Compliance Articles and Resources

News and Important Information

Date of Service Reporting for Radiology Services

Q/A: I’m Being Audited? Is There a Documentation Template I can use?

Resources

Check Out Find-A-Code's Tools & 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 31st, 2022

CMS Updates COVID Vaccine Requirements for Staff

by Wyn Staheli, Director of Content - innoviHealth

CMS is revising its guidance and survey procedures for all provider types related to assessing and maintaining compliance with the staff vaccination regulatory requirements. This new memorandum replaces memoranda QSO 22-07-ALL Revised, QSO 22-09-ALL Revised, and QSO 22-11-ALL Revised.

Oct 25th, 2022

Four Ways Your Organization Can Benefit from Gathering and Reporting Social Determinants of Health Data

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Providers who actively engage in collecting and reporting social determinants of health (SDoH) open avenues of identifying and treating their patients' population health trends. Pairing chronic conditions that are difficult to control with identified SDoH circumstances such as transportation or electricity insecurity, can help identify those patients who may wish to be healthier, but who are dealing with circumstances that prevent compliance, such as transportation or access to electricity, for instance.

Oct 24th, 2022

Seven Major Changes Proposed by CMS in the 2023 Proposed Rule

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.

Aug 21st, 2022

CMS Encourages Medicaid MCOs and CHIP to Employ Section Waivers to Improve SDoH and Reduce Healthcare Costs

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Over the past few years, at least 15 states have consistently pursued the goal of using social determinants of health (SDOH) in their overall healthcare analysis and treatment programs for patients, and CMS has taken notice. Data and outcomes obtained from these state programs have essentially provided an outline of how the government intends to pursue health equity through managed care contracts (MCOs) and Children's Health Insurance Program (CHIP). What is CMS seeing that they like so much and how might that affect future MCO contracts?

Aug 9th, 2022

How CMS Determines Which Telehealth Services are Risk Adjustable

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Medicare Advantage Organizations (MAOs) have gone back and forth on whether or not to use data collected from telehealth, virtual Care, and telephone (audio-only) encounters with Medicare beneficiaries for risk adjustment reporting, but the following published documents from CMS cleared that up once and for all by providing an answer to a question specifically related to this question.

Aug 8th, 2022

Before Requesting a Review on Modifiers, Read This!

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Generally, there is uniformity in the use of modifiers between payers. However, this is not always the case; you may see a difference in payer policies and how modifiers are handled. One way to know if a modifier can be used according to CMS rules can be found when using ...

Aug 1st, 2022

CMS Started to Enforce Applicable Price Transparency Requirements

by Amanda Ballif

Beginning July 1, 2022, CMS started to enforce applicable price transparency requirements because of the Trump Administration's historic price transparency requirement in 2019 to increase competition and lower healthcare costs for all Americans.

Jul 28th, 2022

Calendar Year 2023 Medicare Physician Fee Schedule Proposed Rule

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.

Jul 21st, 2022

Medicare Advantage and Part D Advance Notice Addresses Health Equity Initiatives Slated for 2023

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

The current Administration constantly talks about health equity initiatives but what exactly does that mean for our providers and medical practices? Centers for Medicare and Medicaid Services (CMS) has published the 2023 Medicare Advantage and Part D Advance Noticed with significant focus on their definition of health equity and what is means to promote it within our individual practices and among health payer plans.

Jul 19th, 2022

The Beginning of the End of COVID-19-Related Emergency Blanket Waivers

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

It appears that the end of the 1135 waivers related to the COVID-19 public health emergency (PHE) has begun. According to CMS, the residents of skilled nursing facilities, long-term care facilities, and inpatient hospice centers have struggled due to the effects of some of the 1135 waivers. CMS is focusing primarily on removing the 1135 blanket waivers that pertain to certain aspects of care, training, and maintenance of these facilities to ensure the weakest of our citizens are guaranteed adequate care.

Jul 7th, 2022

New Audio-Only Telehealth Guidance to Meet HIPAA Rules

by U.S. Department of Health & Human Services

Covered entities (healthcare providers and health plans) can use remote communications, called telehealth, to provide services to patients as long as they follow certain guidelines. Because certain populations may have difficulty using audio-video telehealth, HHS is now issuing this guidance on audio-only telehealth. This guidance will help ensure that individuals can continue to benefit from audio-only telehealth by clarifying how covered entities can provide telehealth services and improve public confidence that covered entities are protecting the privacy and security of patients' health information.

Jul 5th, 2022

Sometimes it's the Little Coding Conundrums That Keep Us Concerned

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

We all experience coding situations that make us stop and rethink our coding path. Do we have the most current information on this situation? Does the payer contract change the way we must report the service? Are we missing something? Each of us experience simple to complex coding issues in our work and sometimes it is just nice to collaborate and discuss them openly to see how they may be resolved. Have you ever questioned the proper use of major depressive disorder codes versus the newly added (2021) depression, unspecified code? Take a look at what the OIG said about these codes and how the payer responded.

Jun 30th, 2022

2022-06-16-MLNC - ICD-10-CM Diagnosis Codes: Fiscal Year 2023

by CMS - MLNConnects

News - Comprehensive Error Rate Testing Program Report: Sample Reduced for Reporting Year 2023 - Men’s Health: Talk to Your Patients About Preventive Services - Compliance - Implanted Spinal Neurostimulators: Document Medical Records - Claims, Pricers, & Codes - ICD-10-CM Diagnosis Codes: Fiscal...

Jun 16th, 2022

2022-05-26-MLNC - Biosimilars: Interchangeable Products May Increase Patient Access

by CMS - MLNConnects

News - COVID-19: New Administration Code for Pfizer Pediatric Vaccine Booster Dose - - Biosimilars: Interchangeable Products May Increase Patient Access - - Critical Care Evaluation & Management Services: Comparative Billing Report in May - -...

