2021 ICD-10-CM and ICD-10-PCS CODING HANDBOOK
The handbook's format and style of presentation follows that of previous editions inspired by the Faye Brown approach to coding instruction. The handbook is authored by Nelly Leon-Chisen, RHIA, Director of Coding and Classification at the AHA.
- Fiscal year 2021 code updates, including new information on COVID-19, vaping-related disorder, history of diabetes mellitus or hypertension, immunodeficiency, cytokine release syndrome,cerebrospinal fluid leak, intracranial hypotension, neonatal cerebral infarction, and “chronic stroke”
- Up-to-date guidance on coding signs and symptoms, diseases, disorders, procedures, conditions, complications of care, long-term care, and more
- Reflects the Official Coding Guidelines
- Over 200 chapter-based and final review exercises
- Built-in workbook of case summary exercises
- More than 50 four-color illustrations of anatomy, common disorders, and procedures
Compliance Articles and Resources
News and Important InformationDate of Service Reporting for Radiology Services Q/A: I’m Being Audited? Is There a Documentation Template I can use? Other Related Topics:Check Out Find-A-Code's Tools & ResourcesMedicare Part BNovitas Solutions Additional Links and ResourcesBilling Requirements for OPPSBilling Requirements for OPPS Providers with Multiple Service Locations Select the title to see a summary and a link to the full article. April 26th, 2022 Preventive ServicesBy Shannon DeConda, CPC, CEMC, CEMA, CPMA, CRTT | Published April 26th, 2022 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... March 31st, 2022 $636 Million in Overpayments Made by Medicare to Providers for NeurostimulatorsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 31st, 2022
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 ... June 29th, 2021 Compliance in the Dental Office or Small PracticeBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 29th, 2021 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, ... October 7th, 2020 Stay out of Trouble — Understand the Qualified Medicare Beneficiary (QMB) ProgramBy Wyn Staheli, Director of Content | 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 EssentialBy Wyn Staheli, Director of Content | 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 MillionBy Wyn Staheli, Director of Content | 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 GuidelinesBy Wyn Staheli, Director of Content | 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 TelemedicineBy Wyn Staheli, Director of Content | 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 AuditsBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | 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 CodingBy Wyn Staheli, Director of Content | 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 ToolsBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | 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!By Wyn Staheli, Director of Content | 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?By Aimee Wilcox | 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?By Namas | 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?By Wyn Staheli, Director of Content | 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 ProfitabilityBy Wyn Staheli, Director of Content | Published July 15th, 2019 July 8th, 2019 Q/A: Can I Put the DC’s NPI in Item Number 24J for Massage Services?By Wyn Staheli, Director of Content | 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 ProceduresBy Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | 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?By Wyn Staheli, Director of Content | 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 PenaltiesBy Namas | 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?By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | 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?By Wyn Staheli, Director of Content | 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?By Wyn Staheli, Director of Content | 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 ServicesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | 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 ServicesBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | 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’By Wyn Staheli, Director of Content | 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 PlanBy Wyn Staheli, Director of Content | 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 MisunderstandingsBy Wyn Staheli, Director of Content | 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?By Wyn Staheli, Director of Content | 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 ServicesBy Wyn Staheli, Director of Content | 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 EditsBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | 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 BeneficiariesBy Aimee Wilcox | 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 PatientsBy Wyn Staheli, Director of Content | 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 ... December 18th, 2018 Medicare Advantage Providers are not Required to be Enrolled in MedicareBy Wyn Staheli, Director of Content | Published December 18th, 2018 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 ... December 18th, 2018 Are HIPAA Changes Coming?By Wyn Staheli, Director of Content | Published December 18th, 2018 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 ... December 7th, 2018 Keeping Up to DateBy NAMAS | Published December 7th, 2018 - Last Review/Update December 20th, 2018 Keeping up to date on coding and documentation changes, is critical for medical coders, billers, auditors, and compliance personnel. Every year American Medical Association (AMA) creates, revises, and deletes CPT codes on January 1st. Same thing occurs with the ICD-10 codes in October. For CPT codes, the intention of the... November 29th, 2018 Errors Billing Outpatient Services When Patient is also InpatientBy Wyn