or invalid billing provider identifiers; duplicated service lines; missing required data; inconsistent dates; ... February 1st, 2018 Don’t Be Hesitant About Collecting Co-Pays| Published February 1st, 2018 If you are hesitant about collecting co-pays, consider that you may be paying interest on credit cards, property mortgages, and business loans. Each dollar that you do not collect in co-pays could have been used to pay down the practice debt. Without question, if you are having difficulty finding ways ... February 1st, 2018 Multiple Diagnostic Imaging Payment Reduction| Published February 1st, 2018 CMS and some other payers have adopted policies of reducing payments when certain multiple diagnostic imaging procedures (see Applicable Codes below) are performed in a single session by the same healthcare provider and/or group. They have done the same when there are multiple units for a procedure code. The rationale ... January 31st, 2018 Adjusting Your Collection Strategies to HDHPs| Published January 31st, 2018 - Last Review/Update March 29th, 2018 High Deductible Health Plans (HDHPs) are recent and growing trend in healthcare that is probably here to stay, regardless of the future changes to the national healthcare system or federal regulations..... January 31st, 2018 Mobile Health: Growing Engagement and New Responsibilities| Published January 31st, 2018 - Last Review/Update March 29th, 2018 This week I'm blogging about an M-word. Not MACRA or MIPS, but Mobile Health or mHealth.... January 31st, 2018 Influenza, Are You Billing Correctly?| Published January 31st, 2018 With this year's Flu season being the most widespread on record, providers are seeing more patients and giving more immunizations for influenza than normal. Here are a few things to keep in mind during this flu season.
Know the rules with your payers to ensure proper reimbursement and correct billing. For example, did you ... January 29th, 2018 Dental and Medical- Controlled Substance Awareness| Published January 29th, 2018 As an effort to cut down on opioid abuse and related crimes, in August of 2017 the Attorney General Sessions established a new Department of Justice (DOJ) section called “Opioid Fraud and Abuse Detection Unit”. Due to the serious public health issue and drug overdose deaths, this unit was established and ... January 29th, 2018 Referring and Ordering Physician - CMS-1500 Box 17| Published January 29th, 2018 Enter the name of the referring or ordering physician if the service or item was ordered or referred by a physician. All physicians who order services or refer Medicare beneficiaries must report this data. Similarly, if Medicare policy requires you to report a supervising physician, enter this information in Item ... January 29th, 2018 Aftercare Z Codes| Published January 29th, 2018 Aftercare visit codes cover situations when the initial treatment of a disease has been performed, and the patient requires continued care during the healing or recovery phase, or for the long-term consequences of the disease. The aftercare Z code should not be used if treatment is directed at a current, ... January 26th, 2018 Creating a Culture of Compliance in 2018| Published January 26th, 2018 - Last Review/Update February 7th, 2018 This year (2018), health care organizations (Hospitals, Health Systems and Physician Groups/Practices) must focus on the criticality of creating a culture of compliance to ensure effectiveness and efficiency.... January 24th, 2018 Better Office Communication Leads to Stronger RCM| Published January 24th, 2018 - Last Review/Update March 29th, 2018 According to a recent Physicians Practice study, one of the top five reasons for denied medical claims is a lack of adequate documentation. While this might seem like an electronic records issue, the problem may be bigger than that. ... January 24th, 2018 Revenue Cycle 101: Reduce your Denials with These Tips| Published January 24th, 2018 - Last Review/Update March 29th, 2018 Your practice seems to be doing everything right. You have a team in place, established your RCM process and you’re submitting claim after claim – but your denial rate isn’t going down.... January 24th, 2018 HIPAA and the Opioid Crisis| Published January 24th, 2018 HIPAA and the Opioid Crisis guidance released by HHS. January 23rd, 2018 NEW on Find-A-Code...National Coverage Determinations (NCDs)| Published January 23rd, 2018 - Last Review/Update January 25th, 2018
Medicare limits its coverage of services to those considered to be reasonable and necessary for the diagnosis and treatment of an injury or illness based on coverage guidelines. National Coverage Determinations (NCDs) are created based on research, evidence-based processes, public participation, and other resources, and made available to the public. ... January 22nd, 2018 Compliance: What is it and Why is it Important| Published January 22nd, 2018 - Last Review/Update January 25th, 2018 Compliance. It is one of the buzz words in healthcare that is heard all the time but what is it really, and why is it so important? January 16th, 2018 Patient Relationship Codes| Published January 16th, 2018 Section 1848(r)(4) of MACRA requires that claims submitted for items and services furnished by a physician or applicable practitioner on or after January 1, 2018, include codes for the following:
