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Are You Aware of Medicare Advantage Plans Timely Filing Rules?
August 20th, 2019
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 ...
The Role of Chiropractic in Value Based Payment Systems
July 29th, 2019
By Wyn Staheli, Director of Research | 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.
By Wyn Staheli, Director of Research | 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.
By 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 ...
Q/A: Two Payers Both Paid the Claim. Who Gets the Refund?
May 13th, 2019
By Wyn Staheli, Director of Research | 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 ...
By Wyn Staheli, Director of Research | 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 ...
By By Evan M. Gwilliam, DC MBA BS CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow Clinical Director, PayDC Chiropractic EHR Software President, Gwilliam Consulting LLC drgwil@gmail.com | 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.
By Wyn Staheli, Director of Research | 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 ...
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | 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 ...
Attestations Teaching Physicians vs Split Shared Visits
February 1st, 2019
By BC Advantage | 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 ...
Are You Protecting Your Dental Practice From Fraud?
January 10th, 2019
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | 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 ...
By BC Advantage | Published November 30th, 2018 - Last Review/Update January 9th, 2019
When given the task of auditing a group of charts, most often the scope of the audit is well defined. For me, there are times when my natural inquisitive nature turns on and I find my noticing the "timing" of parts of documentation. These are things that you would not...
By BC Advantage | Published November 26th, 2018 - Last Review/Update November 29th, 2018
This article will focus on the Present on Admission (POA) indicator which is used as a method of reporting whether a patient’s diagnoses are present at the time they are admitted to a facility. We’ll look at a few scenarios to determine the correct reporting of POA and the impact...
We've Always Done It This Way and Other Challenges in Education
October 19th, 2018
By BC Advantage | Published October 19th, 2018 - Last Review/Update November 1st, 2018
As coders, auditors, and compliance professionals, we are the provider's advocates in closing the gap between what is medically necessary and what is required for documentation. Sometimes that places us in the role where we need to save our clinicians from themselves, and the patterns they have fallen into...
Wolters Kluwer provides unit and package pricing for multiple drug price types: Average Wholesale Price (AWP), Wholesale Acquisition Cost (WAC), Direct Price (DP), Manufacturer's Suggested Wholesale Price (SWP), Centers for Medicare & Medicaid Services, Federal Upper Limit (CMS FUL), Average Average Wholesale Price (AAWP), Generic Equivalent Average Price (GEAP). Average...
HIPAA Handling Patient Requests for Medical Record Restriction
September 26th, 2018
By BC Advantage | 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...
The Potential Impacts of a Flat Rate EM Reimbursement on our Industry
September 26th, 2018
By BC Advantage | Published September 26th, 2018 - Last Review/Update October 17th, 2018
The proposed E&M changes by CMS would decrease provider administrative work burden by, per CMS, 51 hours a year; however, how will reducing documentation requirements truly affect the professionals of the healthcare industry? First, let’s discuss the 30,000-foot overview of the most impactful E&M changes—which is the change to the...
Getting the Right Eligibility Information for Payment Your Rights and Health Plans Requirement
September 11th, 2018
By BC Advantage | Published September 11th, 2018 - Last Review/Update September 24th, 2018
We need timely and accurate patient information to bill health plans and receive appropriate payment. Clinical information is, of course, important. But we also need the "administrative" data - patient demographics and especially the insurance information. Physician offices create their clinical information, but usually rely on patients for information on...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published August 27th, 2018
For Medicare purposes, an Ambulatory Surgical Center Resources (ASC) is a distinct entity that operates exclusively to furnish surgical services to patients who do not require hospitalization and in which the expected duration of services does not exceed 24 hours following admission. ASC payment groups determine the amount that...
Documentation: Face to Face for Home Health Certification
July 9th, 2018
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published July 9th, 2018
As a physician, you are responsible for providing appropriate, accurate supporting documentation of your face-to-face encounters (FTF) with your patients regarding home health care.
Analysis of the recent errors identified by the Comprehensive Error Rate Testing (CERT) Review Contractor shows a continuing increase in denials related to documentation for the FTF. The ...
How Does the Physician Compare Website Affect You?
June 25th, 2018
By Wyn Staheli, Director of Research | Published June 25th, 2018
The physician compare website may not be working quite the way you think it is. Not all providers will have rankings showing up for them. Physician compare lists basic information, but quality measure information was not added until this year (2018) and not all quality measures are included in the ...
By Diana Strubler | Published June 15th, 2018 - Last Review/Update July 3rd, 2018
Seema Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS), recently announced that 91% participated in the first year of the Quality Payment Program (QPP), barely squeaking by their goal of 90%....
