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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.
October 6th, 2020
An Infectious Disease Control Plan is Essential
Published October 6th, 2020|
Every business encounters infections. The COVID-10 pandemic has only highlighted this fact, but considering that infectious diseases, such as the seasonal flu, are an ongoing problem, all organizations need to implement an Infectious Disease Control Plan as part of an active compliance plan because it’s required by law. Your organization must take steps to mitigate this risk to both patients and employee
September 1st, 2020
Not Following the Rules Costs Chiropractor $5 Million
Published September 1st, 2020|
Every healthcare office needs to know and understand the rules that apply to billing services and supplies. What lessons can we learn from the mistakes of others? What if we have made the same mistake?
July 28th, 2020
OIG Report Highlights Need to Understand Guidelines
Published July 28th, 2020|
A new OIG report once again highlights the necessity for organizations to fully understand requirements for reporting services and having proper documentation. The types of problems addressed in this report are ongoing issues for multiple types of services and specialties and for many different payers.
April 20th, 2020
Dismal OIG Report on Telemedicine
Published April 20th, 2020|
Providers need to understand the rules for reporting telemedicine services. A recent OIG report shows that this is not the case. What problems are being found in documentation claims? As providers are expanding their telehealth offerings, now is the time to understand the potential pitfalls since disallowed amounts will be taken back.
April 15th, 2020
CMS Temporarily Suspends Contract-Level RADV Audits
Published April 15th, 2020|
The Centers for Medicare and Medicaid Services (CMS) is suspending contract-level RADV audits, related to the payment year 2015 and will not initiate any new ones until after the public health emergency has ended. Any documentation already submitted will be reviewed as usual.
March 25th, 2020
COVID-19: Cybercrime, Telehealth, and Coding
Published March 25th, 2020|
Your inbox is probably like mine with all sorts of announcements about COVID-19. Here are just a few reminders of things we felt should be passed along. We have heard of several cases of cybercrime related to this outbreak. For example, there was a coronavirus map which loads malware onto your ...
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: ...
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 ...
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 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 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 15th, 2019
Denial Management is Key to Profitability
Published July 15th, 2019|
July 8th, 2019
Q/A: Can I Put the DC’s NPI in Item Number 24J for Massage Services?
Published July 8th, 2019|
Question: Are there scenarios in which it is acceptable to put the DC's NPI in box 24j for massage services? Answer: While the answer to this is yes, it is essential to understand that there are very limited scenarios. In most cases, Item Number 24J is only for the NPI of the individual ...
July 1st, 2019
Rules for Rendering Unproven, Investigational or Experimental Procedures
Published July 1st, 2019|
If you haven’t reviewed your state guidelines or taken a recent look at third-party payer policies on unproven, investigational or experimental procedures, now is the perfect time to make sure you’re up to speed with this important information. Most providers are surprised to see commonly used devices or techniques listed ...
June 25th, 2019
Q/A: Can I Refuse to File a Patient's Medical Insurance for an Auto Accident?
Published June 25th, 2019|
Question: Can a Chiropractor refuse to file a patients Medical Insurance for an Auto Accident? Answer: There isn't a simple answer to this question. It depends on who is responsible and state laws. Who is responsible (the auto insurance or the medical insurance) can depend on state requirements as well as who is ...
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 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 ...
May 13th, 2019
Q/A: Two Payers Both Paid the Claim. Who Gets the Refund?
Published May 13th, 2019|
Question We have a personal injury situation where we submitted a claim was sent to the patient's auto policy carrier who refused payment. We then submitted it to her other insurance. Eventually, both companies paid her claims. Her auto paid at full value, and her secondary paid at a reduced rate ...
April 29th, 2019
Q/A: I’m Being Audited? Is There a Documentation Template I can use?
Published April 29th, 2019|
Question: Our Medicare contractor is auditing claims with 98942. Do you have any suggestions for a template for documentation to warrant the use of 98942? Answer: When you submit a claim with code 98942 you are stating that you have determined that it was medically necessary to adjust all 5 of ...
April 23rd, 2019
OIG Announces New Review For Medicare Part B Payments for Podiatry and Ancillary Services
Published April 23rd, 2019|
Due to prior OIG work identifying inappropriate payments for podiatrists and ancillary services, the OIG announced in Feb 2019 they will begin a new review starting in 2020. The OIG stated they will review Medicare Part B payments to determine if medical necessity is supported in accordance with Medicare requirements. Part of the ...
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 15th, 2019
Watch out for People-Related ‘Gotchas’
Published April 15th, 2019|
In Chapter 3 — Compliance of the ChiroCode DeskBook, we warn about the dangers of disgruntled people (pages 172-173). Even if we think that we are a wonderful healthcare provider and office, there are those individuals who can and will create problems. As frustrating as it may be, there are ...
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. ...
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 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 ...
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 7th, 2019
Charging Missed Appointment Fees for Medicare Patients
Published February 7th, 2019 - Last Review/Update February 8th, 2019|
Some providers mistakenly think that they cannot bill a missed appointment fee for Medicare beneficiaries. You can, but Medicare has specific rules that must be followed. These rules are outlined in the Medicare Claims Policy Manual, Chapter 1, Section 30.3.13. You must have an official “Missed Appointment Policy” which is ...
