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How Might the New 2021 E/M Guideline Changes Impact Risk Adjustment?


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 ...

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

How to Search Find-A-Code for Medicare Policies and Guidelines — LCDs, NCDs and Articles —


Help for Searching Find-A-Code when searching for Medicare Policies and Guidelines — LCDs, NCDs and/or Articles.

tags  Topic: Claims Processing    Topic: LCDs and NCDs    Topic: Practice Management    Topic: Training   

Cross-A-Code Instructions in Find-A-Code


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.

tags  Topic: Claims Processing    Topic: Coding    Topic: Documentation    Topic: Medicare    Topic: Practice Management    Topic: Reimbursement   

COVID Vaccine Codes Announced


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.

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

Locating Periodontal Disease in ICD-10-CM


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 ...

tags  Specl: Dental    Topic: Coding    Topic: ICD10CM Coding   

Are You Aware of the 2021 Star Rating System Updates?


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 ...

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

Staging and Grading Periodontitis


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 ...

tags  Specl: Dental    Specl: Oral and Maxillofacial Surgery    Topic: Assessment Tools    Topic: CDT (Dental) Codes   

Incident To


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 ...

tags  Specl: Cardiology|Vascular    Specl: Endocrinology    Specl: Gastroenterology    Specl: General Surgery    Specl: Home Health|Hospice    Specl: Internal Medicine    Specl: Neurology|Neurosurgery    Specl: Obstetrics|Gynecology    Specl: Oncology|Hematology    Specl: Optometry    Specl: Oral and Maxillofacial Surgery    Specl: Orthopedics    Specl: Pain Management    Specl: Primary Care|Family Care    Specl: Pulmonology    Specl: Rheumatology    Specl: Urology|Nephrology   

OIG – Fraud and Abuse Study with COVID-19 Testing


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 ...

tags  Specl: Laboratory|Pathology    Topic: COVID-19    Topic: OIG   

Delving Into the 360 Assessment Fraud Complaint


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.

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

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