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Select the title to see a summary and a link to the full article.
September 23rd, 2020
My Location and CBSA is Missing!
Published September 23rd, 2020|
We often get questions on missing Core Based Statistical Areas, known as CBSAs. CBSAs are used for pricing and other factors according to the geographical location. If you do not see your CBSA, it is important to note they are not missing - it may not have an assignment, according to ...
August 5th, 2020
Coding with PCS When There is No Code
Published August 5th, 2020|
ICD-10-PCS covers ALMOST everything! But not quite! What if a body system does not contain a body part for toes or fingers? What about an elbow? When it does not cover what you are looking for, where do you turn? To the guidelines, of course! There are ICD-10-PCS guidelines just as ...
July 9th, 2020
Payment Adjustment Rules for Multiple Procedures and CCI Edits
Published July 9th, 2020|
Surgical and medical services often include work that is required to be done prior to a procedure and post-procedure. When there are multiple procedures done by the same physician, group, or another qualified healthcare professional on the same day, the pre and post work is only required once. Therefore, CMS ...
July 7th, 2020
New ABN Form is Here
Published July 7th, 2020 - Last Review/Update July 8th, 2020|
The anticipated changes to the Advanced Beneficiary Notice of Non-coverage (ABN) Form (CMS-R-131) have arrived. This important form is issued to the patient or client by providers, physicians, practitioners, and suppliers in situations where Medicare payment is expected to be denied. You can begin using the new ABN immediately if you so wish. However, it becomes mandatory on August 31, 2020.
July 1st, 2020
Understanding UCR Inpatient Fees used on DRGs
Published July 1st, 2020|
June 15th, 2020
Outpatient Facility Pricing
Published June 15th, 2020|
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 ...
May 12th, 2020
Getting Your Practice Back on Track
Published May 12th, 2020|
As we begin returning back to work, we will all face a new normal. The COVID-19 pandemic has changed the face of business. While it has certainly been a challenge to keep up with the ever-changing regulations (that’s likely to continue for a little longer), exciting new opportunities have also been created, such as the expansion of telemedicine. There’s also the maze of government funding that needs to be navigated and an increased awareness of OSHA standards to implement.
April 15th, 2020
CMS Temporarily Suspends Contract-Level RADV Audits
Published April 15th, 2020|
The Centers for Medicare and Medicaid Services (CMS) is suspending contract-level RADV audits, related to the payment year 2015 and will not initiate any new ones until after the public health emergency has ended. Any documentation already submitted will be reviewed as usual.
April 13th, 2020
Financial Impact of CARES Act on Healthcare Providers
Published April 13th, 2020|
The recently enacted Coronavirus Aid, Relief, and Economic Security (CARES) Act has several provisions to ease the financial burden being faced by healthcare providers who have been impacted by the effect of the coronavirus. Learn more about how the Provider Relief Fund and the Accelerated and Advance Payment Program work.
March 24th, 2020
"What is the ICD-10 code for...?" - Search Smarter With Find-A-Code Tools
Published March 24th, 2020|
Do you still find yourself searching the internet for an ICD10 code? Medical coders often type into their search engine, what is the ICD10 code for ... and a specific diagnosis code, to avoid repeatedly dragging out the incredibly large ICD10 codebook. Ironically, some of the most commonly searched ICD10 diagnoses include: ...
October 11th, 2019
Why is HIPAA So Important?
Published October 11th, 2019 - Last Review/Update October 15th, 2019|
Why is HIPAA So Important? Some may think that what they do to protect patient information may be a bit extreme. Others in specialty medical fields and research understand its importance a little more. Most of that importance lies in the information being protected. Every patient has a unique set of ...
August 20th, 2019
Are You Aware of Medicare Advantage Plans Timely Filing Rules?
Published August 20th, 2019|
The Medicare Fee for Service (FFS) program (Traditional or Original Medicare) has a timely filing requirement; a clean claim for services rendered must be received within one year of the date of service or risk payment denial. As any company who has billed Medicare services can attest, the one-year timely filing ...
July 29th, 2019
The Role of Chiropractic in Value Based Payment Systems
Published July 29th, 2019|
Chiropractic care can play a valuable role in overall patient health. It is important to realize that chiropractors can effectively participate in Medicare's new value based payment systems. Read about one organization who has made this transition.
July 22nd, 2019
Are These Problems Hurting Your Practice?
