Claims Articles and Resources
News and Important Information
See also Chapter 1 - Insurance & Reimbursement in Find-A-Code's specialty specific Reimbursement Guides or the ChiroCode DeskBook for important claims processing information.
Additional Links and Resources
Billing Requirements for OPPS
Billing Requirements for OPPS Providers with Multiple Service Locations
Select the title to see a summary and a link to the full article.
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.
August 5th, 2020
Coding with PCS When There is No Code
Published August 5th, 2020|
ICD-10-PCS covers ALMOST everything! But not quite! What if a body system does not contain a body part for toes or fingers? What about an elbow? When it does not cover what you are looking for, where do you turn? To the guidelines, of course! There are ICD-10-PCS guidelines just as ...
July 1st, 2020
Understanding UCR Inpatient Fees used on DRGs
Published July 1st, 2020|
March 24th, 2020
"What is the ICD-10 code for...?" - Search Smarter With Find-A-Code Tools
Published March 24th, 2020|
Do you still find yourself searching the internet for an ICD10 code? Medical coders often type into their search engine, what is the ICD10 code for ... and a specific diagnosis code, to avoid repeatedly dragging out the incredibly large ICD10 codebook. Ironically, some of the most commonly searched ICD10 diagnoses include: ...
March 21st, 2020
Understand the New Codes for Testing & Reporting the COVID-19 Coronavirus (SARS-CoV-2)
Published March 21st, 2020|
The current coronavirus pandemic refers to COVID-19, a novel or new type of coronavirus known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The first victim of the virus was identified in Wuhan, Hubei, China at the end of 2019. There is no immunization available to prevent it from spreading and ...
February 19th, 2020
Q/A: Did Noridian Stop Covering the M99.0- Codes?
Published February 19th, 2020|
Question: I heard that Medicare Noridian Jurisdiction F (Alaska) has been denying claims with M99.00, M99.01, M99.02, M99.03 etc codes when billed with the CMT CPT codes. Did Medicare change their policy?
January 9th, 2020
Who Knew? There are Three Types of Add-On Codes
Published January 9th, 2020|
Using add-on codes with HCPCS/CPT is not as simple as 123! Although there are three different groups of add-on codes assigned by CMS, these are used to identify code edits. It is easy to see the add-on code with some codes; we can see the instructional notes and phrases such ...
November 19th, 2019
Medical Insurance Coverage for TMJ Disorders (TMD)
Published November 19th, 2019 - Last Review/Update November 20th, 2019|
It is agreed that TMJ disorders should be covered by insurance. There are often questions whether it is covered by medical insurance or dental insurance and where the line is that separates coverage.Medical Insurance typically is the primary insurance for TMJ disorders. The reason is that joints are found anywhere ...
November 18th, 2019
Published November 18th, 2019|
Documenting Medical NecessityTo receive reimbursement from medical insurers, you need to make a case that proves that dental surgery is necessary for the patient. To make your case, you need to explain your decision process in terms that a medical insurer can understand, using ICD-10 codes and CPT codes. These ...
September 30th, 2019
Q/A: How Do I Bill a House Call?
Published September 30th, 2019|
Question If a provider makes a house call to/for a patient, is there a way that it is represented on the claim form? A modifier, or something else? Answer Modifiers are not used to identify that a service was performed in the patient's home. However, other modifier rules must be followed (e.g., modifier GP ...
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 ...
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 ...
April 15th, 2019
Q/A: How Many Diagnosis Codes do I use?
Published April 15th, 2019|
Question: My patient has a lot of chronic conditions. Do I need to include all these on the claim? I know that I can have up to 12 diagnoses codes on a single claim. What if I need more than that? Answer: More is not always better. You only need to ...
March 29th, 2019
Published March 29th, 2019 - Last Review/Update April 4th, 2019|
Prolonged Services I find in my own audit reviews that the prolonged service code set is often mistreated: they are avoided and not used even when the scenario supports them, or they get overused and improperly documented. Prolonged services are used in conjunction with all types of Evaluation and Management (E/M) ...
March 7th, 2019
Date of Service Reporting for Radiology Services
Published March 7th, 2019|
Providers need to ensure that they are reporting radiology dates of service the way the payer has requested. Unlike other many other professional services which only have one date of service (DOS), radiology services can span multiple dates. Medicare requirements may differ from professional organization recommendations.