Staheli, Director of Content | Published November 29th, 2018 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 ... November 28th, 2018 No Good Deed Goes UnpunishedBy Dr. Ray Foxworth, MCS-P, President of ChiroHealthUSA | Published November 28th, 2018 - Last Review/Update January 21st, 2019 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. November 9th, 2018 Billing 99211 Its not a freebieBy | Published November 9th, 2018 - Last Review/Update November 29th, 2018 It seems like a simple code to bill, but CPT 99211 (established patient office visit) is by no means a freebie when it comes to documentation and compliance. This lowest level office visit code is sometimes called a "nurse visit" because CPT does not require that a physician be present... October 22nd, 2018 Q/A: Does My LMT need an NPI? How do I Bill Her Services?By Wyn Staheli, Director of Content | Published October 22nd, 2018 - Last Review/Update December 19th, 2018 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, ... September 28th, 2018 Chiropractic OIG Audit Recommendations - Lessons LearnedBy Wyn Staheli, Director of Content | Published September 28th, 2018 The OIG recently concluded an audit on a chiropractic office located in Florida and had some significant findings. They recommended the following:
Refund to the Federal Government the portion of the estimated $169,737 overpayment for claims for chiropractic services that did not comply with Medicare requirements and are within the 4-year ... September 26th, 2018 HIPAA Handling Patient Requests for Medical Record RestrictionBy | Published September 26th, 2018 - Last Review/Update October 17th, 2018 Healthcare compliance professionals frequently face confusing situations about sharing of protected health information (PHI). The Health Insurance Portability and Accountability Act (HIPAA) supports the protection of privacy of medical records. However, even when a patient does not authorize sharing of his record, there are permitted uses and disclosures, such as... September 24th, 2018 Q/A: Do I Have to Accept Any New Patient?By Wyn Staheli, Director of Content | Published September 24th, 2018 - Last Review/Update January 28th, 2019 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? August 31st, 2018 Finalized Confidentiality of Alcohol and Drug Abuse Patient Records RegulationsBy Wyn Staheli, Director of Content | Published August 31st, 2018 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 ... August 13th, 2018 Are incident to services worth the riskBy | Published August 13th, 2018 - Last Review/Update September 24th, 2018 Incident-to services allow non-physician practitioners (NPPs) such as nurse practitioners and physician assistants to bill under a supervising physician if they perform services that are incidental to a physician-created plan of care. Incident-to billing offers two key benefits: First, the physician is reimbursed at 100% of the contracted rate with... August 3rd, 2018 Q/A: Is it Legal to Shred Archived Patient Records After a Certain Amount of Time?By Wyn Staheli, Director of Content | Published August 3rd, 2018 - Last Review/Update January 28th, 2019 Shredding patient records. When is it appropriate? Read more to find out. July 17th, 2018 Attention Providers - Please Make Time to Read this LetterBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 17th, 2018 In an effort to show CMS is committed to changing the rules to accommodate their providers CMS released a letter to Doctors of Medicare Beneficiaries. The letter offers encouragement and a promise to reduce the burden of unnecessary rules and requirements. The letter states “President Trump has made it clear that ... July 12th, 2018 Dual Medicare-Medicaid Billing ProblemsBy Wyn Staheli, Director of Research | Published July 12th, 2018 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 ... June 26th, 2018 WHO Said ICD-11 is Coming SoonBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 26th, 2018 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 ... June 18th, 2018 Medicare Claim Submission ExceptionsBy Wyn Staheli, Director of Content | Published June 18th, 2018 - Last Review/Update January 28th, 2019 There are several exceptions to the Medicare "Mandatory Claim Submission Rule." What are they? June 18th, 2018 Q/A: Can a PT Assistant Perform Physical Therapy Modalities?By Wyn Staheli, Director of Content | Published June 18th, 2018 - Last Review/Update January 30th, 2019 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. June 14th, 2018 Home Oxygen Therapy -- CMN for OxygenBy Raquel Shumway | Published June 14th, 2018 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. June 11th, 2018 Inappropriate Use of Units Costs Practice Over $800,000By Wyn Staheli, Director of Research & Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT | Published June 11th, 2018 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? June 7th, 2018 The Range of Motion ConundrumBy Gregg Friedman, DC, CCSP | Published June 7th, 2018 - Last Review/Update January 30th, 2019 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 30th, 2018 Creating a Culture of Compliance in 2018By Sean M. Weiss & Frank Cohen | Published May 30th, 2018 - Last Review/Update June 4th, 2018 This year (2018), healthcare organizations (Hospitals, Health Systems, and Physician Groups/Practices) must focus on the criticality of creating a culture of compliance to ensure effectiveness and efficiency. Focusing on "compliance"-only approaches leaves healthcare organizations exposed to areas of liability oftentimes far more than what they could ever imagine or even... May 30th, 2018 Routine Waiver of Patient Out of Pocket ExpensesBy Linda Walker | Published May 30th, 2018 - Last Review/Update June 4th, 2018 Medical billers often encounter the dilemma of a physician who wants to be the hero to his or her patients and waive their out-of-pocket expenses. Out-of-pocket expenses include a patient's co-payment, coinsurance, deductibles, charges above U&C (Usual