Jun 14th, 2022

Using Health IT to Support Safer Use and Management of Controlled Substance Prescriptions

by Chelsea Richwine and Christian Johnson

New ONC data show that, as of 2021, nearly all non-federal acute care hospitals were enabled to electronically prescribe controlled substances (EPCS). According to the American Hospital Association (AHA) Information Technology (IT) Supplement Survey, the proportion of non-federal acute care hospitals enabled for EPCS increased from 67% in...

Jun 8th, 2022

Medicare Improper Payment Report (2021)

by Raquel Shumway

The Medicare Improper Payment Report does not measure fraud, but rather, it estimates the payments that did not meet Medicare coverage, coding, and billing rules. The estimated Medicare FFS payment accuracy rate (claims paid correctly) from July 1, 2019 through June 30, 2020, was 93.74%, which is up slightly from last year. The estimated improper payment rate (claims paid incorrectly) was . . .

Apr 26th, 2022

Preventive Services

by Shannon O. DeConda, CPC CPC-I CEMC CEMA CPMA CRTT

In Today’s Take, let’s discuss the difference between preventive care. You might be thinking this is “101”. But it really isn’t. Oftentimes, when conducting chart audits, we not only we see issues with a lack of documentation criteria, especially with Medicare preventive services, but we also see confusion regarding...

Apr 22nd, 2022

Substance Use Disorder Treatment Incentive Program Receives Go Ahead From the OIG

by Raquel Shumway

DynamiCare Health Inc. has developed a contingency management program for those dealing with substance use disorders. DynamiCare Health Inc. has developed a contingency management program for those dealing with substance use disorders. CM “addresses the brain’s reward response in ways that conventional counseling and medications often cannot.” Over a course of 50 years, it has shown that this program is effective. The OIG, upon analysis, has determined that there is low risk for fraud and abuse and has offered their opinion at the request of DynamiCare Health, Inc.

Mar 31st, 2022

$636 Million in Overpayments Made by Medicare to Providers for Neurostimulators

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 ...

Mar 21st, 2022

Coding for a Performance of an X-ray Service vs. Counting the Work as a Part of MDM

by Stephanie Allard, CPC CEMA RHIT

When x-rays are audited on the same date as an E/M encounter we have one of three decisions to make about the work that went into the radiological exam when the practice owns x-ray equipment and does their own interpretations internally. First, we must determine whether the x-ray was...

Mar 14th, 2022

Medicare Auditors Caught Double-Dipping

by Edward Roche, PhD JD

Overlapping extrapolations require providers to pay twice. Some Medicare auditors have been caught “double-dipping,” the practice of sampling and extrapolating against the same set of claims. This is like getting two traffic tickets for a single instance of running a red light. This seedy practice doubles the amount...

Mar 10th, 2022

Cybersecurity & Ransomware Warnings

by Wyn Staheli, Director of Content - innoviHealth

Although HIPAA Security protocols have been in effect for some time, as technology advances, if we are not diligent, gaps can be left available for intruders. On top of that, on February 23, 2022, the American Hospital Association issued a cybersecurity advisory. They stated, “there is concern that Russia may retaliate against the U.S. and allied nations with disruptive cyberattacks.”

Mar 10th, 2022

The Case of the Missing Signature

by David M. Glaser, JD

It’s important to remember that Medicare manuals are not binding, and they can’t “require” anything, including signatures. Regulatory framework is constantly changing. Never assume you know all of the rules, even if you carefully study them all the time. New things are constantly appearing....

Oct 15th, 2021

Is Your Organization Ready to Deal with Provider Relief Fund (PRF) Audit Contractors?

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?

Oct 6th, 2021

ICD-10-CM Cracks Down on the Use of "Unspecified" in the 2021 Official Guidelines

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

We always knew there would come a day when payers would look down on an "unspecified" diagnosis code and possibly even deny it or delay payment until a review of the record could be performed. ICD-10-CM was adopted by the U.S. for data analytics, which cannot be accurate if unspecified codes are reported when the documentation verifies greater specificity. Join us for a look at the many guideline changes to ICD-10-CM, a review of the newest code changes and suggestions on documentation improvement to elevate coding protocols.

Jul 29th, 2021

Medicare's ABN Booklet Revised

by Wyn Staheli, Director of Content - innoviHealth

The “Medicare Advance Written Notices of Non-coverage” booklet, published by CMS’s Medicare Learning Network, was updated. This article discusses the changes to this booklet regarding the use of the ABN.

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 20th, 2021

Intersegmental Traction — What’s Happening with Roller Tables?

by Wyn Staheli, Director of Content - innoviHealth

Intersegmental traction therapy via the use of roller tables has been used by doctors of chiropractic for many years. Recently, questions have arisen regarding the appropriate billing of roller tables. This is largely due to the statement published in the July 2020 CPT Assistant published by the American Medical Association (AMA). Which code should you really be using?

Apr 12th, 2021

Failure to Follow Payer’s Clinical Staff Rules Costs Provider $273K

by Wyn Staheli, Director of Content - innoviHealth

Clinical staff (e.g., LPN, RN, MA) provide essential services which allow providers to leverage their time and improve reimbursement opportunities and run their practices more efficiently. There is, however, an ongoing question of how to appropriately bill for clinical staff time. This is really a complex question which comes down to code descriptions, federal or state licensure, AND payer policies. Failure to understand licensing and payer policies led a Connecticut provider organization down a path that ended in a $273,000 settlement with both federal and state governments.

Jan 11th, 2021

HIPAA Penalty Changes

by Wyn Staheli, Director of Content - innoviHealth

On January 5, 2021, H.R. 7898 was signed into law by President Trump. This new law modifies the HITECH Act such that when an organization experiences a breach, fines and/or penalties may be reduced if (for at least a year) they have instituted “recognized security practices” as defined within the law.