By BC Advantage | Published June 7th, 2018 - Last Review/Update July 3rd, 2018
Bundled payment models continue to attract interest for their potential benefits over traditional fee-for-service payment models. With bundled payments, also known as episode-based payments or packaged pricing, a group of providers is reimbursed based on a contracted price to cover all of the care and services related to a particular ...
By 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....
By Glenn Krauss | Published May 16th, 2018 - Last Review/Update May 24th, 2018
DI's present-day Key Performance Indicators centered upon reimbursement do not truly reflect a meaningful account of performance in impacting the quality, completeness and effectiveness of medical record documentation. Common KPIs include number of physician queries left, number of queries responded to by the physician, number of queries responded to...
By 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.
Saving Time and Money with Automated Insurance Eligibility Verification
May 3rd, 2018
By BC Advantage | Published May 3rd, 2018 - Last Review/Update May 24th, 2018
The healthcare revenue cycle contains multiple potential pinch points for the parties involved: patients don’t enjoy dealing with insurance companies and have trouble understanding their benefits, and they especially hate being responsible for surprise medical costs that aren’t covered by their insurance plan. Healthcare providers compete in a challenging...
By Dugan MadduxDugan Maddux, MD, FACP & Dr. Ahmad SharifAhmad Sharif, MD, MPH | Published April 24th, 2018 - Last Review/Update May 2nd, 2018
Like a moth to a flame, we periodically have to take a close look at FHIR. As mentioned in the March 26 blog post, interoperability was the hot topic at HIMSS, and FHIR is at the blazing edge of interoperability...
Proper record keeping and documentation is not only essential for today’s dental practitioner, but is also required by law. Moreover, correct, current and accurate records directly enhance patient care by enabling the dentist to plan treatments, monitor progress, and provide essential notations. Clear and concise treatment plans, medical alerts, and ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published April 12th, 2018
When a Dental provider is treating a Medicare Beneficiary, it is important to get a copy of the Medicare card to verify the patient's medical benefits, provider eligibility and claims address/submission prior to submitting a claim. CMS is in the process of changing Medicare Policy Numbers, so you may see ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published April 12th, 2018
If you don’t use the correct information or document the proper information and submit a medical claim you will lose! You will lose reimbursement, could be excluded from participating in Federal Health Care programs, you could possibly lose your license and family time. The government has every tool they need, you ...
By BC Advantage | Published April 4th, 2018 - Last Review/Update April 12th, 2018
Evolutions in technology continue to merge with a trend toward consumerism in healthcare. As a result, patients are expecting a different kind of experience in managing their healthcare....
Health Information Exchange and Trusted Exchange Frameworks
February 27th, 2018
By Dugan Maddux, MD, FACP | Published February 27th, 2018 - Last Review/Update April 12th, 2018
Despite progress in health IT, Health Information Exchange (HIE) remains squarely in toll booth mode, with gated stops and slowdowns that may or may not permit information to move forward. ...
The following information is from BC Advantage. As of Dec 31, 2017, Acumen EHR v8.0 achieved Office of the National Coordinator for Health Information Technology (ONC-Health IT) 2015 edition certification! What's a 2015 CEHRT?A CEHRT (Certified EHR Technology) is defined by CMS specifically for their incentive payment programs such as...
If you are hesitant about collecting co-pays, consider that you may be paying interest on credit cards, property mortgages, and business loans. Each dollar that you do not collect in co-pays could have been used to pay down the practice debt. Without question, if you are having difficulty finding ways ...
By Ashley Choate | Published January 31st, 2018 - Last Review/Update March 29th, 2018
High Deductible Health Plans (HDHPs) are recent and growing trend in healthcare that is probably here to stay, regardless of the future changes to the national healthcare system or federal regulations.....
By 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 ...
Dental and Medical- Controlled Substance Awareness
January 29th, 2018
By Chris Woolstenhulme, QCC, CMCS, 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 ...
Referring and Ordering Physician - CMS-1500 Box 17
January 29th, 2018
By Christine Woolstenhulme, QCC, CMCS, CPC, CMRS | Published January 29th, 2018
Enter the name of the referring or ordering physician if the service or item was ordered or referred by a physician. All physicians who order services or refer Medicare beneficiaries must report this data. Similarly, if Medicare policy requires you to report a supervising physician, enter this information in Item ...
By Wyn Staheli, Director of Research | Published January 25th, 2018
Prescription drugs can be quite costly for those who are uninsured or underinsured. Prohibitive costs have been shown to lead to poor patient outcomes because medications are not taken as prescribed. Medicare has taken steps to address this problem with their Medicare Advantage value based plans (see referenced "Medicare Expands Value ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published January 25th, 2018
UCR (Usual, Customary, and Reasonable) pricing is a method of generating healthcare pricing based on the average pricing in a particular geographic location. Gathering information on pricing based on what other providers in that area is charging is commonly used for a fee or payment reference, as it gives a basis ...