and Customary), and even services a plan may not cover in some situations.... May 30th, 2018 What is a Legal Hold and e Discovery AnywayBy Rachel V. Rose, JD, MBA | Published May 30th, 2018 - Last Review/Update June 4th, 2018 Whether I am assisting clients or presenting, I am often asked about legal holds and e-discovery. The transition from paper to electronic records, which include emails, computer faxes, protected health information ("PHI"), personally identifiable information ("PII") and documents that are created, received, maintained or transmitted in an electronic format created... May 22nd, 2018 Q/A: Am I Supposed to List the Frequency and Duration on the ABN?By Wyn Staheli, Director of Content | Published May 22nd, 2018 - Last Review/Update January 28th, 2019 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 | Published May 7th, 2018 - Last Review/Update January 30th, 2019 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? May 4th, 2018 The Devil is in the Data DetailsBy J. Paul Spencer, CPC, COC | Published May 4th, 2018 - Last Review/Update May 24th, 2018 As an auditor who has reviewed thousands and thousands of encounter documents for level of service, a predictable pattern has merged when it comes to the Medical Decision Making (MDM) component that has attracted my attention. April 30th, 2018 Q/A: Should I be Using Modifier 96 on PT Claims?By Wyn Staheli, Director of Content | Published April 30th, 2018 - Last Review/Update January 30th, 2019 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? April 23rd, 2018 Q/A: Someone Broke into My Office. What do I do Now?By Wyn Staheli, Director of Content | Published April 23rd, 2018 - Last Review/Update January 24th, 2019 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? April 20th, 2018 The PSAVE Pilot Program: Should You Self-Audit Your Medicare Claims?By Robert Liles, JD, MBA, MS | Published April 20th, 2018 - Last Review/Update April 25th, 2018 As the Medicare program has grown, the Centers for Medicare and Medicaid Services (CMS) has employed a variety of different claims audit mechanisms to better ensure that the Medicare Trust Fund is protected from waste, fraud and abuse.... April 9th, 2018 CMS Compliance Guidelines Focused TrainingsBy Christine Woolstenhulme, QCC, CMCS, CPC, CMRS | Published April 9th, 2018 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 ... March 8th, 2018 Documentation for Home Health Services (Part A non DRG)By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 27th, 2018 The Medical Learning Network provides coverage guidance, which should be documented, for home health services. March 8th, 2018 Documentation for Skilled Nursing FacilitiesBy Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 27th, 2018 The Medicare Learning Network provides guidance on required documentation for Skilled Nursing Facilities (SNF). February 23rd, 2018 The Comprehensive Error Rate Testing ProgramBy Frank Cohen, MBA, MPA | Published February 23rd, 2018 - Last Review/Update February 26th, 2018 With nearly a million physicians in this country, how do auditing organizations determine whom to audit? February 2nd, 2018 Scoring & Reporting Your Audit FindingsBy Shannon DeConda, CPC, CPC-I, CEMC, CEMA, CPMA, CRTT | Published February 2nd, 2018 - Last Review/Update February 7th, 2018 This week we had a great question posted to our online forum, and I thought it would be a nice thought- provoking question for our auditing and compliance tip of the week. February 1st, 2018 OIG Reviews Medicare Advantage ClaimsBy Wyn Staheli, Director of Content | Published February 1st, 2018 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; ... January 31st, 2018 Mobile Health: Growing Engagement and New ResponsibilitiesBy Dugan Maddux, MD, FACP | Published January 31st, 2018 - Last Review/Update March 29th, 2018 This week I'm blogging about an M-word. Not MACRA or MIPS, but Mobile Health or mHealth.... January 31st, 2018 Developing Coding Policies for ComplianceBy Marge McQuade, CMSCS, CHCI, CPOM | Published January 31st, 2018 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 ... January 29th, 2018 Dental and Medical- Controlled Substance AwarenessBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 29th, 2018 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 ... January 26th, 2018 Creating a Culture of Compliance in 2018By Sean M. Weiss, CHC, CEMA, CMCO, CP MA, CPC-P, CMPE, CPC | Published January 26th, 2018 - Last Review/Update February 7th, 2018 This year (2018), health care organizations (Hospitals, Health Systems and Physician Groups/Practices) must focus on the criticality of creating a culture of compliance to ensure effectiveness and efficiency.... January 23rd, 2018 NEW on Find-A-Code...National Coverage Determinations (NCDs)By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published January 23rd, 2018 - Last Review/Update January 25th, 2018 Medicare limits its coverage of services to those considered to be reasonable and necessary for the diagnosis and treatment of an injury or illness based on coverage guidelines. National Coverage Determinations (NCDs) are created based on research, evidence-based processes, public participation, and other resources, and made available to the public. ... January 22nd, 2018 Compliance: What is it and Why is it ImportantBy Joan S. Hartman, RHIT | Published January 22nd, 2018 - Last Review/Update January 25th, 2018 Compliance. It is one of the buzz words in healthcare that is heard all the time but what is it really, and why is it so important? January 2nd, 2018 Quality Payment Program in 2018By Wyn Staheli, Director of Research | Published January 2nd, 2018 - Last Review/Update January 30th, 2019 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 December 21st, 2017 OIG Advisory Opinion Recinded - Lessons LearnedBy Wyn Staheli, Director of Content | Published December 21st, 2017 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 ... December 15th, 2017 Is Your Practice in Need of a Wellness