Oct 12th, 2020

Medicare Improper Payment Report (2019)

by Jared Staheli, MPP

The Medicare Improper Payment Report for 2019 has been released by the OIG. Please note that the improper payment rate does not measure fraud. Rather, it estimates the payments that did not meet Medicare coverage, coding, and billing rules. The estimated Medicare FFS payment accuracy rate (claims paid correctly) from July ...

Oct 12th, 2020

Medicare Improper Payment Report for Behavioral Health Services (2019)

by Jared Staheli, MPP

CMS audits claims on an annual basis to identify improper payments. These improper payments do not measure fraud. Rather, they estimate the share of payments that did not meet Medicare coverage, coding, and billing rules. In the most recent Improper Payment Report, behavioral health services have some of the highest Part ...

Oct 12th, 2020

Medicare Improper Payment Report for Chiropractic (2019)

by Jared Staheli, MPP

CMS audits claims on an annual basis to identify improper payments. These improper payments do not measure fraud. Rather, they estimate the share of payments that did not meet Medicare coverage, coding, and billing rules. In the most recent Improper Payment Report by specialty, chiropractic has the highest Part B improper payment ...

Oct 7th, 2020

Stay out of Trouble — Understand the Qualified Medicare Beneficiary (QMB) Program

by Wyn Staheli, Director of Content - innoviHealth

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.

Oct 6th, 2020

An Infectious Disease Control Plan is Essential

by Wyn Staheli, Director of Content - innoviHealth

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

Sep 1st, 2020

Not Following the Rules Costs Chiropractor $5 Million

by Wyn Staheli, Director of Content - innoviHealth

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?

Jul 28th, 2020

OIG Report Highlights Need to Understand Guidelines

by Wyn Staheli, Director of Content - innoviHealth

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.

Apr 20th, 2020

Dismal OIG Report on Telemedicine

by Wyn Staheli, Director of Content - innoviHealth

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.

Apr 15th, 2020

CMS Temporarily Suspends Contract-Level RADV Audits

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

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.

Mar 25th, 2020

COVID-19: Cybercrime, Telehealth, and Coding

by Wyn Staheli, Director of Content - innoviHealth

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 ...

Mar 24th, 2020

"What is the ICD-10 code for...?" - Search Smarter With Find-A-Code Tools

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

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: ...

Jan 21st, 2020

Inadequate Exclusion Screenings Could Put Your Practice at Risk

by Wyn Staheli, Director of Content - innoviHealth

Exclusion screenings require far more than just checking a name on a federal database at the time you are hiring someone. Far too many providers don’t realize that in order to meet compliance requirements, there is MUCH more involved. There are actually over 40 exclusion screening databases/lists that need to be checked.

Oct 1st, 2019

2020 Official ICD-10-CM Coding Guideline Changes Are Here!

by Wyn Staheli, Director of Content - innoviHealth

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 ...

Aug 20th, 2019

Are You Aware of Medicare Advantage Plans Timely Filing Rules?

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

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 ...

Aug 13th, 2019

Will Medicare Change Their Rules Regarding Coverage of Services Provided by a Chiropractor?

by Wyn Staheli, Director of Content - innoviHealth

Two separate pieces of legislation introduced in the House of Representatives (H.R. 2883 and H.R. 3654) have the potential to change some of Medicare’s policies regarding doctors of chiropractic. Find out what these two bills are all about and how they could affect Medicare policies.

Aug 9th, 2019

The OIG Work Plan: What Is It and Why Should I Care?

by NAMAS

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 ...

Jul 22nd, 2019

Are These Problems Hurting Your Practice?

by Wyn Staheli, Director of Content - innoviHealth

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.

Jul 15th, 2019

Denial Management is Key to Profitability

by Wyn Staheli, Director of Content - innoviHealth

Jul 8th, 2019

Q/A: Can I Put the DC’s NPI in Item Number 24J for Massage Services?

by Wyn Staheli, Director of Content - innoviHealth

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 ...

Jul 1st, 2019

Q/A: Do I Really Need to Have an Interpreter?

by Wyn Staheli, Director of Content - innoviHealth

Question: I heard that I need to have an interpreter if someone who only speaks Spanish comes into my office. Is this really true? Answer: Yes! There are both state and federal laws that need to be considered. The applicable federal laws are: Title VI of the Civil Rights Act of 1964, Americans with Disabilities ...

Jul 1st, 2019

Rules for Rendering Unproven, Investigational or Experimental Procedures

by Brandy Brimhall, CPC CMCO CPCO CCCPC CPMA QCC

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 ...

Jun 27th, 2019

2018 Medicare Improper Payment Report Shows Slight Improvement but There's Still Work to be Done

by Wyn Staheli, Director of Content - innoviHealth

The Medicare Improper Payment Report for 2018 is not a measurement of fraud. Rather, it is an estimate of the claims paid by Medicare which did not meet Medicare coverage, coding, and billing rules. The estimated Medicare FFS payment accuracy rate (claims paid correctly) from July 1, 2016 through June 30, 2017, was 91.9 percent. ...

Jun 25th, 2019

Q/A: Can I Refuse to File a Patient's Medical Insurance for an Auto Accident?

by Wyn Staheli, Director of Content - innoviHealth

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 ...

Jun 21st, 2019

Small Breaches Can Be Subject to Large Penalties

by NAMAS

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 ...

Jun 13th, 2019

What Medical Necessity Tools Does Find-A-Code Offer?

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

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?

by Wyn Staheli, Director of Content - innoviHealth

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 ...

Apr 29th, 2019

Q/A: I’m Being Audited? Is There a Documentation Template I can use?

by Wyn Staheli, Director of Content - innoviHealth

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 ...

Apr 23rd, 2019

Let's Talk High Risk E/M Services

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

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 ...

Apr 23rd, 2019

OIG Announces New Review For Medicare Part B Payments for Podiatry and Ancillary Services

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

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 ...