By Ashley Choate | Published January 24th, 2018 - Last Review/Update March 29th, 2018
According to a recent Physicians Practice study, one of the top five reasons for denied medical claims is a lack of adequate documentation. While this might seem like an electronic records issue, the problem may be bigger than that. ...
Advance Beneficiary Notice of Noncoverage (ABN) Modifier Guidelines
January 11th, 2018
By Find-A-Code | Published January 11th, 2018
The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131 may be used for services which are likely to be non-covered, whether for medical necessity or for other reasons. Refer to CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30, for complete instructions.Effective from April 1, 2010, non-covered services should be billed with modifier GA, GX, GY, or GZ, as ...
By Marge McQuade, CMSCS, CHCI, CPOM | Published January 4th, 2018
Adequate documentation is an essential part of selecting a correct code in any setting. When providers order a test, the information that they document regarding the test results determines the primary and secondary diagnosis codes a coder assigns.
If a physician confirms a diagnosis based on the results of a diagnostic ...
By Kelly Ogle, BSDH, MIOP, CMPM, CHOP | Published December 29th, 2017 - Last Review/Update January 31st, 2018
In each practice, there are patients who present with a multitude of problems. These problems can range from the smallest of symptoms to the more complex illnesses.....
By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC | Published November 17th, 2017 - Last Review/Update January 31st, 2018
I want this story that I am about to share with you to fit with the majority of clients that I represent and work with because I have represented clients with refund demands as small as $1,000 and clients who had demands greater than $30 million. This year has been ...
Can an Unlicensed Person Perform Physical Therapy Services Such as 97110?
November 16th, 2017
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.
Avoid Deactivation of your Medicare Billing Privileges
October 18th, 2017
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published October 18th, 2017
According to the Affordable Care Act all Medicare providers are required to re-validate their enrollment information every three or five years. To determine if you are due for re-validation the list below will display a re-validation due date. If you have a due date of “TBD”, this means there has not ...
By Shannon Cameron, MBA, MHIIM, CPC | Published September 29th, 2017 - Last Review/Update January 31st, 2018
Big data and its use in the healthcare spectrum has proven to be an incredible source of the knowledge and has rapidly abetted progress in seemingly all areas of healthcare......
By Shannon DeConda, CPC, CPC-I, CEMC, CMSCS, CPMA, CEMA | Published September 15th, 2017 - Last Review/Update January 31st, 2018
Have you looked for published guidance on cloning/copying and pasting from the Centers for Medicare & Medicaid Services (CMS)? There is one published resource that provides rudimentary guidance.....
The Importance of Time, Timelines, and Timing with Your Commercial Lease – For Medical Professional Tenants
August 16th, 2017
By Jeff Grandfield and Dale Willerton – The Lease Coach | Published August 16th, 2017
Readers of our new book, Negotiating Commercial Leases & Renewals FOR DUMMIES, will learn (in part) that the leasing process can take differing amounts of time, depending on whether you’re opening your first or fifth location. You can discover a lot during your first few lease deals that you can ...
More than any other industry, healthcare is almost notorious for its lack of price transparency. While patients generally know how much their copay will be and certainly how much their final bill turns out to be, few hospitals and practices publish the actual costs of their services prior to those ...
One of the easiest things a practice can do to increase collections makes it easier for patients to pay by whatever method they have available at the time of the visit, says Christine Taxin Adjunct Professor at NYU Dental School and Owner of Links2Success.biz.
Negotiating Free Rent – For Medical Professional Tenants
June 15th, 2017
By Jeff Grandfield and Dale Willerton – The Lease Coach | Published June 15th, 2017
Free rent is just one negotiable factor in a commercial lease. To be clear, free rent is a period of time where you are not paying the Base or Minimum Rent (but are, typically, paying your Operating Costs) and you are open for business. Many medical professional tenants confuse this ...
Real Estate: The Second-Highest Expense in Your Practice
March 15th, 2017
By Carr Healthcare Realty | Published March 15th, 2017 - Last Review/Update February 8th, 2019
When it comes to managing expenses in your practice, there are dozens of categories to evaluate: equipment, technology, loan costs and interest rates, sundries, marketing, and on and on they go. Many practice owners are quick to shop-out what they believe are the most obvious expenses, but few understand the impact of one of the largest expenses and how it can be dramatically reduced to increase profitability.