Visit?By Valora Gurganious, MBA, CHBC | Published December 15th, 2017 - Last Review/Update January 31st, 2018 Is your practice busier than ever, but net practice income continues to drop? December 12th, 2017 Developing Billing & Coding PoliciesBy Marge McQuade CMSCS, CHCI, CPOM | Published December 12th, 2017 The financial health of every medical practice rests upon correctly coded claims. This is true from not only a financial standpoint since coding drives reimbursement, but from a compliance perspective as well. All of the resources available for coding information and guidance are meaningless without the practice manager sifting through... December 1st, 2017 Auditing the Use of a ScribeBy Shannon DeConda, CPC, CPC-I, CEMC, CEMA, CPMA, CRTT | Published December 1st, 2017 - Last Review/Update January 31st, 2018 A scribe is someone that can act as a walking transcriptionist on behalf of a medical provider...... November 16th, 2017 Can an Unlicensed Person Perform Physical Therapy Services Such as 97110?By Wyn Staheli, Director of Research | Published November 16th, 2017 - Last Review/Update January 30th, 2019 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. October 13th, 2017 Can Chiropractors Opt-out of Medicare?By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published October 13th, 2017 - Last Review/Update February 5th, 2019 Chiropractors cannot opt-opt of Medicare. Does that only refer to chiropractors that see Medicare patients? Do all Florida chiropractors have to complete Medicare enrollment/credentialing? Bottom line- do ALL chiropractors, no matter where or who, have to complete Medicare enrollment since they cannot Opt-out? October 6th, 2017 Your NAMAS Weekly Auditing & Compliance Tip for October 6, 2017By NAMAS | Published October 6th, 2017 - Last Review/Update October 16th, 2017
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 ... September 14th, 2017 Double Dipping in the History of the Evaluation and Management NoteBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published September 14th, 2017 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 ... September 1st, 2017 2017 Physical Therapy Evaluation & Management CodesBy Kathy Price, RHIT, CPC, CCS-P, CPMA | Published September 1st, 2017 - Last Review/Update January 31st, 2018 As you know, 2017 brought us new evaluation and management codes for physical and occupational therapy.... September 1st, 2017 Quick Tip from ChiroCode -- DocumentationBy ChiroCode | Published September 1st, 2017 - Last Review/Update January 31st, 2019 Documentation Solutions, a quick tip video by Dr Gwilliam. August 17th, 2017 Q/A: What are the Rules for a Fill-in (locum tenens) Doctor?By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published August 17th, 2017 - Last Review/Update February 5th, 2019 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 August 4th, 2017 Cybersecurity - Are you sure you are secure?By Wyn Staheli, Director of Content | Published August 4th, 2017 An article by Medical Economics highlights the June report of the Health Care Industry Cybersecurity Task Force. Their report confirmed once again that healthcare providers are not adequately addressing cybersecurity as part of the compliance programs. The threat of hackers is very real and providers need to ensure that they have taken ... June 30th, 2017 Getting Serious About Your Practice’s ComplianceBy Jesse Overbay, JD | Published June 30th, 2017 By now, hopefully most (if not all) practices know that the Office of Inspector General (OIG) has been stressing the importance of creating and abiding by a compliance plan for most of this decade. In its own words, the OIG believes "that a healthcare provider can use internal controls to ... June 28th, 2017 Medicare Announces New Cards to Be IssuedBy Dr. Mario Fucinari, Author & Member of the Carrier Advisory Committee for Medicare | Published June 28th, 2017 - Last Review/Update February 8th, 2019 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. April 14th, 2017 Compliance RulesBy Melissa Hall | Published April 14th, 2017 - Last Review/Update February 8th, 2019 Can we send a survey to our patients and still be compliant? Are there rules that regulate this? April 14th, 2017 Office of Inspector General (OIG) - Compliance Program GuidanceBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 14th, 2017 The compliance program guidance documents are listed below.
09-30-2008Supplemental Compliance Program Guidance for Nursing Facilities (73 Fed.Reg. 56832; September 30, 2008)
Compliance Program Guidance for Nursing Facilities (65 Fed. Reg. 14289; March 16, 2000)
11-28-2005Draft Compliance Program Guidance for Recipients of PHS Research Awards (70 Fed.Reg. 71312; November 28, 2005)
NSTC Launches Government-Wide Initiative ... April 10th, 2017 False Claim Penalties Increase AgainBy Wyn Staheli, Director of Content | Published April 10th, 2017 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 ... February 23rd, 2017 Physician Compensation Fraud AlertBy Wyn Staheli, Director of Content | Published February 23rd, 2017 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 ... February 23rd, 2017 Medicaid ReviewsBy Wyn Staheli, Director of Content | Published February 23rd, 2017 All federal healthcare programs are required to implement programs to prevent and reduce provider fraud, waste, and abuse and this includes the Medicaid program. Two groups work in conjunction with the Centers for Medicare and Medicaid Services (CMS) and the Office of the Inspector General (OIG):
the Medicaid Integrity Program (MIP) works at ... February 23rd, 2017 Emergency Preparedness Final RuleBy Wyn Staheli, Director of Content | Published February 23rd, 2017 Compliance has a new standard for emergency preparedness plans. On September 8, 2016, CMS issued the final rule titled “Emergency preparedness requirements for Medicare and Medicaid participating providers and suppliers.” This rule creates emergency preparedness Medicare Conditions of Participation (COPs).
