Claims Articles and Resources
News and Important Information
What Medical Necessity Tools Does Find-A-Code Offer?
Keys to Successful Claims Filing
See also Chapter 1 - Insurance & Reimbursement in Find-A-Code's specialty specific Reimbursement Guides or the ChiroCode DeskBook for important claims processing information.
Resources
Additional Links and Resources
Select the title to see a summary and a link to the full article. some articles require a subscription to view.
Dec 27th, 2022
Compliance Billing: Power Mobility Devices
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
In May of 2022, the OIG conducted a nationwide audit of Power Mobility Device (PMD) repairs for Medicare beneficiaries. The findings were not favorable; the audit revealed CMS paid 20% of durable medical suppliers incorrectly during the audit period of October 01, 2018- September 30, 2019. This was a total of $8 million in device repairs out of $40 million paid by CMS. We gathered information in this article to assist providers and suppliers in keeping the payments received, protecting beneficiaries, and assisting you in ensuring compliance.
Oct 24th, 2022
2023 Evaluation & Management Updates Free Webinar
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Congratulations on a successful 2021 implementation of the Evaluation and Management (E/M) changes! That was a big change, but now an even bigger change is headed your way for inpatient and all other E/M categories. How great is it that almost all of the E/M categories will now be scored based on medical decision making (MDM) or total provider time? Standardized scoring and one set of E/M guidelines has the potential of bringing about a change or improvement of provider fatigue due to over regulation and documentation burden.
Oct 24th, 2022
End-Stage Renal Disease Risk Model Updates for 2023
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
For the first time, ESRD Medicare beneficiaries were permitted to enroll in Medicare Advantage plans beginning in 2021. Since that time, CMS has been working to revise the program to reduce costs, improve quality, and drive benefits. Effective January 1, 2025, one such change will include a definition change for "oral-only drugs." Why is Medicare changing the definition of these drugs and how will that be a driving force in advancing care models for ESRD in the future?
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
As the COVID-19-related public health emergency (PHE) seems to be dying down, CMS publishes the 2023 Medicare Proposed Rule that outlines more than a dozen major changes to existing programs, including some that relate to telemedicine after the PHE is declared officially over. Of the many changes, seven (7) really stand out and make us think about how the end of the PHE may affect services such as telemedicine or new E/M encounter types.
Sep 8th, 2022
Are You Prepared to Avoid Repayments
by Raquel Shumway
Watchful care is needed when submitting claims.
The Office of the Inspector General (OIG), after completing an audit on a Medicare Advantage Plan in August 2022, is now demanding repayment of claims to the tune of $3,518,465. Although the payer is contesting that amount, it is possible that they may begin demanding repayments from the providers to cover their costs of repayment.
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Each October 1st, the newest updates to ICD-10-CM take effect. This year with more than a thousand new codes added there is a lot of information to dig into and prepare our providers for. Many of the deleted and changed code descriptions, including the endeavor to capture social determinants of health, were made to enable expansion of specific coding categories so additional details could be reported, when captured in the documentation.
Aug 4th, 2022
Billing and Coding: Bone Mass Measurement
by Amanda Ballif
Guidance for billing, coding, and other guidelines in relation to local coverage policy L36460-Bone Mass Measurement.
by Amanda Ballif
The Centers for Medicare and Medicaid Services (CMS) is soliciting public comments on proposed changes for Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues effective on January 1, 2023 and thereafter. The Calendar Year (CY) 2023 PFS proposed rule is one of several proposed rules aimed at increasing equity in health care.
Jun 30th, 2022
More Audits and More Problems
by Ronald Hirsch, MD FACP CHCQM CHRI
More audits are coming, how do we stay compliant? We have been saying it but now it is happening. More audits are coming your way. One of the two CMS Recovery Audit Contractors seems to have taken on a business expansion plan. It appears they are contacting payers...
May 4th, 2022
Making the Case for Clean Claims
by Knicole C. Emanuel, Esq.