care episode groups
patient condition groups
patient relationship categories
Previously, CMS decided to use procedure code modifiers to report patient relationship codes on Medicare ... January 11th, 2018 Advance Beneficiary Notice of Noncoverage (ABN) Modifier Guidelines| Published January 11th, 2018 The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131 may be used for services which are likely to be non-covered, whether for medical necessity or for other reasons. Refer to CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30, for complete instructions.Effective from April 1, 2010, non-covered services should be billed with modifier GA, GX, GY, or GZ, as ... January 4th, 2018 Modifiers 54-55, split surgical and postoperative care| Published January 4th, 2018 54 -Surgical care only; Surgeon is performing only the preoperative and intra-operative care
55 - Postoperative management only; Physician, other than surgeon, assumes all or part of postoperative care
Modifiers should be placed on the surgical code
Used on 10 day and 90 day surgical procedures
Both the surgeon and the physician providing the postoperative ... January 3rd, 2018 Abuse, Neglect, or Maltreatment| Published January 3rd, 2018 According to the official ICD-10-CM Guidelines, in situations of maltreatment (e.g., adult and child abuse, neglect, etc.), the sequence of coding is important. Regardless of whether it is suspected or confirmed, it is important to document the type of abuse. Use the following sequence:
An appropriate code from category T74- (confirmed) or T76- (suspected)
Any accompanying mental ... There are more articles. View all articles... View articles for the current specialty by subtopic: Select the webinar title to view a summary and link to the webinar video. September 25th, 2019 August 29th, 2019 — ICD-10-CM Changes Effective October 1, 2019Are you aware of the ICD-10-CM code changes set take effect as of October 1, 2020? Do any of them apply to your organization? Which of them will be assigned as an HCC? What are the documentation and coding guidelines applicable to them and which guidelines are changing or being ... June 17th, 2019 Telehealth Policies for Medicare and Commercial PayersTelehealth Policies for Medicare and Commercial Payers February 28th, 2019 E/M and the Organ Systems Part 2 of 2E/M and the Organ Systems Part 2 of 2 February 21st, 2019 E-M and the Organ Systems (Part 1)E-M and the Organ Systems (Part 1) January 10th, 2019 HCC Coding ToolHow to use Find-A-Code's HCC Coding Tool January 14th, 2019 Success with Out-of-Network Billing in Today's Environment Part 2In this webinar Maxine will be presenting information and tips for understanding and billing Employment Retirement Income Security Act (ERISA) insurance plans. She will explain the rules and regulations concerning ERISA plans, as well as procedures for handling/appealing "adverse denials" of claims. Coders and Insurance Billing Specialists should not miss this informative presentation. January 14th, 2019 Coding and Auditing for Upper Extremity ProceduresIn this webinar, Aimee will review coding and auditing information for procedures commonly performed on the upper extremities and how to locate vital information that could help prevent coding errors and reduce risk in case of an audit. January 14th, 2019 Success with Out-of-Network Billing in Today's Environment Part 1In this webinar Maxine will be presenting information and tips for understanding and billing Employment Retirement Income Security Act (ERISA) insurance plans. She will explain the rules and regulations concerning ERISA plans, as well as procedures for handling/appealing "adverse denials" of claims. Coders and Insurance Billing Specialists should not miss this informative presentation. January 14th, 2019 Anatomy and Diagnostic Coding for Wound CareIn this webinar, Brandon Leavitt will review the anatomy of wounds from injury, disease, and other conditions and the proper ICD-10-CM coding for them. A review of pressure and non-pressure, and venous stasis ulcers, burns, corrosions, neoplasms, and other diseases affecting the integument will be presented. January 14th, 2019 All About Knee Coding & AuditingTotal knee replacement now acceptable ASC procedure also, not auditing for a year.
Knee replacement coding, knee joint injections, auditing using FAC, LCDs, drugs, modifiers. January 14th, 2019 Anatomy of the KneeCoders and billers in orthopedic practices must
understand the knee extensively. Join Dee to
master the anatomy of the knee joint, and
understand how it applies to ICD-10-CM