There are specific standards for each of the named types of providers ... January 23rd, 2017 Why Should I Document a Differential Diagnosis?By Evan M. Gwilliam, DC MBA BS CPC CCPC CPC-I QCC MCS-P CPMA CMHP | Published January 23rd, 2017 - Last Review/Update February 8th, 2019 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. January 23rd, 2017 Q/A: Where Can I Find More Information on HIPAA Penalties?By ChiroCode | Published January 23rd, 2017 - Last Review/Update March 5th, 2019 Neglecting or overlooking a sound HIPAA Compliance policy can be crippling to a practice.
Where can I find more information on HIPAA penalties? January 13th, 2017 Q/A: Is my Software Vendor a Business Associate to my Practice?By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published January 13th, 2017 - Last Review/Update February 8th, 2019 Q: Is my software vendor a business associate to my practice? December 15th, 2016 How do I Determine who is a Business Associate to Our Practice?By Melissa Hall | Published December 15th, 2016 - Last Review/Update March 5th, 2019 How do I determine who is a Business Associate? October 14th, 2016 Q/A: Are You Liable When a Business Associate Has a Data Breach?By ChiroCode | Published October 14th, 2016 - Last Review/Update March 5th, 2019 We have a Business Associate who has recently had a data breach, are we liable? September 24th, 2016 Medicare Improper Payment Report for Behavioral Health Services (2015)By Wyn Staheli, Director of Content | Published September 24th, 2016 Medicare claims review sheds light on problem areas for behavioral health providers. July 29th, 2016 Cloned E/M notesBy | Published July 29th, 2016 Have you ever read a physician office note and thought it was strangely familiar? Or, not just familiar but identical to another note? Well, Medicare contractors have noticed the same thing, and the Office of Inspector General has included this on their 2011 Work Plan. Medicare contractors have noted an... July 29th, 2016 What's My Benefit For Implementing Compliance SolutionsBy ChiroCode | Published July 29th, 2016 - Last Review/Update March 4th, 2019 Lots of Chiropractic practices want to know why compliance is necessary and how implementing compliance can help the practice. July 28th, 2016 Pre-op visits: True or False?By | Published July 28th, 2016 Are the following statements true or false? • The PCP cannot be paid to do a pre-op assessment of a Medicare patient prior to surgery because of the new consult rules. • The surgeon can never be paid to do a pre-op visit if s/he is going to take the... July 28th, 2016 OIG adds to increased scrutiny of how patients pay for rising share of drug costsBy | Published July 28th, 2016 Charity programs that help patients pay for the rising cost-sharing obligations of needed drugs may run afoul of anti-kickback rules when the charity’s scope is so narrow that it guides the patient toward specific drugs for treatment or providers, the HHS Office of Inspector General said last week.The OIG’s Supplemental... July 28th, 2016 OIG Work Plan to look at excessive patient billing, place of service errorsBy | Published July 28th, 2016 The 2014 OIG Work Plan has finally been released and, while it doesn’t have a lot of new issues for physician practices, there are definitely some areas worth your attention to avoid future compliance hassles. If you’ve been wondering where it’s been, the OIG decided to change the timing of... July 28th, 2016 OIG Work Plan 2012-Do your own review of these areasBy | Published July 28th, 2016 The Office of Inspector General released its Work Plan for 2012. As in past years, the Work Plan describes the areas of interest that the OIG will investigate in the coming year. There are sections for hospitals, nursing homes, and of course, physicians. There is a pdf file attached to... July 5th, 2016 Q&A: We just learned that for Meaningful Use attestation, we have to complete a Security Risk Assessment. What is that and how do we do it?By ChiroCode | Published July 5th, 2016 - Last Review/Update March 4th, 2019 Q&A:
We just learned that for Meaningful Use attestation, we have to complete a Security Risk Assessment. What is that and how do we do it? June 16th, 2016 Q&A: Will Using Lower Level Codes Reduce Our Chances of Being Audited?By ChiroCode | Published June 16th, 2016 - Last Review/Update March 5th, 2019 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? June 15th, 2016 Mastering Medicare: When Opting Out is not an OptionBy Dr. Ray Foxworth, Certified Medical Compliance Specialist and President of ChiroHealthUSA | Published June 15th, 2016 - Last Review/Update March 5th, 2019 Unlike MDs and DOs, chiropractors may not opt out of Medicare.
When it comes to Medicare, providers and patients alike feel like beating their heads against the wall. Signing up to be a provider or a patient is confusing, understanding what is covered is confusing and just about the time you think you have it figured out, you receive a notice that suggests you don’t.
The hassles of Medicare certainly validate any sane person questioning whether they should see a Medicare patient, but with the rising number of Medicare patients in the US do you really want to limit your patient base? June 7th, 2016 Q/A: Do you Have any Recommendations for Audit Prevention?By Melissa Hall | Published June 7th, 2016 - Last Review/Update March 5th, 2019 Q: Do you have any recommendations for audit prevention? May 26th, 2016 Groupon: Is it worth the risk?By Dr. Ray Foxworth, Certified Medical Compliance Specialist and President of ChiroHealthUSA | Published May 26th, 2016 - Last Review/Update March 5th, 2019 Our team is frequently asked if it is legal for chiropractic offices to offer coupons or Groupons. We’re not allowed, as a profession, to dramatically discount our services, offer free treatments, or provide gifts or free meals for potential patients. Any one of these things can be considered an “inducement.” Practices that improperly induce patients to seek care or services, for example, by providing coupons for care or supplies, may find that they are in violation of the law if they aren’t careful.
