Life Care Planners

News and Important Information

Coding with PCS When There is No Code 

VA-UCR Prof Services Modifier Charge Factor

Newest Launch - We Now Have Outpatient Facility Pricing!

Tools and Resources for Life Care Planners

Spinal Cord Stimulator Used for Chronic Pain


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Resources

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$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 ...

Are NCCI Edits and Modifiers Just for Medicare?

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

The National Correct Coding Initiative (NCCI) edits were developed by CMS to help promote proper coding and control improper coding that leads to incorrect payments with part B claims. It is important to understand that NCCI edits do not include every possible code combination or every type of un-bundling combination. With that ...

Understanding UCR Inpatient Fees used on DRGs

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Outpatient Facility Pricing

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Our newest feature launch offers UCR pricing for Outpatient Facility. We recently released pricing information based on databases of insurance claims from private-sector health care providers.Usual, customary, and reasonable charges (UCR) are medical fees used when there are no contractual pricing agreements and are used by certain healthcare plans and third-party payers to generate ...

Spinal Cord Stimulator Used for Chronic Pain

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Chronic pain is a condition that can be diagnosed on its own or diagnosed as a part of another condition. When coding chronic pain, there is no time frame defining when pain becomes chronic pain; the provider’s documentation should be used to guide the use of these codes. ICD-10-CM Diagnosis Codes ...

Tools and Resources for Life Care Planners

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Life Care Planners play a vital and underappreciated including understanding the progression of a disease and lifetime clinical treatment options, research, delete (I combined this into the paragraph above) compiled into one easy-to-use resource. a unified providing a single destination for procedure coding coding to find information on...

Anesthesia and Fee Calculation

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Fees for anesthesia services are not calculated the same as for other types of procedures. There are four elements to consider when calculating anesthesia fees. Medicare accepts base units and time units; however, depending on the third party payer, they may or may not accept physical status units and/or qualifying circumstances units. Base Unit (of the CPT code) Time (in ...

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Compliance  (2022-06-16)

Implanted Spinal Neurostimulators: Document Medical Records

In a recent report, the Office of Inspector General found that Medicare improperly paid claims for implanted spinal neurostimulators when providers didn’t provide sufficient documentation supporting medical necessity. For dates of service on or after July 1, 2021, you must ask your Medicare Administrative Contractor to authorize these services before performing the procedure in the hospital outpatient department.

Learn what you need to include in patient medical records:

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