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 ...
January 22nd, 2019
Home Oxygen Therapy
Published January 22nd, 2019|
Home Oxygen Therapy Guidelines
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 ...
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September 4th, 2018
Mandatory Chart Reviews - What You Need to Know
In this webinar, we are going to discuss what a Chart Review is, why it's mandatory, YOUR benefits to conducting our outsourcing a Chart Review along with the general steps for preparing, performing and properly documenting a Chart Review and its findings. Also, learn what to do post Chart Review - what your next steps should be and how to prioritize.
August 7th, 2018
Medicare reviews claims for a variety of reasons. Some are routine and are not a problem for the doctor or the practice. Some are investigatory in nature and indicate a serious potential threat for both the doctor and the practice. Dr. Ron Short will go over the types of reviews and which are routine and which should cause you to lose sleep. In this webinar you will learn: -What routine reviews are and why they are conducted -What reviews are a potential risk -What triggers reviews -When to get help and what kind of help to get
July 31st, 2018
Lift the Cloud: Part 1 of 2
In this presentation, Dr. Gwilliam, a widely renowned auditor and coder, will reveal to you the references he and other auditors use when reviewing your claims and documentation. These include coding books, Medicare guidelines, and private payor policies. Buckle up for a wild ride.
June 26th, 2018
ICD-10 Guidelines for the Chiropractor
Time for a little refresher. You might think you know ICD-10 now that it has been around for a while. The guidelines teach which codes go first, how certain key words are defined, and ensure that you submit the right information on your claim forms. This webinar will be taught by Dr. Evan Gwilliam who helped write ChiroCode's ICD-10 book and is a certified ICD-10 instructor.
May 29th, 2018
The Most Expensive Documentation Mistakes Chiropractors Make
Notes need to give payers the information they need in order to adjudicate your claims. Do your notes include what they need to see? Can you standardize and simplify your note taking process to decrease your administrative burden? In this webinar, Dr. Gwilliam, Certified Coder, Certified Professional Medical Auditor, and Clinical Director for PayDC Chiropractic EHR Software, will show you how to make it easy. He will review examples and boost your confidence that you are doing things correctly.
March 27th, 2018
This presentation will review how risk management is no longer limited to just malpractice claims. It also includes your financial policy. There is now a greater risk of financial loss due to improper discounting and faulty financial and collection policies than ever before. It is widely known that the Office of Inspector General (OIG) and Medicare are cracking down on healthcare fraud and abuse, but what most chiropractors are unaware of, is how widely successful these efforts have been. In this presentation, we will identify the five most dangerous things we face in chiropractic and how to avoid them. All attendees will receive a free sample 1-page financial policy that can be customized for their practice and a link to receive a free risk assessment score for their practice.
January 19th, 2017
What Claim Forms are Revealing
What Claim Forms are Revealing
Can I Perform 2 Untimed Codes at the Same Time?Claims Topic PageClaims Topic Page - ChiropracticData on Application and Coverage Denials - by Government Accountability OfficeDesignation of Authorized Representative Form - by ACAInstaGuide - Complete 1500 Claim Form Filing Instructions - by InstaCode InstituteLINK BROKE- ERISA FAQ Page - by the Dept of LaborMap of States & Jurisdictions - by the National Association of Insurance CommissionersMedicare Claims Processing Manual - Chapter 25Medicare Claims Processing Manual, Chapter 12Medicare Claims Processing Manual, Chapter 9 - Rural Health Clinics/Federally Qualified Health CentersMedicare Electronic Claims Exemption - by CMSOfficial DOL text regarding internal claims and appeals under PPACAParticipating vs. Non-Participating (Medicare Part B Claims)Q/A: How Do I Respond to a Patient's Request to Not Submit the Claim to Their Insurance?Reminder to Stop Billing Duplicate Claims by Medicare Learning NetworkScrub-A-Claim by Find-A-Code.comSelf-Funded Plans and the PPACA: Is this the new normal?Timely Claims Filing: Additional Instructions - MedLearn Article by CMSUB-04 FL 17 – Patient Discharge Status CodesUB-04 FLs 39-41 - Value Codes and AmountsUB04 Claim Form Instructions
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