So what will that mean to you and your practice? It isn’t pretty. May 19th, 2016 Your Reasons to Delay Compliance Implementation are GONE!By Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published May 19th, 2016 ChiroCode has proudly served chiropractic for more than 30 years and continues to work to bring the most necessary, affordable, and user friendly products and services to practices. Increased regulation has hindered practices by creating uncertainty around the nature of guidelines and the expensive penalties that arise from non-compliance with ... April 30th, 2016 Phase 2 of OCR HIPAA Audits BeginsBy Wyn Staheli, Director of Content | Published April 30th, 2016 Phase 2 of HIPAA audits have begun. What do you need to know? April 28th, 2016 Q&A: What is a Program for a Systematic Approach to Becoming Compliant?By Melissa Hall | Published April 28th, 2016 - Last Review/Update March 5th, 2019 What is a comprehensive program for a systematic approach to becoming a compliant office? April 28th, 2016 An Important Rule that You're Probably Not FollowingBy ChiroCode | Published April 28th, 2016 - Last Review/Update March 5th, 2019 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. April 13th, 2016 Lack of Business Associate Agreement (BAA) Costs Non-Profit 1.55 MillionBy Wyn Staheli, Director of Content | Published April 13th, 2016 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? April 6th, 2016 HIPAA Violations - The Process Is The AnswerBy Instacode Institute | Published April 6th, 2016 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. April 5th, 2016 Voluntary Disclosure - Look Before You LeapBy Melissa Hall | Published April 5th, 2016 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. March 16th, 2016 Protected Health Information De-Identification StandardsBy Instacode Institute | Published March 16th, 2016 - Last Review/Update January 27th, 2017 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. March 4th, 2016 Medicare Improper Payment Report for Behavioral Health Services (2014)By Wyn Staheli, Director of Content | Published March 4th, 2016 Medicare Improper Payment Report information regarding Behavioral Health Services March 4th, 2016 Guidance For Modifier 24 UsageBy Sara San Pedro, CPC, CEMC, CPMA | Published March 4th, 2016 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... February 24th, 2016 Employee Exclusions Screenings Must be High PriorityBy Wyn Staheli | Published February 24th, 2016 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. February 11th, 2016 What are the Rules for Safeguarding Patient Records?By ChiroCode | Published February 11th, 2016 - Last Review/Update March 5th, 2019 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). February 1st, 2016 Will Incident-To in Your Organization Pass a Compliance Audit?By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published February 1st, 2016 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. February 1st, 2016 Medicare -To Participate or Not!By | Published February 1st, 2016 - Last Review/Update February 18th, 2016 What are the reasons for looking into Medicare as a dentist? You do have choices, pick the best option for your office. January 6th, 2016 EMRs - Coding and Compliance ConcernsBy | Published January 6th, 2016 The past year has been an exciting time for healthcare professionals, bringing more changes, opportunities and challenges than ever before. The Health Information Technology for Economic and Clinical Health (HITECH) Act, which is a portion of the American Recovery and Reinvestment Act of 2009,... December 21st, 2015 Review Incident - To for ComplianceBy Aimee Wilcox, MA CST CCS-P | Published December 21st, 2015 If your organization performs incident-to services, be sure to perform a periodic review of the rules that govern incident to and then compare them to the practices of your providers to ensure they would pass an audit. Here are just a few of the guidelines that should be reviewed; however, ... November 9th, 2015 OSHA Recordkeeping Rule UpdatedBy InstaCode Institute | Published November 9th, 2015 Many healthcare providers are unaware that they are obligated to adhere to all OSHA rules and regulations relevant to their place of business. This includes safety plans and reporting of injuries. New record keeping rules went into effect on January 1, 2015. As part of the new ruling, an online reporting ... August 19th, 2015 Discharge of an EmployeeBy | Published August 19th, 2015 Q: Our office has recently had to let an employee go that had been here for a long period of time. What would you recommend to us to ensure we have handled this properly?
A: Not having any information of the circumstances, here are a few general recommendations for you to ... August 19th, 2015 Chiropractic Listed as Focal Point in 2015 OIG Work PlanBy Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published August 19th, 2015 - Last Review/Update January 30th, 2017 With the recent release of the 2015 OIG Work Plan, many providers and facilities are reviewing the content to learn which areas of interest pertaining to their specialty will be points of interest for federal auditing programs for the 2015 Fiscal Year. The information contained in this Work Plan addresses the ... August 10th, 2015 Alphabet Soup for Waste and Fraud InspectorsBy Melissa Hall | Published August 10th, 2015 - Last Review/Update January 27th, 2017 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 ... April 24th, 2015 Have you been excluded from Medicare?By Dr. Chris Andersn | Published April 24th, 2015 - Last Review/Update June 9th, 2016 Compliance is an issue that you should look at as an expedition rather than an endpoint. Board complaints can be a terrifying ordeal, especially if you don’t keep up on compliance in your clinic. Board complaints are something that you have to expect to happen but you can turn that ... April 9th, 2015 G0105 - Colorectal Cancer Screening; Colonoscopy on Individual at High RiskBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 9th, 2015 - Last Review/Update August 8th, 2017 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). ... February 26th, 2015 Avoiding Medicare and Medicaid Fraud and AbuseBy | Published February 26th, 2015 - Last Review/Update January 27th, 2017 Recently, the U.S. Department of Health and Human Services Office of Inspector General updated their booklet, “Avoiding Medicare and Medicaid Fraud and Abuse.”