Apr 15th, 2019

Watch out for People-Related ‘Gotchas’

by Wyn Staheli, Director of Content - innoviHealth

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 ...

Apr 8th, 2019

Prepayment Review Battle Plan

by Wyn Staheli, Director of Content - innoviHealth

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. ...

Mar 25th, 2019

Clearing Up Some Medicare Participation Misunderstandings

by Wyn Staheli, Director of Content - innoviHealth

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 ...

Mar 22nd, 2019

Q/A: How do we Know Which Codes a Payer Will Allow?

by Wyn Staheli, Director of Content - innoviHealth

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 ...

Mar 7th, 2019

Date of Service Reporting for Radiology Services

by Wyn Staheli, Director of Content - innoviHealth

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.

Mar 1st, 2019

Understanding NCCI Edits

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

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 ...

Feb 14th, 2019

Proposed Rule: Expanded Telemedicine Benefits for Medicare Advantage Beneficiaries

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

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 ...

Feb 7th, 2019

Charging Missed Appointment Fees for Medicare Patients

by Wyn Staheli, Director of Content - innoviHealth

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 ...

Dec 18th, 2018

Are HIPAA Changes Coming?

by Wyn Staheli, Director of Content - innoviHealth

On December 14, 2018, the Office for Civil Rights (OCR) issued a Request for Information (RFI). They are considering making changes to some of the HIPAA regulations. Earlier this year at the HIMSS (Healthcare Information and Management Systems Society) meeting, Roger Severino, the head of the Office for Civil Rights ...

Dec 18th, 2018

Medicare Advantage Providers are not Required to be Enrolled in Medicare

by Wyn Staheli, Director of Content - innoviHealth

There was a ruling that was requiring providers to be enrolled in Medicare in order to provide services for Part C (Medicare Advantage (MA)) and/or Part D. However, on April 2, 2018, CMS released the 2019 Final Rules for MA and Part D which changed this previous ruling. According to ...

Nov 29th, 2018

Errors Billing Outpatient Services When Patient is also Inpatient

by Wyn Staheli, Director of Content - innoviHealth

The OIG recently reported that Medicare inappropriately paid acute-care hospitals for outpatient services provided to patients who were inpatients of another facility including long term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, and critical access hospitals. CMS suggests using the following resources to ensure compliance: Medicare Inappropriately Paid Acute-Care Hospitals for ...

Nov 28th, 2018

No Good Deed Goes Unpunished

by Ray Foxworth, DC FICC MCS-P

You simply need to read the headlines, posts, and tweets, about providers across the healthcare profession being audited, fined, and some even convicted, to see that the costs of non-compliance are real. We tell ourselves, “It won’t happen to me.” The reality is that it easily could. Your license is your livelihood.

Oct 22nd, 2018

Q/A: Does My LMT need an NPI? How do I Bill Her Services?

by Wyn Staheli, Director of Content - innoviHealth

Question: I am setting up an LMT to work as employee under Dr. Clifton, DC. i need to know several things - hoping they are related and can be grouped into this one question.... does she need her own NPI? where does that NPI # go? what box #? if not, ...

Sep 24th, 2018

Q/A: Do I Have to Accept Any New Patient?

by Wyn Staheli, Director of Content - innoviHealth

Question: Is it legal for us to not allow a patient to be seen in our office if their parents have bad debt with us?

Aug 31st, 2018

Finalized Confidentiality of Alcohol and Drug Abuse Patient Records Regulations

by Wyn Staheli, Director of Content - innoviHealth

In January, the U.S. Department of Health and Human Services (HHS) issued updates to the privacy regulations regarding the confidentiality of patient information of substance use disorder patients (42 CFR Part 2). This notice included references to better alignment with HIPAA regulations, but did state that Part 2 is more protective ...

Aug 20th, 2018

PSAVE Pilot Program - What Does it Mean to You?

by Wyn Staheli, Director of Content - innoviHealth

Noridian's pilot program Provider Self-Audit with Validation and Extrapolation (PSAVE) has been extended which means that it has been successful for the payer, which means that they are saving money. Historically, when a pilot program is proven to be successful, it isn’t too long before other MACs follow. Before signing up to participate, providers need to carefully evaluate the program. Are the benefits worth the costs?

Aug 3rd, 2018

Q/A: Is it Legal to Shred Archived Patient Records After a Certain Amount of Time?

by Wyn Staheli, Director of Content - innoviHealth

Shredding patient records. When is it appropriate? Read more to find out.

Jul 12th, 2018

Dual Medicare-Medicaid Billing Problems

by Wyn Staheli, Director of Content - innoviHealth

It is important to keep in mind that Medicaid is run at a state level so there can be some differences when it comes to coverage. However, the rules regarding balance billing of covered services is set at the federal level. The law states (emphasis added): A state plan must provide ...

Jun 26th, 2018

WHO Said ICD-11 is Coming Soon

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Sooner or later ICD-11 will be released, and it sounds like it will be sooner than later. WHO released the news on June 18, 2018. The World Health Organization stated “ICD-11 will be presented at the World Health Assembly in May 2019 for adoption by Member States, and will come ...

Jun 18th, 2018

Medicare Claim Submission Exceptions

by Wyn Staheli, Director of Content - innoviHealth

There are several exceptions to the Medicare "Mandatory Claim Submission Rule." What are they?

Jun 18th, 2018

Q/A: Can a PT Assistant Perform Physical Therapy Modalities?

by Wyn Staheli, Director of Content - innoviHealth

Whether or not a physical therapy assistant (PTA) may perform physical therapy modalities depends on two factors: state law and payer policies. Read here for more.

