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Accurately Reporting Diabetic Medication Use in 2023

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

Along with the ICD-10-CM coding updates, effective as of October 1st, the guidelines were also updated to provide additional information on reporting diabetic medications in both the general diabetic population and pregnant diabetics. Accurate reporting is vital to ensure not only maximum funding for risk adjusted health plans, but also to ensure medical necessity for the services provided to this patient population.

How Does the Definition of "Problem Assessed" Change in the 2023 E/M Guideline Updates?

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

The 2023 Evaluation and Management changes have been published and efforts are ongoing to educate coders and provider organizations on the guideline and code description changes that will impact professional coding in the facility setting. These changes required a significant revision to the guidelines and definitions of the various levels of complexity associated with the Number and Complexity of "Problems Addressed" during an encounter, which is the first element of medical decision making (MDM) and the following explanations and examples should provide a greater understanding of the changes headed our way in January.

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

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

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

2023 Evaluation & Management Updates Free Webinar

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

Congratulations on a successful 2021 implementation of the Evaluation and Management (E/M) changes! That was a big change, but now an even bigger change is headed your way for inpatient and all other E/M categories. How great is it that almost all of the E/M categories will now be scored based on medical decision making (MDM) or total provider time? Standardized scoring and one set of E/M guidelines has the potential of bringing about a change or improvement of provider fatigue due to over regulation and documentation burden.

End-Stage Renal Disease Risk Model Updates for 2023

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

For the first time, ESRD Medicare beneficiaries were permitted to enroll in Medicare Advantage plans beginning in 2021. Since that time, CMS has been working to revise the program to reduce costs, improve quality, and drive benefits. Effective January 1, 2025, one such change will include a definition change for "oral-only drugs." Why is Medicare changing the definition of these drugs and how will that be a driving force in advancing care models for ESRD in the future?

Seven Major Changes Proposed by CMS in the 2023 Proposed Rule

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

As the COVID-19-related public health emergency (PHE) seems to be dying down, CMS publishes the 2023 Medicare Proposed Rule that outlines more than a dozen major changes to existing programs, including some that relate to telemedicine after the PHE is declared officially over. Of the many changes, seven (7) really stand out and make us think about how the end of the PHE may affect services such as telemedicine or new E/M encounter types.

Significant Changes to Emergency Department E/M Reporting Coming in 2023

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

In just a few short months, major revisions to the remaining Evaluation and Management categories in the Current Procedural Terminology (CPT) code book will go into effect. How many of these changes will affect your organization and how ready are you for them? While the changes to the remaining E/M categories will closely resemble the 2021 changes to the E/M Office and Other Outpatient (99202-99215) codes, there are some major differences that need to be carefully reviewed, such as how E/M will change for the Emergency Department services.

Are Leading Queries Prohibited by Law or Lore?

by  Erica E. Remer, MD CCDS

AHIMA released its CDI Practice Brief Monday. At Yom Kippur services, I found myself thinking about the question Dr. Ronald Hirsch posed to me the day before. My rabbi was talking in her sermon about the difference between halacha and minhag. Halacha is law; it is the prescriptions...

Yes, You Have What It Takes To Lead Your Practice And Your Profession

by  Kem Tolliver, CMPE, CPC, CMOM

If you’ve been in any healthcare role for more than two years, you’ve seen quite a bit of change. And guess what, it’s not over. We are living and working in uncertain times. This climate requires each of us to step outside of our comfort zones to lead exactly where we stand. It’s not required of one to have a “title” to lead. What is required, however, is a willingness to trust your instincts, look for answers and rely on your team.

What is the ICD-10 Code for May-Thurner Syndrome?

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

May-Thurner syndrome is not identified in the Alphabetic Index of the ICD-10-CM codebook, so what is the ICD10 code for reporting this condition? Eponymous diseases are conditions, illnesses, syndromes, disorders, or disease named after the person who either discovered it (usually a physician) or in some cases the patient who was diagnosed with the disease (think Lou Gherig's disease). When trying to identify these diseases in the Alphabetic Index you may have to do a little additional research to identify the actual name of the condition rather than the eponymous name. So what exactly is the ICD-10-CM code for May-Thurner syndrome and what other names does it go by?

CMS Publishes Over 1,000 New ICD-10-CM Codes Effective on October 1, 2022

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

Each October 1st, the newest updates to ICD-10-CM take effect. This year with more than a thousand new codes added there is a lot of information to dig into and prepare our providers for. Many of the deleted and changed code descriptions, including the endeavor to capture social determinants of health, were made to enable expansion of specific coding categories so additional details could be reported, when captured in the documentation.

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

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

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

Calendar Year 2023 Medicare Advantage and Part C & D Payment Policies

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

Each year CMS publishes an Advance Notice of the upcoming years Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies and asks for comments related to it. Each of the comments are carefully reviewed and responded to and often are impactful to changes seen between the Advance Notice and final publication referred to as the Rate Announcement. With health equity as a primary focus for 2023, CMS announced some policy changes that may impact your organization.

How CMS Determines Which Telehealth Services are Risk Adjustable

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

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

Billing and Coding: Bone Mass Measurement

by  Amanda Ballif

Guidance for billing, coding, and other guidelines in relation to local coverage policy L36460-Bone Mass Measurement.

CMS Started to Enforce Applicable Price Transparency Requirements

by  Amanda Ballif

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

Calendar Year 2023 Medicare Physician Fee Schedule Proposed Rule

by  Amanda Ballif

The Centers for Medicare and Medicaid Services (CMS) is soliciting public comments on proposed changes for Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues effective on January 1, 2023 and thereafter. The Calendar Year (CY) 2023 PFS proposed rule is one of several proposed rules aimed at increasing equity in health care.

Addressing Trauma and Mass Violence

by  Amanda Ballif

After events of mass violence, it’s easy to feel helpless, like there is little we can do. In fact, we can help individuals, families, and communities build resilience and connect with others to cope together. The SAMHSA-funded National Child Traumatic Stress Network has developed a range of resources to help children, families, educators, and communities including the following which you can access via links in this article.

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

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

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

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

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

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

2023 Annual Update Summary

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

Be sure you are ready for 2023 with this review of the upcoming coding and reimbursement updates for 2023. This informative webinar discusses changes to CPT codes and guidelines including a summary of the changes to E/M services and an overview of changes to other CPT categories.

Coding 2022 Care Management Services 

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

Do Minor Procedures Feel like Major Work? 

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

Reporting Telemedicine Services by Aimee Wilcox 

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

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

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

Inappropriate Payments Made to Chiropractors – An OIG Review 

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

In this webinar, Dr. Gwilliam will take you on a fun filled journey through all of the reports created by the Office of the Inspector General based on their reviews of chiropractors. If you can understand what they see, and what advice they give Medicare when dealing with chiropractors, then you will be better prepared to not become their next target. This webinar may feel a little frightening with hundreds of thousands of dollars paid back to CMS, but, by the end, you will know exactly what to do and what not to do.

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

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

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

Mighty MACRA! 

by  Find-A-Code™

Mighty MACRA!

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