By ChiroCode | Published February 16th, 2017 - Last Review/Update March 5th, 2019
Many providers are unsure of where their fee schedule actually came from or when it was last reviewed. As a component of compliance and for other preventive purposes, fee schedules should be evaluated once per year. Read more to help evaluate your fee schedules.
Code Sets - Health Care Provider Taxonomy Code Set Link
January 24th, 2017
By Raquel Shumway | Published January 24th, 2017
Every Provider needs to know their Health Care Provider Taxonomy Codes. The Taxonomy Codes define the provider type, classification, and area of specialization. We have provided a link and instructions to help you locate your code.
By ChiroCode | Published January 13th, 2017 - Last Review/Update January 31st, 2019
Whiplash Damages in Rear-end Collisions - The Patient’s Dilemma:
The rear-end collision is a major cause of cervical spine injuries which often require treatment by chiropractors and other health care practitioners. Claims adjusters trivialize soft tissue injuries [it’s “only” a sprain or strain] but whiplash is real and so are the damages that come with it.
By Wyn Staheli, Director of Research | Published December 19th, 2016
Benchmarking is simply a standard or point of reference against which things may be compared or assessed. For all businesses, it is a way of comparing your business processes to another business in the same industry to determine where shortfalls exist or improvements can be made to maintain profitability.
By Wyn Staheli, Director of Research | Published December 7th, 2016
All healthcare providers need to be aware that there are both appropriate and inappropriate ways to discount your fees. Both state and federal laws can impact your practice financial policy regarding fee discounts. Additionally, we recommend carefully reviewing either Chapter 1.5-Fees of the Behavioral Health DeskBook or the Insurance and Reimbursement chapter ...
Companies who regularly handle such sensitive information as patient medical records have a particular responsibility to maintain the confidentiality of the data. Failure to exercise the appropriate degree of care – whether intentional or not – can have a significant adverse financial impact on your firm.
The Federal Health Insurance Portability ...
By BC Advantage | Published November 29th, 2016 - Last Review/Update December 8th, 2016
E/M stands for "evaluation and management". E/M coding is the process by which provider-patient encounters are translated into five digit CPT codes to facilitate billing. CPT stands for "current procedural terminology." These are the numeric codes which are submitted to insurers for payment. Most billable procedures have their own CPT ...
By ChiroCode | Published October 25th, 2016 - Last Review/Update March 5th, 2019
On October 19 the Office of Inspector General for Health and Human Services (OIG) released another report on chiropractic. Oddly enough the Wall Street Journal had an article on that report published the day it was released (I wonder how that happened). Read hear to see the results.
By Wyn Staheli, Director of Research | Published September 17th, 2016
Consumer Directed Healthcare Plans (CDHP) were developed as a way to shift the control of healthcare dollars from the insurance companies to the patient (consumer). The goal of these types of plans is to allow the patient to take a more active role in their own health and healthcare decisions ...
By | Published July 28th, 2016 - Last Review/Update January 25th, 2017
Using Liens in PI Cases
When it comes to getting paid on PI cases, few documents and protocols are as important as those relating to a well drafted financial policy, along with a set of unalterable financial protocols (at least not easy to change). With these in place, you are ...
Commercial Lease Assignments for Chiropractic Tenants
June 23rd, 2016
By Jeff Grandfield and Dale Willerton | Published June 23rd, 2016
When The Lease Coach speaks at chiropractic conventions (such as Parker Seminars in Las Vegas), we are magnets for commercial leasing-related questions. Among the most common are concerns relating to assigning or transferring a Lease Agreement. As we explain in our new book, Negotiating Commercial Leases & Renewals For Dummies, ...
By Wyn Staheli, Director of Research | Published June 21st, 2016
When a claim has been determined to be paid more than the allowed amount, it is considered an overpayment. The action to be taken depends on how the overpayment is discovered. This article covers voluntary overpayment refund procedures as well as a Voluntary Overpayment Form.
Q&A: Will Using Lower Level Codes Reduce Our Chances of Being Audited?
June 16th, 2016
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?
Mastering Medicare: When Opting Out is not an Option
June 15th, 2016
By 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?
Understanding and Using Taxonomy Codes to Maximize Reimbursement
June 9th, 2016
By | Published June 9th, 2016
Taxonomy codes are used by insurers as indicators of legal scope of practice. Scope of practice is key to getting reimbursed under the Affordable Care Act or ObamaCare. However, Most providers will only choose one taxonomy code to describe their training. This limits their scope of practice. To maximize scope ...
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.
Have you had to send money back to a dental insurance company? You may have received a letter informing you that a patient received benefits but then turned out to be ineligible and now the insurance company wants their money back. Hopefully, you sent them a check for the amount ...