Jun 14th, 2018

Home Oxygen Therapy -- CMN for Oxygen

by Raquel Shumway

The Certificate of Medical Necessity (CMN) for Oxygen is a required form that helps to document the medical necessity for oxygen therapy. It also documents other coverage criteria for the oxygen use. For payment on a home oxygen claim, the information in the supplier’s records or the patient’s medical record must be substantiated with the information in the CMN.

Jun 11th, 2018

Inappropriate Use of Units Costs Practice Over $800,000

by Wyn Staheli, Director of Content - innoviHealth and Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

A recent OIG enforcement action emphasizes the need to understand the proper use of units. A healthcare provider in Connecticut improperly submitted multiple units for drug screening urine tests. The proper billing of units has proven to be problematic for more than just lab tests. Is your billing of drugs & biologicals, injections and timed codes appropriate?

Jun 7th, 2018

The Range of Motion Conundrum

by Gregg Friedman, DC CCSP

As both a chiropractor for 31 years and one who reviews a lot of medical records for the medicolegal arena and has been teaching documentation for many years, the range of motion question comes up frequently. Although we used to get reimbursed very well for a specific range of motion code back in ...

May 22nd, 2018

Q/A: Am I Supposed to List the Frequency and Duration on the ABN?

by Wyn Staheli, Director of Content - innoviHealth

How to fill out Box D (Services) on the ABN form. What information is required?

May 7th, 2018

Q/A: How Do I Respond to a Patient's Request to Not Submit the Claim to Their Insurance?

by Wyn Staheli, Director of Content - innoviHealth

A number of patients now have high deductible plans. Sometimes, deductibles can be $5000 or $10,000. My payer contract states that I must submit all claims to insurance for covered services. However, sometimes patients with these high deductibles come to my office and state that they would prefer to receive a modest discount for paying cash and in turn, not have their services submitted to insurance. As a doctor, this places me in a tough situation. Do I follow the patient's wishes or the payer contract?

Apr 30th, 2018

Q/A: Should I be Using Modifier 96 on PT Claims?

by Wyn Staheli, Director of Content - innoviHealth

As chiropractors we feel the new modifier 97 is more appropriate than 96 for our PT codes such as stim and traction. Yet Carefirst is asking for 96 only. Should we use this code on all the PT codes and for all the other insurance companies?

Apr 23rd, 2018

Q/A: Someone Broke into My Office. What do I do Now?

by Wyn Staheli, Director of Content - innoviHealth

My office was broken into last night. I use electronic health records, but we do store some protected health information for my patients in paper files. These files are not secured, so the burglars did have access to them. It did not appear that the files were touched as the burglars were looking for cash. What responsibilities to I have to my patients in a situation like this? Do I need to contact them and advise them that their PHI could have been compromised?

Apr 9th, 2018

CMS Compliance Guidelines Focused Trainings

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Since the publication of the Compliance Program Guidelines in 2012, the Medicare Part C & D Oversight and Enforcement Group, Division of Compliance Enforcement, has presented a series of focused trainings for the industry on the application of the seven elements of an effective compliance program. These trainings are designed ...

Mar 8th, 2018

Documentation for Home Health Services (Part A non DRG)

by Medicare Learning Network

The Medical Learning Network provides coverage guidance, which should be documented, for home health services.

Feb 1st, 2018

OIG Reviews Medicare Advantage Claims

by Wyn Staheli, Director of Content - innoviHealth

On January 16, 2018, the OIG released a report of their findings on claims data for Medicare Advantage plans. While it appears that there were not significant issues, they did find that: "Types of potential errors included inactive or invalid billing provider identifiers; duplicated service lines; missing required data; inconsistent dates; ...

Jan 31st, 2018

Developing Coding Policies for Compliance

by Marge McQuade, CMSCS CHCI CPOM

Every physician practice depends upon correct coding and billing for their financial success. Coding drives reimbursement. All of the resources available for coding information and guidance are meaningless without the practice manager translating it into provider-specific coding policies and compliance plan. As a practice manager, you need to develop a ...

Jan 29th, 2018

Dental and Medical- Controlled Substance Awareness

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

As an effort to cut down on opioid abuse and related crimes, in August of 2017 the Attorney General Sessions established a new Department of Justice (DOJ) section called “Opioid Fraud and Abuse Detection Unit”. Due to the serious public health issue and drug overdose deaths, this unit was established and ...

Jan 24th, 2018

HIPAA and the Opioid Crisis

by Wyn Staheli, Director of Content - innoviHealth

HIPAA and the Opioid Crisis guidance released by HHS.

Jan 16th, 2018

Patient Relationship Codes

by Wyn Staheli, Director of Content - innoviHealth

Section 1848(r)(4) of MACRA requires that claims submitted for items and services furnished by a physician or applicable practitioner on or after January 1, 2018, include codes for the following: care episode groups patient condition groups patient relationship categories Previously, CMS decided to use procedure code modifiers to report patient relationship codes on Medicare ...

Jan 2nd, 2018

Quality Payment Program in 2018

by Wyn Staheli, Director of Content - innoviHealth

I checked the government website to see if I am an eligible clinician and it says that I am not. I just don't want to get blindsided with a letter saying I will be penalized. Is there anything you would suggest or recommend that I do now to protect myself from future penalties. Thank you

Dec 21st, 2017

OIG Advisory Opinion Recinded - Lessons Learned

by Wyn Staheli, Director of Content - innoviHealth

In the compliance world, it is important to know when the OIG makes an advisory opinion on a subject. For example, the advisory on Time of Service or Prompt Pay Discounts helps to ensure that providers are creating policies and procedures which will meet the standards of the OIG in the case ...

Nov 16th, 2017

Can an Unlicensed Person Perform Physical Therapy Services Such as 97110?

by Wyn Staheli, Director of Content - innoviHealth

Can an unlicensed person perform code a 97110 service as long as they're under doctor supervision? I use only PT, ATC, or DC's to perform these codes and I've been told that I don't need such highly qualified therapists to perform therapy.

