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Drugs and Biologicals Pub-100 Ch 17
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Select the title to see a summary and a link to the full article.
October 7th, 2020
Stay out of Trouble — Understand the Qualified Medicare Beneficiary (QMB) Program
Published October 7th, 2020|
To assist low-income Medicare beneficiaries, CMS created the Qualified Medicare Beneficiary (QMB) program; a Medicaid benefit which pays for Medicare deductibles, coinsurance, or copays for any Medicare-covered items and services for Medicare Part A, Part B, and Medicare Advantage (Part C). Providers/suppliers are prohibited from billing premiums and cost sharing to Medicare beneficiaries who are enrolled in QMB.
July 15th, 2020
Use the Correct Diagnosis Codes and Revenue Codes to Get Paid for PAD Rehab
Published July 15th, 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 ...
July 14th, 2020
Are NCCI Edits and Modifiers Just for Medicare?
Published July 14th, 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 ...
April 8th, 2020
ICD-10-CM Official Coding and Reporting Guidelines Updated for COVID-19
Published April 8th, 2020|
The ICD-10-CM Official Coding and Reporting Guidelines have just been updated to include COVID reporting. Additional information beyond the previously released interim guidelines are included. These are the rules that should be followed for claims submission. The notice states that this is for April 1, 2020 through September 30, 2020.
March 31st, 2020
CMS-Coverage for Therapeutic Shoes for Individuals with Diabetes
Published March 31st, 2020|
Therapeutic shoes and inserts can play a vital role in a diabetic patient's health. Medicare may cover one pair every year and three pairs of custom inserts each calendar year if the patient qualifies and everything is handled correctly. Medicare Benefit Policy Manual explains what is needed for a person with diabetes to ...
March 26th, 2020
New Biofeedback Codes to replace 90911 Eff 2020-01-01
Published March 26th, 2020|
CMS announced 90912 and 90913 are to be used starting January 2020 in place of 90911. According to CMS MLN, these new codes, designated as “sometimes therapy”, are reported to furnish these services outside a therapy plan of care when appropriate. Codes are permitted to be used by physicians and Non-Physician Practitioners (NPPs), ...
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 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 17th, 2019
Act Now on CMS Proposal to Cover Acupuncture for Chronic Low Back Pain
Published July 17th, 2019|
Now is the time to comment on a proposal to cover acupuncture for chronic low back pain. This comment period is the part of the HHS response to the opioid crisis. You only have until August 14th to officially comment.
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 8th, 2019
Will the New Low Level Laser Therapy Code Solve Your Billing Issues?
Published July 8th, 2019|
Low level laser therapy (LLLT), also known as cold laser therapy, is a form of phototherapy which uses a device that produces laser beam wavelengths, typically between 600 and 1000 nm and watts from 5–500 milliwatts (mW). It is often used to treat the following: Inflammatory conditions (e.g., Rheumatoid Arthritis, Carpal ...
May 13th, 2019
Electrical Stimulation and Electromagnetic Therapy Devices
Published May 13th, 2019 - Last Review/Update May 20th, 2019|
Electrical Stimulation and Electromagnetic Therapy Devices can be used for pain, muscle atrophy, help spinal cord injuries, treat symptoms caused by other medical conditions and can be used in the treatment of wounds. This Regence BC/BS article lists codes and devices and gives guidance on coding from Medicare Advantage viewpoint.
February 5th, 2019
Clinical Staff vs. Healthcare Professional
Published February 5th, 2019|
State scope of practice laws and regulations will help determine who is considered Clinical staff and Other qualified Health Care professionals. Physician or other qualified healthcare professionals: Must have a State license, education training showing qualifications as well as facility privileges. Examples of Qualified Healthcare professionals: (NOTE: this list is not all-inclusive, please refer to your payer ...
February 1st, 2019
Physical Therapy Caps Q/A
Published February 1st, 2019 - Last Review/Update February 4th, 2019|
Question: How do I code it so that PT services in a chiropractic office don’t count against their PT visit max? Is there a way to code claims so that they are considered chiropractic only? But still get compensated enough? We have been running into some issues as of late ...
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May 14th, 2019
Confusing Codes for Chiropractors - 97110 versus 97112 versus 97530
In this webinar, you'll get a deep dive into three therapeutic procedure codes. Dr. Gwilliam, a chiropractor and certified professional coder, will take you thorough the ins and outs of therapeutic exercises, activities, and neuromuscular reeducation. They will be compared and contrasted with examples to make sure everyone leaves with the confidence to document and bill them correctly.
September 25th, 2018
Neuromuscular Reeducation, Massage Therapy - Proper Use, Documentation and Coding
In this webinar, Dr. Howard Levinson (Forensic Consultant) will address the erroneous use and billing of Neuromuscular Reeducation, Massage Therapy and Hydrotherapy in chiropractic clinics. He will offer strategies regarding how these services may be used appropriately in the chiropractic setting and provide documentation and coding information.
August 28th, 2018
Posture Rehab and Motor Control Exercise
Join the Posture Expert, Dr. Steven Weiniger, and find out why the American College of Physicians recommends motor control exercise (MCE) for low back pain over drugs and surgery. Learn how StrongPosture® MCE protocols synergizes with chiropractic by correlating the individual’s unique perceptions with objective benchmarks to systematically correct sensorimotor errors and functionally strengthen posture.
July 10th, 2018
How to Use Medical Codes for PI Care
Can you or can you not use “medical” codes (fracture, surgery, illness, etc.) for PI care? Is it legal? Why would you even consider them?
May 22nd, 2018
Coding and Documenting Physical Therapy Treatment Modalities
Presented by Evan Gwilliam DC MBA BS CPC NCICS CCPC CCCPC CPC-I MCS-P CPMA May 22nd, 2018 Tuesday @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 PM ET Ever wonder how to get paid for that e-stim or ultrasound? Do payers give you a hard time and ...
May 1st, 2018
Proving Medical Necessity and Functional Improvement
Medicare is required by law to pay for care that is medically necessary. Medicare considers functional improvement to be the primary indicator of medical necessity for chiropractic care. It is up to you, the doctor, to prove functional improvement and medical necessity with your documentation. Dr. Short will show you how to use common practice tools to document functional improvement, medical necessity and maximum medical improvement. You will learn: -What is Medicare’s definition of medical necessity. -What does Medicare’s determination of Medical Necessity mean to your care plan. -How to prove medical necessity. -How to report this information to Medicare. -How to determine Maximum Medical Improvement.
January 4th, 2018
Proper Coding and Billing for Drugs, Biologicals and Injections
Proper Coding and Billing for Drugs, Biologicals and Injections
Advanced Beneficiary Notice of Noncoverage (ABN) Form Instructions ToolBilateral Surgeries: Claim SubmissionCommonly Used Medicare Modifiers - GA, GX, GY, GZDME Billing guideanceMedicare Part B Clinical Laboratory Fee ScheduleMLN - Billing and Payment Policies for Negative Pressure Wound Therapy (NPWT) Using a Disposable DeviceNoridian: Allowed Amount ReductionsPhysician Assistant (PA) Resources NoridianThe 8 Minute Rule - How Does It Work? PT Billing Services
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August 25th, 2020
Do You Have All the Right Dental Resources Needed to Succeed in Dental Medical Billing and Coding?
Discussion with LaMont Leavitt (CEO of innoviHealth) and Christine Taxin (Adjunct professor at New York University, President of Dental Medical Billing, and Links2Success). Some of the resources and tools they discuss will help you with your dental coding/billing and education.
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