Certified Community Behavioral Health Clinics (CCBHC) Moving Forward
May 3rd, 2016
By Wyn Staheli, Director of Research | Published May 3rd, 2016
Certified Community Behavioral Health Clinics (CCBHCs) were created in an effort to improve access and outcomes behavioral healthcare by providing community-based mental and substance use disorder treatment through an integrative approach to care.
Provider/Patient Dynamic Changes as Result of High Deductible Plans
May 3rd, 2016
By Wyn Staheli, Director of Research | Published May 3rd, 2016
High-deductible plans are changing the way patients utilize medical services, therefore, providers must also adapt by adjusting both their communication and billing practices to keep pace with these changes.
An Important Rule that You're Probably Not Following
April 28th, 2016
By 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.
By Wyn Staheli, Director of Research | Published April 13th, 2016
Telehealth and telemedicine are covered for many payers for services such as consultation, office visits, individual psychotherapy, and pharmacologic management delivered via a telecommunications system.
By 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.
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.
Protected Health Information De-Identification Standards
March 16th, 2016
By 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.
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published March 7th, 2016
Medicare no longer wants providers to use ABN's for anyone other than CMS. Therefore, if contracted under commercial payers and 3rd party payers, you may need to contact the payer for a pre-service organization determination regarding coverage. This must be done before the provider can perform the service and bill the beneficiary ...
By Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published March 4th, 2016
It's difficult to know where to start when selecting the best software for your practice. With dozens of selections to choose from, making the right choice can be a daunting task. For new or established practices looking to implement or upgrade software into their practices, there are some general need-to-know ...
What are the Rules for Safeguarding Patient Records?
February 11th, 2016
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).
Will Incident-To in Your Organization Pass a Compliance Audit?
February 1st, 2016
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | 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.
When working my AR, I work my surgeries separately since that is my big money or bulk money. I want to make sure I get that money in as quickly as possible. For me, I created an excel spreadsheet. The columns are: DOS - PATIENT NAME/MRN...
Chiropractic Tenants – Choosing the Location Where Your Practice will Thrive
August 10th, 2015
By By Jeff Grandfield & Dale Willerton – The Lease Coach | Published August 10th, 2015
As we explain in our new book, Negotiating Commercial Leases & Renewals For Dummies (Wiley, 2013) and when we recently spoke at Parker Seminars in Las Vegas, finding the right location or property for your practice is one of the most important decisions you can make. It’s not always easy, ...
By ChiroCode | Published August 10th, 2015 - Last Review/Update January 27th, 2017
Refund demands from payers are not all alike; some could be justified. Recently a payer asked for a refund request from a ChiroCode subscriber. She said: "We sent the No Refund letter from ChiroCode. However, they ignored it and they still want a refund. What do I do next?"
Demands for a refund from ...
By ChiroCode | 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 ...
By ChiroCode | Published August 10th, 2015 - Last Review/Update January 27th, 2017
It is a common practice for a solo doctor to find someone to cover for them while they are away from the office for a temporary or extended period of time, such as medical leave, or vacation. Some offices fail to code properly for the services rendered by the “fill-in” doctor. When completing the CMS 1500 ...
Chiropractors - Negotiate a Mid-term Rent Reduction for Your Commercial Lease
August 3rd, 2015
By Jeff Grandfield and Dale Willerton - The Lease Coach | Published August 3rd, 2015
When The Lease Coach spoke at Parker Seminars in Las Vegas, we met a number of struggling chiropractors leasing commercial space. These chiropractic tenants desperately need a rent reduction ... right now.
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published July 20th, 2015
It's no secret that healthcare costs are on the rise. But what's worrisome is that patients' out-of-pocket costs are skyrocketing too.
The average patient's deductible has jumped 49 percent since 2009. This is not only burdensome to patients, but to medical practices as well because outstanding patient balances now make up ...
Reporting Requirements and Specifications for Indian Health Services (Rev. 1040, 09-11-06)
June 25th, 2015
By Jared Staheli | Published June 25th, 2015
In order to facilitate report generation and data collection regarding IHS physicians, practitioners and services, the designated carrier shall assign PINs to each IHS physician and practitioner in a manner that will allow the designated carrier to ascertain which facilities are IHS, Indian tribe or tribal organization. For example, the ...
Reporting the Ordering/Referring NPI on Claims for DMEPOS Items Dispensed Without a Physician’s Order (Rev. 1368, 04-07-08)
June 18th, 2015
By Jared Staheli | Published June 18th, 2015
Chapter 5, section 5.2.1 of the Medicare Program Integrity Manual (PIM) states that, in order for Medicare to make payment for an item of Durable Medical Equipment Prosthetic, and Orthotic Supplies (DMEPOS), the DMEPOS supplier must obtain a prescription from the
For Coordination of Benefit purposes, DMEPOS suppliers shall use the ...