Oct 23rd, 2017

Summary of OIG Reports for Chiropractic

by Wyn Staheli, Director of Content - innoviHealth

The Office of the Inspector General was created to protect the integrity of the U.S. Department of Health and Human Services. They investigate fraud, waste, and abuse in HHS programs and make recommendations to various enforcement agencies. Every few years they investigate chiropractic services. Here is a summary of the reports the ...

Oct 6th, 2017

Your NAMAS Weekly Auditing & Compliance Tip for October 6, 2017

by NAMAS

October 6, 2017 Acronyms and Abbreviations: When You Fall Into The Grey Area We've all been there... you are coding or auditing, and then a note comes up that is not like the ones you've reviewed before. The language is unclear, the acronym(s) could mean so many different things, and it's hard to get ...

Sep 29th, 2017

Stark Law for Healthcare Providers

by Brandy Brimhall, CPC CMCO CPCO CCCPC CPMA QCC

Be aware of physician self-referral laws and how they affect your practice.

Sep 14th, 2017

Double Dipping in the History of the Evaluation and Management Note

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

There are many rules and guidelines a coder must be aware of when it comes to appropriately selecting an Evaluation and Management (EM) code and avoiding doubling dipping is one of them. Double dipping occurs when the same information is used in more than one of the subcomponents of history. The subcomponents of history include: Chief Complaint ...

Sep 1st, 2017

2017 Physical Therapy Evaluation & Management Codes

by Kathy Price, RHIT CPC CCS-P CPMA

As you know, 2017 brought us new evaluation and management codes for physical and occupational therapy....

Sep 1st, 2017

Medicare Improper Payment Report (2016)

by Wyn Staheli, Director of Content - innoviHealth

The Medicare Improper Payment Report for 2016 has been released by the OIG. Please note that the improper payment rate does not measure fraud. Rather, it estimates the payments that did not meet Medicare coverage, coding, and billing rules. The estimated Medicare FFS payment accuracy rate (claims paid correctly) from ...

Sep 1st, 2017

Medicare Improper Payment Report for Behavioral Health Services (2016)

by Wyn Staheli, Director of Content - innoviHealth

Aug 17th, 2017

Q/A: What are the Rules for a Fill-in (locum tenens) Doctor?

by Brandy Brimhall, CPC CMCO CPCO CCCPC CPMA QCC

A locum tenens provider is one that works in the place of the regular physician for a short duration of time. Guideline typically allows this time period to be a 60 day maximum, when a substitute doctor would be brought in to your office to cover your original doctor's actual schedule during the time he/she is absent. Read further for more information

Jun 28th, 2017

Medicare Announces New Cards to Be Issued

by Mario Fucinari, DC CCSP CPCO MCS-P MCS-I

Identity theft has become a major problem in the United States. As a prevention measure, the Centers for Medicare& Medicaid Services (CMS) is readying a fraud prevention initiative that removes Social Security numbers from Medicare cards to help combat identity theft, and safeguard taxpayer dollars.

Apr 14th, 2017

Compliance Rules

by Melissa Hall

Can we send a survey to our patients and still be compliant? Are there rules that regulate this?

Apr 10th, 2017

False Claim Penalties Increase Again

by Wyn Staheli, Director of Content - innoviHealth

On February 3, 2017, the Department of Justice (DOJ) issued a Final Rule to increase the civil monetary penalties assessed under the False Claims Act (FCA), due to inflation for the year 2017, to an all-time high of $10,957 (minimum) to $21,916 (maximum). Thirty years ago, in 1986, Congress amended the False ...

Feb 27th, 2017

How to Properly Dispose Protected Health Information (PHI)

by InstaCode Institute

HIPAA requires covered entities to properly dispose of Protected Health Information (PHI) in the following manner: Paper, film, or other hard copy media has been shredded or destroyed such that the PHI cannot be read or otherwise cannot be reconstructed. Electronic media has been cleared, purged, or destroyed consistent with NIST Special Publication 800-88, Guidelines for Media ...

Feb 23rd, 2017

Physician Compensation Fraud Alert

by Wyn Staheli, Director of Content - innoviHealth

In June 2015, the Office of Inspector General (OIG) issued a Fraud Alert focused on physicians and compensation arrangements. Providers need to ensure that these arrangements do not violate the Anti-Kickback Statute. Healthcare providers found to have committed fraud are subject to possible criminal, civil and administrative sanctions. In this alert ...

Jan 23rd, 2017

Why Should I Document a Differential Diagnosis?

by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

Generating a differential diagnosis — that is, developing a list of the possible conditions that might produce a patient's symptoms and signs — is an important part of clinical reasoning. It allows a provider to perform appropriate testing to rule out possibilities and confirm a final diagnosis. Courts view the formulation and documentation of a differential diagnosis as evidence of a physician's competence, prudence, and thoughtfulness.

Jan 13th, 2017

Q/A: Is my Software Vendor a Business Associate to my Practice?

by Brandy Brimhall, CPC CMCO CPCO CCCPC CPMA QCC

Q: Is my software vendor a business associate to my practice?

Dec 12th, 2016

60 Day Final Rule

by Wyn Staheli, Director of Content - innoviHealth

Effective March 14, 2016, the CMS Final Rule clarifying the standards for handling overpayments for both Medicare and Medicaid takes effect. Failure to report and subsequently return an overpayment within 60 days after the overpayment was “identified” is a violation of the False Claims Act.

Jun 21st, 2016

Voluntary Overpayments

by Wyn Staheli, Director of Content - innoviHealth

When a claim has been determined to be paid more than the allowed amount, it is considered an overpayment. The action to be taken depends on how the overpayment is discovered. This article covers voluntary overpayment refund procedures as well as a Voluntary Overpayment Form.