In this publication, the Government agencies, including the Department of Justice, the Department of Health and Human Services office of Inspector General, and the Centers for Medicare and ... February 3rd, 2015 PPACA Provider Non-Discrimination FAQBy | Published February 3rd, 2015 - Last Review/Update June 9th, 2016 The following information (emphasis added) is from: http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs15.html
Provider Non-Discrimination PHS Act section 2706(a), as added by the Affordable Care Act, states that a “group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against ... January 23rd, 2015 Chiropractic Listed as Focal Point in 2015 OIG Work PlanBy | Published January 23rd, 2015 - Last Review/Update January 30th, 2017 With the recent release of the 2015 OIG Work Plan, many providers and facilities are reviewing the content to learn which areas of interest pertaining to their specialty will be points of interest for federal auditing programs for the 2015 Fiscal Year. The information contained in this Work Plan addresses ... January 9th, 2015 What NOT to Ask Candidates in a Job InterviewBy | Published January 9th, 2015 - Last Review/Update January 30th, 2017 Conducting a job interview for potential new employees is a common occurrence, yet is often done in a manner of disorganization. Employers are frequently asking questions that shouldn't be asked and neglecting to ask those questions that may be more essential for conducting a proper interview. Federal and state laws ... December 30th, 2014 Understanding TOS Discounts and DMPOsBy | Published December 30th, 2014 - Last Review/Update March 9th, 2016 Time-of-Service (TOS) discounts are a common occurrence in chiropractic. What is often assumed is that if insurance isn't involved, there are no rules that apply.
Unfortunately, this is a myth that can become costly to practices and damage provider/patient relationships. So read on to learn the facts about TOS discounting and ... December 19th, 2014 Compliance Program - What are the Requirements to Implement an Effective ProgramBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 19th, 2014 - Last Review/Update March 1st, 2016 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 ... December 15th, 2014 OIG Reports Success in Efforts to Prevent Fraud, Waste, and AbuseBy | Published December 15th, 2014 - Last Review/Update January 30th, 2017 The HHS OIG Work Plan for the 2015 Fiscal Year has recently been released. In this publication, the OIG addresses the accomplishments made from the previous year's Plan as well as the objectives that will be of interest for the coming new year. Accomplishments for the 2014 Fiscal Year are ... December 4th, 2014 OASIS Data to be Submitted via Assessment Submission and Processing (ASAP) System Effective Jan 1, 2015By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 4th, 2014 - Last Review/Update March 1st, 2016 Effective January 1, 2015, OASIS assessment data will be submitted to CMS via the national OASIS Assessment Submission and Processing (ASAP) system. With the implementation of the OASIS ASAP system, Home Health Agencies will no longer submit OASIS assessment data to CMS via their state databases. To access the ... November 21st, 2014 Establishing a Multi-Disciplinary Practice and Being LegalBy Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published November 21st, 2014 - Last Review/Update January 30th, 2017 Q: How do you add another provider type such as a Nurse Practitioner to your practice to provide additional services to patients and legally bill for those services under their license?
A: Multi-disciplinary practices are under scrutiny at the moment by ZPIC, CMS and State Boards. For your reference, just below, there ... November 19th, 2014 Getting Ready for 2015By | Published November 19th, 2014 - Last Review/Update January 30th, 2017 Each new year brings a bundle of surprises in terms of changes and updates that practices must learn and implement. In effort to aid in the preparation of this year, I have listed some common helpful tips that you might follow in order to best manage your workload ahead.
-Evaluate fees: Fee ... November 19th, 2014 Understanding ZPICBy | Published November 19th, 2014 - Last Review/Update January 30th, 2017 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. November 19th, 2014 Understanding RACBy Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published November 19th, 2014 - Last Review/Update January 30th, 2017 Recovery Audit Contractors, also known as RAC, is a program that seeks to identify and correct improper payments for services provided to Medicare Parts A & B beneficiaries. This includes both recoupment of overpayments and corrected distribution of underpayments made by CMS.  RAC began in 2005 as a three-year demonstration project consisting ... November 17th, 2014 Conducting a Gap Analysis for Your Documentation & Billing SystemsBy Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published November 17th, 2014 - Last Review/Update January 30th, 2017 What is a Gap Analysis?