Buying vs. Leasing Commercial Practice Space: Pros and Cons for Chiropractic Tenants
June 10th, 2015
By By: Jeff Grandfield and Dale Willerton – The Lease Coach | Published June 10th, 2015
As we explain in our new book, Negotiating Commercial Leases & Renewals For Dummies, the most common reason tenants lease space instead of buying a location is because 95 percent of all commercial and office space is for lease and not for sale.
If you are in an enviable position ...
Payer Relations: Be on Top of Your Payer Contract Negotiations With These 8 Pointers
May 11th, 2015
By Christine Taxin | Published May 11th, 2015 - Last Review/Update June 9th, 2016
Begin early to get everything in place right. You don’t have to maintain your contracts on a January-December calendar, but it is quite necessary to review your contracts and consider negotiations on a timely basis so that you don’t experience any losses. Your payers might ...
Patient Responsibility - What to collect at the front desk
May 11th, 2015
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published May 11th, 2015 - Last Review/Update June 9th, 2016
Co-pay versus co-insurance are easy to mix up and they are two entirely different forms of cost sharing. When you reach your deductible, you must pay a percentage of the remaining costs - this is the co-insurance amount.
Each health insurance plan establishes these fees up front - they are often printed on your ...
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 ...
Selecting the Best Location for Your Chiropractic Office
March 30th, 2015
By | Published March 30th, 2015 - Last Review/Update June 9th, 2016
By: Jeff Grandfield and Dale Willerton – The Lease Coach
When we do site selection for a chiropractor, we are not looking for the cheapest location we can find, but instead the location that will enable the doctor to maximize his or her patient volume. As we explain in our new ...
By | Published March 17th, 2015 - Last Review/Update June 9th, 2016
We have two different samples for Patient Information Forms. We suggest that you review both and determine which best fits your practice model. Form #2 is editable so it could be easily modified for your organization. Both forms provide the basic information necessary for all types of healthcare practices.
Instructions for: Patient ...
5 Key Steps to Hiring Great Staff and the New Science for Reducing Your Risk
February 5th, 2015
By | Published February 5th, 2015
5 Key Steps to Hiring Great Staff and the New Science for Reducing Your Risk
Presented by Jeff Henderson
Learn...
-The 7 common pitfalls of hiring
-The primary reason for 80% of turnover
-How to identify your best candidate—every time.
-How Nobel-nominated science can help uncover the
the attitudes, work-ethic and hidden risks of candidates
so you can stop guessing...and hire with confidence.
By Wyn Staheli | Published February 4th, 2015 - Last Review/Update June 9th, 2016
Sometimes called "disposable," "temporary," or "one-time use" numbers, a virtual credit card number is "like putting a wall" between your transaction and your regular account, says Steve Kenneally, vice president of the American Bankers Association. Although these cards can protect the cardholder from fraud, the use of virtual cards as ...
By | 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 ...
By | Published January 30th, 2015 - Last Review/Update June 9th, 2016
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 ...
By Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | 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 ...
By Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published January 9th, 2015 - Last Review/Update June 13th, 2016
Did you know that inconsistent and un-reviewed fee schedules can lead to some of the following occurrences:
• Prompt an audit or some level of claims review
• Cause claims delays
• Increase provider liability in case of an audit or investigation
• Potentially lead to being paid less than the actual value of ...
By ChiroCode | Published January 8th, 2015 - Last Review/Update January 30th, 2017
All healthcare providers need to be aware that there are both appropriate and inappropriate ways to discount your fees. Both state and federal laws can impact your practice financial policy regarding fee discounts. Additionally, we recommend carefully reviewing Section F-Fees of the ChiroCode DeskBook for important information on fee schedules and ...
Chiropractors - Negotiate Your Commercial Lease “For Dummies”
January 8th, 2015
By | Published January 8th, 2015 - Last Review/Update March 9th, 2016
By: Dale Willerton – The Lease Coach
For many chiropractors, negotiating a good lease or lease renewal against an experienced agent or landlord can be a challenge. While a chiropractor focuses on patient care, savvy real estate agents and brokers are specialized sales people. Their job is to sell chiropractic tenants ...
Conducting a Gap Analysis for Your Documentation & Billing Systems
November 24th, 2014
By | Published November 24th, 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 ...
By Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | 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 contains information about each zone as well as activity and updates in those regions.Â
ZPIC
Zone
States in Zone
Safeguard Services (SGS)
1
California, Hawaii, Nevada, American Samoa, Guam, Mariana Islands
Health Integrity
(subcontractor ...