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November 6th, 2018
Medicare continues to increase their efforts to review doctors and recover “overpayments”. This increases the likelihood that your notes will be reviewed and that you will be required to pay money back to Medicare. In this webinar Dr. Short will show you: Why you should appeal every adverse decision. How to appeal adverse decisions. What information you need in your documentation for an effective appeal. How to structure your appeals to be most effective.
August 14th, 2018
How to Create a Medicare Compliance Plan
In this webinar, Dr. Marty Kotlar (certified coding and compliance expert) will discuss how to create an OIG/Medicare compliance plan. He will explain how to create policies, how to perform a "self-test" on your SOAP notes, search the Medicare exclusions list, Stark, anti-kickback and how to handle compliance concerns.
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
June 12th, 2018
Healthcare Compliance- Fraud/Waste/Abuse…Avoiding the Pitfalls
Presented by Howard Levinson, DC June 12, 2018 Tuesday @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 PM ET Dr. Levinson will discuss what constitutes healthcare fraud, waste and abuse and some of the strategies the insurance industry uses to identify outlier providers. Examples of healthcare providers who ...
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.
April 3rd, 2018
Strategy to Assess & Strengthen Cervical Posture
Join the posture expert, Dr. Steven Weiniger, to learn how observing posture engages people for StrongPosture® habits… such as getting adjusted! Posture literally sets the baseline for all locomotor function, and current research confirms the importance of improving vertical alignment to functionally improve pain as well as longevity. DCs across the globe use the free PostureZone app and StrongPosture® rehab protocols to literally help people stand taller. Learn the framework to communicate bio-mechanics to patients, the public and other professionals. First for patient compliance, then results, and then for retention and referrals!
June 29th, 2017
How to Convert Your Medicare Patients to Cash to Avoid the Penalties of MACRA
The #1 concern reported by CMS about chiropractors is that, as a profession, we do a poor job of understanding maintenance care. Of course, that is THEIR definition of maintenance care. When you better understand the rules of medical necessity in Medicare, you begin to see what they are talking about. The truth is that there is a “gray” area between the distinct “white” of active treatment and the “black” of maintenance treatment, and that gray area is confusing when defining “covered” vs. “not covered” chiropractic care in Medicare. Join us to find out the following critical information in time for the MACRA Section 514 implementation January 1, 2017: Find out exactly what Medicare deems as maintenance care and how to recognize it with our patients Learn what your options are for treating your Medicare patient’s maintenance care for cash Hear scripting that is vital to your patient understanding what’s going on with their coverage, or lack thereof Properly document the difference between active and maintenance care Better manage those little incidents that come up for chronic, Medicare patients
3 year ruleASC Payment RulesAssignments of BenefitsCMS Provider Minute Video: Utilizing Your MAC to Prepare for CERT ReviewComplaince Program Guidance for Third-Party Medical Billing CompaniesComplete & Easy HIPAA Compliance 4th EditionCompliance Program Guidance for Ambulance SuppliersCompliance Program Guidance for Clinical LaboratoriesCompliance Program Guidance for Home Health AgenciesCompliance Program Guidance for HospicesCompliance Program Guidance for HospitalsCompliance Program Guidance for Individual and Small Group Physician PracticesCompliance Program Guidance for Medicare+Choice OrganizationsCompliance Program Guidance for Nursing FacilitiesCompliance Program Guidance for Pharmaceutical ManufacturersCompliance Program Guidance for the Durable Medical Equipment, Prosthetics, Orthotics, and Supply IndustryDetailed Information on the New Safety Data Sheets (SDS)Disposal of Protected Health InformationFAQs About the Disposal of Protected Health Information - HHSHIPAA Risk Assessments are Essential to Avoid LiabilityHIPAA: Health Insurance Portability and Accountability Act by AMAJoint CommissionLow Volume Appeals Settlement Call: Audio Recording and TranscriptMedicaid Program Integrity Education PageMedicare Recovery Audit by HHS Office of the Inspector GeneralNSTC Government-Wide Initiative for HHS Research GrantsOfficial HIPAA Guidelines for Media SanitationOIG Compliance Program for Individual and Small Group Physician PracticesOIG Compliance Program for Individual and Small Group Physician Practices - Federal RegisterOIG WorkPlan 2014OSHA Compliance Topics PageOSHA Small Business Resources - includes trainingOSHA's Computer Workstations eToolOverview of Mandatory Complinace ProgramPhysician Payment WebsiteProvider Compliance Tips for Diabetic Test StripsProvider Compliance Tips for Hospital Beds and AccessoriesProvider Compliance Tips for Infusion Pumps and Related DrugsProvider Compliance Tips for Laboratory Tests - Blood CountsSkilled Nursing Facility Federal RegulationsSupplemental Compliance Program Guidance for HospitalsSupplemental Compliance Program Guide for Nursing FacilitiesTemporary Worker Injury and Illness Recordkeeping Requirements by OSHAUnited States Department of Labor; Occupational Safety and Health Administration
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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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