A Gap Analysis is a process by which a practice conducts a baseline assessment of the company's coding, billing, operations, and business practices. The objective of a Gap Analysis is to ensure that the practice is in full compliance with applicable legal and ethical requirements. This ... November 17th, 2014 Social Media and Healthcare: Unprofessional Conduct and What It Can CostBy | Published November 17th, 2014 - Last Review/Update January 30th, 2017 In this electronic age, Social Media has quickly become a very successful tool used for advertising/marketing, communication of various topics and reaching readers and networks beyond our wildest dreams. These networks are often leading to various opportunities or other positive occurrences that we may not have otherwise experienced. Social Media ... October 24th, 2014 Q & A: Is it a HIPAA Violation to Email Patients?By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published October 24th, 2014 - Last Review/Update January 30th, 2017 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 ... October 16th, 2014 Is Compliance a Dirty Word?By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published October 16th, 2014 - Last Review/Update January 23rd, 2017 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 ... October 16th, 2014 The Role of Statistical Analysis in Fighting FraudBy Jared Staheli | Published October 16th, 2014 - Last Review/Update January 30th, 2017 It is common knowledge that fraud is a large problem for payers, who must spend money paying fraudulent claims as well as on recovery. New developments in statistical analysis helps to combat this. October 6th, 2014 OSHA - Hazard Communication Standard Final Rule (Globally Harmonized System)By | Published October 6th, 2014 - Last Review/Update January 30th, 2017 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 ... October 3rd, 2014 Good Attorneys and Bad AttorneysBy | Published October 3rd, 2014 - Last Review/Update January 27th, 2017 A “good” lawyer could be a “bad” lawyer when it come to your unique problem(s). Never ask or expect any professional person (doctor or lawyer) to perform beyond their scope of practice or ability. A college law degree and passing the state bar, is only a license which permits them ... October 2nd, 2014 OSHA- Hazard Communication Standard Final Rule (Globally Harmonized System)By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 2nd, 2014 - Last Review/Update January 30th, 2017 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 ... September 26th, 2014 Patient Electronic Access Tipsheet - Measure ComplianceBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 26th, 2014 - Last Review/Update January 30th, 2017 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 ... September 25th, 2014 Healthcare Fraud Investigations in FY 2013By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 25th, 2014 - Last Review/Update January 30th, 2017 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 ... September 11th, 2014 According to HIPAA, who are my Business Associates?By Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published September 11th, 2014 - Last Review/Update January 30th, 2017 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? ... August 29th, 2014 Who in the World are my Business Associates?By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 29th, 2014 - Last Review/Update January 30th, 2017 The associates in the provider’s world and healthcare society are filled with loads of potential business associates and endless Individual identifiable health information.
 We have had so many questions about business associates I thought I would go to the source and put together some information from HHS.gov, otherwise known as U.S. ... March 18th, 2014 How can I make sure new hires have not been in trouble with Medicare?By Christopher Anderson, DC MCS-P | Published March 18th, 2014 - Last Review/Update January 25th, 2017 To avoid liability, it is recommended to routinely check (every 3 months) the LEIE to ensure that new hires and current employees are not on the excluded list.
One of the many parts of the compliance program is to see if your current staff (including yourself, regular staff and associate doctors) have been placed on the OIG (Office of the Inspector General) List of Excluded Individuals and Entities (LEIE).
OIG has the authority to exclude individuals and entities from Federally funded health care programs and maintains a list (List of Excluded Individuals and Entities or LEIE)of all currently excluded individuals and entities. Anyone who hires an individual or entity on the LEIE may be subject to monetary penalties.
It’s as simple as 1…2…3..
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February 19th, 2014 Are Text Messages HIPAA Compliant?By | Published February 19th, 2014 - Last Review/Update January 27th, 2017 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 ... September 30th, 2013 Are You Compliant with the New HIPAA Regulations?By | Published September 30th, 2013 - Last Review/Update January 27th, 2017 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 ... September 24th, 2013 Federal Health Care Fraud Summary 2012By | Published September 24th, 2013 - Last Review/Update January 27th, 2017 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 September 6th, 2013 Ominbus Final Rule and BAA Contracts DeadlineBy | Published September 6th, 2013 - Last Review/Update January 27th, 2017 The official deadline for HIPAA covered entities to reach compliance with the provisions of the Omnibus Rule is officially set as September 23, 2013. This date is right around the corner and as a result, providers are concerned about meeting this deadline. The definition for a business associate has been ... There are more articles. View all articles... View articles for the current subject by subtopic:
Select the webinar title to view a summary and link to the webinar video. November 6th, 2018 Medicare ReviewsMedicare 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 PlanIn 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 ReviewsMedicare 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 PitfallsPresented 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 MakeNotes 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 PostureJoin 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 MACRAThe #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 April 26th, 2016 Alert!! THOUSAND$ at Risk for Chiropractors in 2016Join this group of compliance professionals to learn about compliance hot topics, common Q/A, need-to-know details for compliance implementation and evaluation and much more. Also, this webinar will present to you advanced compliance training tools that will save you time, money and be easy to time manage as you navigate and implement compliance. There is so much to cover in this webinar session, doctors and CA's will not want to miss out. November 7th, 2013 HIPAA Has New Requirements (New as of 2013-11-07)HIPAA Has New Requirements
... 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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