Social Media and Healthcare: Unprofessional Conduct and What It Can Cost
November 17th, 2014
By Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | 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 ...
By | Published October 29th, 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, here are some common helpful tips that you might follow in order to best manage your workload ahead.
-Evaluate fees: Fee schedules ...
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 ...
By Christine Taxin | Published October 20th, 2014 - Last Review/Update January 27th, 2017
Are PPOs are affecting the value of your practice?
Did you know that taking a 20% PPO write-off on a $200 procedure with a 60% overhead cuts practice profits in half?
By participating in PPO plans, you agree to take a certain discount on fees; however, your fixed overhead costs remain the same ...
By Christine Taxin | Published October 20th, 2014 - Last Review/Update January 27th, 2017
Least Expensive Alternative Treatment Clause
What your patients do not know!
When alternate benefit or LEAT provisions are applied, they are not meant to dictate treatment, question professional judgment or interfere with doctor-patient relationships. The ultimate decision on treatment is up to the dentist and patient. The LEAT provision actually funds a ...
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 ...
By | Published October 15th, 2014 - Last Review/Update January 30th, 2017
In February, 2014, CMS announced the "pausing" of the RAC (Recovery Audit Contractors) program to allow current RAC contractors to complete remaining claim audits and related duties before CMS begins the process of reviewing RAC program contracts as well as allowing time for CMS to make improvements in the RAC program itself. ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published October 9th, 2014 - Last Review/Update January 23rd, 2017
Medicare has set annual therapy caps at $1920 and they start over Jan. 1 of each year. Medicare combined the therapy limits SLP (Speech-Language Pathology) and PT (Physical Therapy) for a combined total of $1920.00 in 2014. There is also a therapy cap limit for OT (Occupational Therapy) Services of $1920. ...
New and Modified Provider Taxonomy Codes for Oct 1st, 2014
October 9th, 2014
By | Published October 9th, 2014 - Last Review/Update January 30th, 2017
New codes added 7/1/2014, effective 10/1/2014
175T00000X
Under the Other Service Providers Type the Peer Specialist was added:Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.Source: National Uniform Claim Committee
246ZX2200X
Under the ...
To Participate or Not to Participate, That is The Question.
October 9th, 2014
By Christine Taxin | Published October 9th, 2014 - Last Review/Update January 27th, 2017
Insurance! Can it be profitable or a big loser?
Participating with insurance can initially bring down your revenue as you cut your fees per procedure. It is important to remember that your overhead will not decrease along with the fees. The question is can you make up the revenue by increasing ...
OSHA - Hazard Communication Standard Final Rule (Globally Harmonized System)
October 6th, 2014
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 ...
By | Published September 30th, 2014 - Last Review/Update January 30th, 2017
It is a common practice for a solo doctor to find someone to cover for them while they are away from the office for a temporary or extended period of time, such as medical leave, or vacation. Some offices fail to code properly for the services rendered by the “fill-in” ...
By Chris Woolstenhulme, QCC, CMCS, 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 ...
Virtual Credit Cards -A new trend in trying to keep up with E-Health
September 25th, 2014
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published September 25th, 2014 - Last Review/Update January 30th, 2017
Beware of the changes sneaking in as “money streams” in the name of EFT standards. Virtual Credit Cards are being used in provider’s offices as payments from payers; clearinghouses are starting to offer this service as well.
Effective January 1, 2014, health plans were required to offer electronic funds transfer (EFT). ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published September 18th, 2014 - Last Review/Update January 30th, 2017
How many code sets are there?
Find-A-Code Content
Did you know?
Along with the ever so popular code sets we are so familiar with and use every day such as:
ICD-9, ICD-10, DRG’s, CPT, HCPCS, ICD-9 Vol. 3, CDT, ICD-10 PCS, APC and NDC codes,
Find-A-Code has lists of many other code sets (To access ...
According to HIPAA, who are my Business Associates?
September 11th, 2014
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? ...
Cyber Insurance? What kind of Insurance Policy it that?
September 9th, 2014
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published September 9th, 2014 - Last Review/Update January 30th, 2017
Due to the increase of medical transactions stored online and in the cloud, cyber intrusions will only increase.
Cyber insurance also known as privacy and network security insurance can help cover the costs incurred if your computer system is compromised, or after a data breach which can include a HIPAA ...
By | Published August 28th, 2014 - Last Review/Update January 30th, 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 ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published August 26th, 2014 - Last Review/Update January 25th, 2017
Be sure you have office procedures in place to keep an eye on the time frame of your claims: Claims denied by Medicare for “untimely submission” are not eligible for appeal. In fact most carriers do not afford you an appeal if timely filing is an issue; there are only ...