Jun 16th, 2016

Q&A: Will Using Lower Level Codes Reduce Our Chances of Being Audited?

by ChiroCode™

Q&A: If we use low level codes on each visit (such as 98940, 99212, 99202), will our chances of being audited be less than if we billed higher level codes?

Apr 30th, 2016

Phase 2 of OCR HIPAA Audits Begins

by Wyn Staheli, Director of Content - innoviHealth

Phase 2 of HIPAA audits have begun. What do you need to know?

Apr 28th, 2016

An Important Rule that You're Probably Not Following

by ChiroCode™

The HIPAA Security Rule requires that covered entities (your practice) conduct a Security Risk Assessment (SRA) for your organization, at a minimum of once per year. It is critical that practices perform the Security Risk Assessment for multiple of reasons. Not only is it important to comply with rules and regulations, but also, for what you may consider to be a more motivational reason, to protect your practice (and bank account) from what could become disabling fines and penalties.

Apr 13th, 2016

Lack of Business Associate Agreement (BAA) Costs Non-Profit 1.55 Million

by Wyn Staheli, Director of Content - innoviHealth

Failure to have a properly executed Business Associate Agreements (BAA) costs one organization $1.55 Million. In today's highly technological environment, it is too easy to skip the necessary precautions and easy for electronic devices to get lost or stolen. Are you prepared?

Apr 6th, 2016

HIPAA Violations - The Process Is The Answer

by InstaCode Institute

It's not just the names and addresses that matter -- It's the compliance. If you can demonstrate that you are hleping yourself to maintain HIPAA compliance by careful documentation and proper procedures, you can go a long way toward avoiding being fined by the HIPAA squads. Complete & Easy HIPAA Compliance is a clear, simple “Just help me do what I have to do!” workbook that contains all the things the designated security officer must do to instantiate a robust HIPAA compliance program. It comes complete with over 45 forms and letters which can be used to state the office policies, spell out procedures, and ensure that each patient will be protected in their rights under HIPAA policy. It also can help demonstrate that a compliance program is in progress.

Apr 5th, 2016

Voluntary Disclosure - Look Before You Leap

by Melissa Hall

Occasionally providers are faced with the need to assess the option of making a voluntary disclosure to the government. Here are steps that every provider should consider before disclosing information to the government.

Mar 16th, 2016

Protected Health Information De-Identification Standards

by InstaCode Institute

This article contains detailed information on the OCR guidance regarding the de-identification of Protected Health Information (PHI). Avoid HIPAA violations and learn specifically what de-identification is.

Mar 4th, 2016

Guidance For Modifier 24 Usage

by Sara San Pedro, CPC CEMC CPMA

NAMAS Weekly Auditing and Compliance Tips Modifier 24 (Unrelated Evaluation and Management Service by the Same Physician during a Postoperative Period) has generated more scrutiny lately because of the attention it is receiving from Recovery Auditors and payors. An assignment of modifier 24 will oftentimes trigger a medical record...

Mar 4th, 2016

Medicare Improper Payment Report for Behavioral Health Services (2014)

by Wyn Staheli, Director of Content - innoviHealth

Medicare Improper Payment Report information regarding Behavioral Health Services

Feb 24th, 2016

Employee Exclusions Screenings Must be High Priority

by Wyn Staheli, Director of Content - innoviHealth

Many healthcare organizations are not aware of how critically important it is to screen their employees against ALL state and federal exclusions databases. This article has important information for organization to ensure compliance.

Feb 11th, 2016

What are the Rules for Safeguarding Patient Records?

by ChiroCode™

Secure medical records is a broad topic that should be addressed in detail by all practices. There are multiple items to consider when meeting standards to best safeguard protected health information (PHI).

Feb 1st, 2016

Medicare -To Participate or Not!

by Brittney Murdock, QCC CMCS CPC

What are the reasons for looking into Medicare as a dentist? You do have choices, pick the best option for your office.

Feb 1st, 2016

Will Incident-To in Your Organization Pass a Compliance Audit?

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Practices that bill incident to services need to periodically audit compliance with Medicare and private payor guidelines to avoid potential denials or third-party audits.

Aug 10th, 2015

Alphabet Soup for Waste and Fraud Inspectors

by Melissa Hall

The following are some of the acronyms you would need to know when communicating with auditors: National Correct Coding Initiative (NCCI) Edits: Use of codes that should not occur on the same day, effectively treating the same area twice. Medically Unlikely Edits (MUE): Exceeding the anticipated units of service (time spent) for a given HCPCS or CPT code. Office of the ...

Apr 9th, 2015

G0105 - Colorectal Cancer Screening; Colonoscopy on Individual at High Risk

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Screening colonoscopies (code G0105) may be paid when performed by a doctor of medicine or osteopathy at a frequency of once every 24 months for beneficiaries at high risk for developing colorectal cancer (i.e., at least 23 months have passed following the month in which the last covered G0105 screening colonoscopy was performed). ...

Feb 9th, 2015

Encryption

by Wyn Staheli, Director of Content - innoviHealth

How secure is your computer? Do you have a password on your computer? Do you have the automatic log offs turned on? Is your computer encrypted? Are your off-site storage files encrypted? This document is designed to give some basic information about making your office a little more secure. It is not ...

Dec 19th, 2014

Compliance Program - What are the Requirements to Implement an Effective Program

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

All sponsors are required to adopt and implement an effective compliance program,which must include measures to prevent, detect and correct Part C or D program noncompliance as well as FWA. The compliance program must, at a minimum, include the following core requirements: 1. Written Policies, Procedures and Standards of Conduct; 2. Compliance ...

Nov 19th, 2014

Understanding ZPIC

by Jared Staheli, MPP

The following chart identifies each of the 7 zones for ZPIC and the states/regions within each zone. Links are provided for each zone which contain information about each zone as well as activity and updates in those regions.