diagnosis coding. January 14th, 2019 Evaluation and Management Coding and AuditingAre you responsible for selecting or reviewing Evaluation and Management service levels? Do you wonder how well you know the rules and how to apply them? Join Aimee in this webinar to review and then applly the rules of E/M coding. She will also do a live demonstration of the new Find-A-Code E/M Calculator Tool to assess the level of E/M service for two office visits, one new (99201-99205) and the other established (99212-99215). January 15th, 2019 Coding and Auditing TeleHealth ServicesDo you report or audit Telemedicine services now or are you considering offering them? Come and learn more about the rules and guidelines surrounding Telehealth services including, documentation requirements, eligible CPT and HCPCS Level II codes, modifiers, and the newest updates to Medicare Telehealth policies. January 15th, 2019 Using Find-A-Codes Anatomy ImagesDiagnosis coding is difficult when clinician documentation does not match up with the definitions found in the ICD-10-CM code set. Find-A-Code's anatomy images educate both coders and students - bridging the gap between coders and clinicians while simplifying code selection. January 15th, 2019 FAC Updates Plus Tools for HCC Coding Chart Review FebruaryJoin Taylor to see how you can access free CEUs in 3 clicks, included with top-tier Find-A-Code subscriptions! Also highlighting our New and Improved NCDs system, and how to use the WK Drug Database for HCC Coding/Chart Review January 15th, 2019 Learn How to Optimize Your Subscription, Searching and MoreBe more productive, work smarter not harder using Find-A-Code. With so much to offer, it is important to understand how to navigate our site to get the most out of your subscription. January 15th, 2019 2018 Updates and New Tools2018 Find-A-Code updates and new tools January 15th, 2019 Proper Coding and Billing for Drugs, Biologicals and InjectionsProper Coding and Billing for Drugs, Biologicals and Injections January 15th, 2019 The Importance of Gathering Organizing and Using Fee SchedulesThe Importance of Gathering Organizing and Using Fee Schedules January 15th, 2019 Using Find-A-Code's New Evaluation and Management Calculator ToolUsing Find-A-Code's New Evaluation and Management Calculator Tool January 15th, 2019 HCC Risk AdjustmentHCC Risk Adjustment January 15th, 2019 How to Check NCCI Edits Using FindACodeHow to Check NCCI Edits Using FindACode January 17th, 2019 ICD-10-CM Updates for the Auditor, a NAMAS webinarICD-10-CM Updates for the Auditor, a NAMAS webinar January 21st, 2019 ICD-10-CM Training - Session 08ICD-10-CM Training - Session 08 January 21st, 2019 ICD-10-CM Training - Session 07ICD-10-CM Training - Session 07 January 21st, 2019 ICD-10-CM Training - Session 06ICD-10-CM Training - Session 06 January 21st, 2019 ICD-10-CM Training - Session 05ICD-10-CM Training - Session 05 January 22nd, 2019 ICD-10-CM Training - Session 36ICD-10-CM Training - Session 36 January 22nd, 2019 ICD-10-CM Training - Session 35ICD-10-CM Training - Session 35 January 22nd, 2019 ICD-10-CM Training - Session 34ICD-10-CM Training - Session 34 January 22nd, 2019 ICD-10-CM Training - Session 33ICD-10-CM Training - Session 33 January 21st, 2019 ICD-10-CM Training - Session 04ICD-10-CM Training - Session 04 January 22nd, 2019 ICD-10-CM Training - Session 32ICD-10-CM Training - Session 32 January 22nd, 2019 ICD-10-CM Training - Session 31ICD-10-CM Training - Session 31 January 21st, 2019 ICD-10-CM Training - Session 03ICD-10-CM Training - Session 03 January 21st, 2019 ICD-10-CM Training - Session 02ICD-10-CM Training - Session 02 January 22nd, 2019 ICD-10-CM Training - Session 30ICD-10-CM Training - Session 30 January 22nd, 2019 ICD-10-CM Training - Session 29ICD-10-CM Training - Session 29 January 22nd, 2019 ICD-10-CM Training - Session 28ICD-10-CM Training - Session 28 January 22nd, 2019 ICD-10-CM Training - Session 27ICD-10-CM Training - Session 27 January 21st, 2019 ICD-10-CM Training - Session 01ICD-10-CM Training - Session 01 January 21st, 2019 ICD-10-CM Training - Session 26ICD-10-CM Training - Session 26 January 21st, 2019 ICD-10-CM Training - Session 25ICD-10-CM Training - Session 25 January 21st, 2019 ICD-10-CM Training - Session 24ICD-10-CM Training - Session 24 January 21st, 2019 ICD-10-CM Training - Session 23ICD-10-CM Training - Session 23 January 21st, 2019 ICD-10-CM Training - Session 22ICD-10-CM Training - Session 22 January 21st, 2019 ICD-10-CM Training - Session 21ICD-10-CM Training - Session 21 January 21st, 2019 ICD-10-CM Training - Session 20ICD-10-CM Training - Session 20 January 21st, 2019 ICD-10-CM Training - Session 19ICD-10-CM Training - Session 19 January 21st, 2019 ICD-10-CM Training - Session 18ICD-10-CM Training - Session 18 January 21st, 2019 ICD-10-CM Training - Session 17ICD-10-CM Training - Session 17 January 21st, 2019 ICD-10-CM Training - Session 16ICD-10-CM Training - Session 16 January 21st, 2019 ICD-10-CM Training - Session 15ICD-10-CM Training - Session 15 January 21st, 2019 ICD-10-CM Training - Session 14ICD-10-CM Training - Session 14 January 21st, 2019 ICD-10-CM Training - Session 13ICD-10-CM Training - Session 13 January 21st, 2019 ICD-10-CM Training - Session 12ICD-10-CM Training - Session 12 January 21st, 2019 ICD-10-CM Training - Session 11ICD-10-CM Training - Session 11 January 21st, 2019 ICD-10-CM Training - Session 10ICD-10-CM Training - Session 10 January 21st, 2019 ICD-10-CM Training - Session 09ICD-10-CM Training - Session 09 There are more webinars. 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