Published July 22nd, 2019|
There are many things that can be missed when trying to run an effective and profitable practice. This article covers some important tasks that are often overlooked such as not reviewing your payer contracts or failing to check eligibility.
June 21st, 2019
Small Breaches Can Be Subject to Large Penalties
Published June 21st, 2019 - Last Review/Update June 27th, 2019|
Small Breaches Can Be Subject to Large Penalties We may have heard about the large fines issued by the Office for Civil Rights (OCR) against big organizations like Anthem or the University of Texas MD Anderson Cancer Center. These organizations have been in the news due to privacy breaches that constituted violations ...
May 13th, 2019
Q/A: Two Payers Both Paid the Claim. Who Gets the Refund?
Published May 13th, 2019|
Question We have a personal injury situation where we submitted a claim was sent to the patient's auto policy carrier who refused payment. We then submitted it to her other insurance. Eventually, both companies paid her claims. Her auto paid at full value, and her secondary paid at a reduced rate ...
May 13th, 2019
Prioritize Your Patient's Financial Experience
Published May 13th, 2019|
For many years, the ChiroCode DeskBook has emphasized the need for providers to firmly establish the patient’s financial responsibility through clear communication. We even created a “Patient Financial Responsibility Acknowledgment Form” to help providers with this process. Lately, the lack of pricing transparency has been in the news and even ...
April 22nd, 2019
Auditing Chiropractic Services
Published April 22nd, 2019|
Chiropractic is unique from other types of health care and auditors need to be aware of the nuances of this field. Chiropractic has become the focus of more and more audits as doctors seem to struggle to create records that properly support the care provided to the patient throughout the entire episode.
April 15th, 2019
Watch out for People-Related ‘Gotchas’
Published April 15th, 2019|
In Chapter 3 — Compliance of the ChiroCode DeskBook, we warn about the dangers of disgruntled people (pages 172-173). Even if we think that we are a wonderful healthcare provider and office, there are those individuals who can and will create problems. As frustrating as it may be, there are ...
March 1st, 2019
Understanding NCCI Edits
Published March 1st, 2019|
Medicare creates and maintains the National Correct Coding Initiative (NCCI) edits and NCCI Policy Manual, which identify code pair edits. When performed on the same patient, on the same day, and by the same provider, the secondary code is considered an integral part of the primary code, and payment for ...
February 22nd, 2019
Q/A: What's the Difference Between Q5 and Q6 for a Substitute Provider?
Published February 22nd, 2019 - Last Review/Update March 5th, 2019|
It is important to understand that modifiers Q5 and Q6 are not interchangeable. So when do you use each of them?
February 5th, 2019
Clinical Staff vs. Healthcare Professional
Published February 5th, 2019|
State scope of practice laws and regulations will help determine who is considered Clinical staff and Other qualified Health Care professionals. Physician or other qualified healthcare professionals: Must have a State license, education training showing qualifications as well as facility privileges. Examples of Qualified Healthcare professionals: (NOTE: this list is not all-inclusive, please refer to your payer ...
February 1st, 2019
Attestations Teaching Physicians vs Split Shared Visits
Published February 1st, 2019 - Last Review/Update February 7th, 2019|
Physicians often use the term "attestation" to refer to any kind of statement they insert into a progress note for an encounter involving work by a resident, non-physician practitioner (NPP), or scribe. However, for compliance and documentation purposes, "attestation" has a specific meaning and there are distinct requirements for what ...
January 10th, 2019
Are You Protecting Your Dental Practice From Fraud?
Published January 10th, 2019|
With the expansion of dental coverage through Medicaid and Medicare Advantage plans, an ever-increasing number of dental claims have come under scrutiny for fraud. One such payer, Aetna, is actively pursuing dental fraud by employing their special investigative units (SIUs) to identify and investigate providers who demonstrate unusual coding and ...
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ABN- Medicare Advance Written Notices of Noncoverage (October 2018)AMA-Preventive services coding guidesDiscount Plan or Health Insurance? by FTCDisposal of Protected Health InformationHIPAA: Health Insurance Portability and Accountability Act by AMAMedicare OverpaymentsMedicare: To Participate or Not to Participate?MLN: Medicare Vision Services Fact SheetOfficial HIPAA Guidelines for Media SanitationOIG Compliance Program for Individual and Small Group Physician Practices - Federal RegisterOSHA's Computer Workstations eToolSkilled Nursing Facility Best Practice GuidelinesState Health Insurance Mandates & the ACA Essential Benefits Provisions - by the National Conference of State Legislataures
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