Oct 24th, 2014

Q & A: Is it a HIPAA Violation to Email Patients?

by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

Straight from the Office of Civil Rights: Q: Does the HIPAA Privacy Rule permit health care providers to use e-mail to discuss health issues and treatment with their patients? A: Yes. The Privacy Rule allows covered health care providers to communicate electronically, such as through e-mail, with their patients, provided they apply ...

Oct 16th, 2014

Is Compliance a Dirty Word?

by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

In October of 2000 in the Federal Register the Office of the Inspector General (who investigates fraud against the federal government on behalf of the Department of Health and Human Services) offered general guidelines for health care facilities to set up a “Compliance Program”. This advice has long been pushed ...

Oct 2nd, 2014

OSHA- Hazard Communication Standard Final Rule (Globally Harmonized System)

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

The Hazard Communication Standard in 1983 gave workers the "right to know," but the new Globally Harmonized System gives workers the "right to understand." What you need to do and when: Chemical users: Continue to update safety data sheets when new ones become available, provide training on the new label elements and ...

Sep 26th, 2014

Patient Electronic Access Tipsheet - Measure Compliance

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

MEASURE COMPLIANCE - Meeting the Patient Electronic Access Objective Starting in 2014, CMS requires that providers participating in both Stage 1 and Stage 2 of the EHR Incentive Programs must meet the Patient Electronic Access objective, which gives patients access to their health information in a timely manner. Providers participating in ...

Sep 25th, 2014

Healthcare Fraud Investigations in FY 2013

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Enforcement Actions in FY 2013: the Department of Justice (DOJ) opened 1,013 new criminal health care fraud investigations involving 1,910 potential defendants. Federal prosecutors had 2,041 health care fraud criminal investigations pending, involving 3,535 potential defendants, and filed criminal charges in 480 cases involving 843 defendants. A total of 718 ...

Sep 11th, 2014

According to HIPAA, who are my Business Associates?

by Brandy Brimhall, CPC CMCO CPCO CCCPC CPMA QCC

Providers work with many different groups and many of them have some interaction with Protected Health Information (PHI). In an effort to help us understand who qualifies as Business Associates the Department of Health & Human Services has provided some resources. But first … what is PHI or individually identifiable health information? ...

Sep 9th, 2014

Compliance Specialists

by Jared Staheli, MPP

Compliance specialists are responsible for monitoring health and human services program operations for compliance with federal and state regulations and standards in order to promote health and safety, assure that public services are delivered properly, or prevent fraud. Areas assessed may include service delivery, eligibility determination and payment, medical reimbursement, ...

May 28th, 2014

OSHA Penalty Calculation Information

by Wyn Staheli, Director of Content - innoviHealth

This article contains information from OSHA which outlines the penalty structure for OSHA violations. It includes a list of different types of violations that may be cited and the penalties that may be proposed by the area director. Also listed are additional violations for which citations and proposed penalties may be issued upon conviction. These are the types of violations that may be cited and the penalties that may be proposed

Feb 19th, 2014

Are Text Messages HIPAA Compliant?

by Jared Staheli, MPP

As more and more people are using mobile and wireless devices, a new buzzword has emerged: mHealth. According to a National Institute of Health consensus group, mHealth is "the use of mobile and wireless devices to improve health outcomes, healthcare services and health research." Historically, the biggest gaps and HIPAA violations ...

Feb 12th, 2014

EHR Hardship Exemption

by Karalyn

The following information is from the Centers for Medicare & Medicaid Services (CMS) regarding the Electronic Health Records (EHR) payment reduction hardship exemption.

Sep 30th, 2013

Are You Compliant with the New HIPAA Regulations?

by Jared Staheli, MPP

September 23rd, 2013 was the deadline for HIPAA Omnibus Final Rule compliance. It seems to have just snuck up on everybody. ChiroCode has spoken with some clincis who say that they don't need to worry about it because ”they are just a small practice.” Please, do not wait any longer to ...

Sep 24th, 2013

Federal Health Care Fraud Summary 2012

by Karalyn

Be aware of the possible monetary results and enforcement actions imposed for fraud. This is the annual report of the Department of Justice Health Care Fraud and Abuse Control Program for FY 2012

Subscribers will see related documentation, coding and billing tips. Access to this feature is available in the following products:

HCC Plus
Find-A-Code Professional
Find-A-Code Facility Base

Select the title to see a summary and a link to the full webinar information. some webinars require a subscription to view.

May 10th, 2022

Exclusions: What They Mean to You

by Ron Short, DC MCS-P CPC

May 5th, 2022

Do Minor Procedures Feel like Major Work?

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Apr 12th, 2022

What do Chiropractors Need to do to Comply with the No Surprises Act?

by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

Apr 4th, 2017

Does a Self-Care Rx Effect Medical Reimbursement and How?

by Tom Grant DC, Med-Legal Consultant, Pragma Intel Director of Education

This is the easiest of therapies to initiate and it adds great medical value. Most DC's do not prescribe/proscribe self-care instructions. Self-care Rx's have defined timelines for implementation and updates. Done incorrectly, self-care Rx's damage medical value and decrease reimbursements.

Nov 7th, 2013

HIPAA Has New Requirements (New as of 2013-11-07)

by Wyn Staheli, Director of Content - innoviHealth

HIPAA Has New Requirements ...

Links and resources by topic.

Appeals

Auditing

Billing

CLIA

CMS1500

CPT Coding

Coding

Collections

Compliance

DME

Documentation

EHR

Federal Register

Fees

Fraud

HCPCS Coding

HIPAA

Hospital

Insurance

Medicaid

Medicare

OIG

OSHA

Payer Guidelines

Pharmaceutical

Practice Management

Procedure Coding

Reimbursement

Risk Adjustment

Security

Technology

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.

MY NEWSLETTERS

FEES

FACILITY

RISK ADJUSTMENT

Compliance Articles and Resources

News and Important Information

Other Related Topics:

Resources