Medicare providers are your claims clean? Federal regulations mandate that 90 percent of “clean claims” must be paid to healthcare providers within 30 days. But what if the payor doesn’t pay within 30 days? What if your claims are unclean? The problem is – who determines what a...
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
According to the OIG "MEDICARE OVERPAID MORE THAN $636 MILLION FOR NEUROSTIMULATOR IMPLANTATION SURGERIES."
So often we think if we get paid, we must be doing it right, well this is not always the case. You may get paid and then have to return the funds if billed incorrectly or a step ...
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Medicare is making changes to the reporting guidelines for split or shared services. Some important changes have already gone into effect as of January 1, 2022 and others are scheduled to go into effect in 2023. If your organization reports split or shared services, it’s time to look more closely at how the new rules will affect your compliance policies and reimbursement.
Feb 9th, 2022
How Soon Will the United States Adopt ICD-11?
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
The ICD-11 diagnostic codeset went into effect worldwide on January 1, 2022 and has been adopted by some countries while others are still considering implementation, including the United States. The changes from ICD-9 to ICD-10 were significant but the change to ICD-11 will include the addition of new chapters, concepts, and symbols like the ampersand (&). Take a minute to familiarize yourself with this diagnostic coding set. The goal is to adopt a single version that has the flexibility to accommodate future code revisions and additions.
Oct 28th, 2021
Understanding ASCs and APCs: Indicators and Place of Service
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
The decision regarding the most appropriate care setting for a given surgical procedure is determined by the physician based on the patient's individual clinical needs and preferences. Of course, there is a difference in reimbursement, and the billing depends on where the procedure took place, such as an office setting, inpatient ...
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Audits are currently underway to verify the monies distributed through the CARES Act were warranted and properly used by those organizations that received them. The federal government has contracted with financial institutions such as KPMG and PricewaterhouseCoopers, among others, to perform these audits referred to as Provider Relief Fund (PRF) audit contractors, funded with monies from the very same program. There were four phases of funding disbursements with phase 1 audits beginning in September. How ready are you to be audited?
Sep 29th, 2021
Injection Services
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Injection Service Codes
Injection service codes, are reported under administration of vaccines/toxoids, using 96372, 90460, 90461, 90471, 90472, 0001A, 0002A, 0003A, 0011A, 0012A, 0021A, 0022A, 0031A, 0041A, and 0042A.
Other injections services include:
Non-antineoplastic hormonal therapy injections – 96372
Anti-neoplastic nonhormonal injection therapy 96401
Anti-neoplastic hormonal injection therapy- 96402
Allergen immunotherapy - 95115-95117
According to CMS, do ...
Aug 4th, 2021
Understanding How Place of Service Codes Work
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
The Place of service (POS) codes are used by CMS, Medicaid, and other private insurance to indicate where medically related items and services are sold or dispensed for a patient. POS codes are used for professional billing and are required to be reported on each claim submitted on a CMS-1500 ...
Jun 29th, 2021
Compliance in the Dental Office or Small Practice
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
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, ...
May 12th, 2021
Since When did Dental Claims Require Diagnosis Codes?
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
The objective of the Accountable Care organization is to integrate and consolidate patient care management to improve patient outcomes. Changes and coordination of dental and medical care are already becoming more apparent when dental offices are being required to bill a patient's medical plan for dental visits due to an ...
Nov 18th, 2020
Cross-A-Code Instructions in Find-A-Code
by Raquel Shumway
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.
Select the title to see a summary and a link to the full webinar information. some webinars require a subscription to view.
Jan 19th, 2017
What Claim Forms are Revealing
by Find-A-Code™
What Claim Forms are RevealingLinks and resources by topic.
Billing
CMS1500
CPT Coding
Claims Processing
Coding
Denial Management
Documentation
ERISA
Facilities
Fees
HIPAA
Hospital
ICD10CM Coding
Insurance
Medicare
Payer Guidelines
Practice Management
Reimbursement
UB04 Form and Coding
suggest a resource
If you know of a resource that should be included here (links, data, etc.) please contact us.
Thank you for choosing Find-A-Code, please Sign In to remove ads.
Quick, Current, Complete - www.findacode.com