By David Berky | Published August 14th, 2014 - Last Review/Update January 25th, 2017
The Center for Medicare and Medicaid Services (CMS) has approved the final version for the new ICD-10-CM and ICD-10 PCS. Until coders and billers convert to this new ICD-10-CM coding system on October 1st, 2014 (now 2015), they will continue to use the ICD-9-CM codes and CPT/HCPCS codes. However, CMS is recommending that professionals start this new training and become well versed with these two new ICD-10 code sets.
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published August 12th, 2014 - Last Review/Update January 23rd, 2017
Information related to Medicare's E-Health programs can be viewed here. (Click Here) E-Health includes: E-Prescribing Electronic Health Records Personal Health Records EHR Incentive Programs  eRx Electronic Prescribing Incentive Program (Click Here) The eRx Incentive Program Ended in 2013, but Electronic Prescribing Continues with Meaningful Use. ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published August 12th, 2014 - Last Review/Update January 25th, 2017
I like to call this a FREE clinic visit; it is a pet peeve of mine to see an office lose money due to timely filing. There is no reason for this type of loss; however it is more and more common. First of all Insurance companies are shortening the time ...
Durable Medical Equipment, Prosthetics, Orthotics and Supplies
August 7th, 2014
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published August 7th, 2014 - Last Review/Update January 25th, 2017
Reimbursement for most Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) is established by fee schedules. Payment is limited to the lower of the actual charge or the fee schedule amount.  We have given you some basic information to get you started including modifiers and how CMS views DMEPOS, please ...
By Wyn Staheli, Director of Research | Published August 4th, 2014 - Last Review/Update March 5th, 2019
The following frequently asked questions (FAQs) are adapted from the American Pyschiatric Association (APA). It is relevant to all types of providers with questions about managed care.
Q: I am having a problem getting in the network of managed care company X. They have a contract with a major employer in the ...
CMS has announced a new Provider Relations Coordinator
July 31st, 2014
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published July 31st, 2014 - Last Review/Update January 25th, 2017
07/08/2014 CMS has announced a new Provider Relations Coordinator, Latesha Walker. Latesha is your point of contact for RAC audits. Medicare will do no additional RAC reviews under the current contract; they are making changes to improve the current program. The final date Auditors sent claim adjustment files to Medicare ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published July 31st, 2014 - Last Review/Update January 25th, 2017
It is apparent as the healthcare changes so does Managed Care contracts. You need to be more aware, they are more complex than ever and can be confusing, take heed as you enter into a new contract as a participating provider. Below are just a few issues to be sensitive ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published July 31st, 2014 - Last Review/Update January 25th, 2017
We all know how time consuming and costly COB (Coordination of Benefits) can be to a practice.  February 2014, CAQH launched a new plan called COB Smart Registry. This will help expand the communication between health care plans and providers. Joining with some Major Health Plans CAQH has come up ...
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published July 31st, 2014 - Last Review/Update January 25th, 2017
It is a common practice for a solo doctor to find someone to cover for them while they are away from the office for a temporary or extended period of time, such as medical leave, or vacation. Some offices fail to code properly for the services rendered by the “fill-in” ...
By Wyn Staheli, Director of Research | Published July 16th, 2014 - Last Review/Update January 25th, 2017
For anyone who is not a computer techie, the announcement by Microsoft about discontinuing support for Windows XP may not mean much. However, from a HIPAA perspective, this is very important information because Section 164.308(a)(5)(ii)(B) of the HIPAA Security Rules includes an 'addressable' requirement of Protection from Malicious Software where ...
How the Internet is Reshaping Medical Coding and Billing
July 15th, 2014
By David Berky | Published July 15th, 2014 - Last Review/Update January 25th, 2017
Since the Internet is affecting (usually for better) every industry, why should it come as a surprise that medical coding and billing is now heavily dependent on the Internet? Actually, a number of important challenges and changes in the healthcare industry, and in technology as a whole, are pushing medical ...
Errors and Ommissions Insurance for a Billing Company
July 14th, 2014
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published July 14th, 2014 - Last Review/Update January 25th, 2017
I've owned a billing company for the past 20 years. It has been a great journey: 20 years ago it was called a Home-Based Business, today it is called a Corporation (for protection and liability reasons). Medical billing has been considered low risk... until now. With HIPAA, E&O and ...
How can I make sure new hires have not been in trouble with Medicare?
March 18th, 2014
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..
Read More
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 ...
By | Published February 12th, 2014 - Last Review/Update January 27th, 2017
The following information is from the Centers for Medicare & Medicaid Services (CMS) regarding the Electronic Health Records (EHR) payment reduction hardship exemption.
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 ...
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