Supplies and DME (Durable Medical)

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Does the Pro Fee Calculator Include UCR Fees?

by  Wyn Staheli, Director of Content - innoviHealth

Find-A-Code’s Pro Fee Calculator is an easy-to-use tool for calculating fees for CPT and HCPCS codes. Need to apply modifiers or additional units? The Pro Fee calculator can do this and much more. Check it out.

Reporting Evaluation & Management (E/M) Services with Wellness or Preventive Medicine Service Encounters

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

Preventive medicine services, initial preventive physical examinations (IPPE), and the annual wellness exam consist of many required performance and documentation criteria to ensure ample patient history is obtained and charted in an effort to reduce the risk of disease and disease progression. Although not planned, these encounters often include a problem-oriented visit as well, requiring the coder to know how to separate out the preventive service from the problem-oriented encounter for coding and billing.

Reporting Drug Wastage with Modifier JW and NEW Modifier JZ

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

Modifier JW has been around since 2003 with changes in Medicare policies to ensure standard utilization in 2017; however, because of a continued lack of reporting consistency, Medicare has created and implemented policy related to reporting a new modifier, JZ. How does this impact Medicare reimbursement and why is this modifier so important?

CMS Announces Changes to DME Program

by  Wyn Staheli, Director of Content - innoviHealth

CMS recently announced that there have been some changes made to the DMEPOS program. The Medicare Learning Network (MLN) “DMEPOS Quality Standards” lists several changes to the program. Read more about understanding these changes.

Three Things To Know When Reporting Prolonged Services in 2023

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

The Evaluation and Management (E/M) changes made in 2021 and again in 2023 brought about new CPT codes and guidelines for reporting prolonged services. Just as Medicare disagreed with CPT in the manner in which prolonged service times should be calculated, they did so again with the new 2023 changes. Here are three things you should know when reporting prolonged services for all E/M services.

Compliance Billing: Power Mobility Devices

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

In May of 2022, the OIG conducted a nationwide audit of Power Mobility Device (PMD) repairs for Medicare beneficiaries. The findings were not favorable; the audit revealed CMS paid 20% of durable medical suppliers incorrectly during the audit period of October 01, 2018- September 30, 2019. This was a total of $8 million in device repairs out of $40 million paid by CMS. We gathered information in this article to assist providers and suppliers in keeping the payments received, protecting beneficiaries, and assisting you in ensuring compliance.

2022-11-23-MLNC - Weekly Edition

Colorectal Cancer Screening Test: Reduced Coinsurance for Related Procedures Begins January 1 - - Ambulance Fee Schedule: CY 2023 Inflation Factor & Productivity Adjustment - - Medicare Ground Ambulance Data Collection System: Information to Help You Report - -...

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.

Medicare Updates -- SNF, Neurostimulators, Ambulance Fee Schedule and more (2022-10-20)

by  CMS - MLNConnects

Skilled Nursing Facility Provider Preview Reports: Review by November 14 - Help Your Patients Make Informed Health Care Decisions - Ambulance Fee Schedule: CY 2023 Ambulance Inflation Factor & Productivity Adjustment - Compliance - Implanted Spinal Neurostimulators: Document Medical Records - Claims, Pricers, & Codes...

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.

Billing for Incontinence and Urinary Products

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

We all understand anything covered under health insurance must be medically necessary. In other words, it must be essential in treating and managing a patient's condition or to evaluate, diagnose, or treat an illness, injury, disease, or its symptoms. In this article, we will address catheters, urological supplies, and disposable ...

Emergency Department - APC Reimbursement Method

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

CMS pays emergency department visits through a payment method using Ambulatory Payment Classifications (APCs). Most payers also use the APC reimbursement system; however, there may be some differences in payer policies (always review your specific payer policy). APCs are the primary type of payment made under the OPPS, comprising groupings ...

Are You Prepared to Avoid Repayments

by  Raquel Shumway

Watchful care is needed when submitting claims. The Office of the Inspector General (OIG), after completing an audit on a Medicare Advantage Plan in August 2022, is now demanding repayment of claims to the tune of $3,518,465. Although the payer is contesting that amount, it is possible that they may begin demanding repayments from the providers to cover their costs of repayment.

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?

CMS says Less Paperwork for DME Suppliers after Jan 2023!

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

This is important news for durable medical suppliers! Effective January 1, 2023, CMS is discontinuing the use of Certificates of Medical Necessity (CMNs) and DME information forms (DIFs). We knew this was coming as the MLN sent out an article on May 23, 2022, but it is time to make sure your staff knows about these changes.

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.

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.

Accurate Coding Is The Key To Your Job - Here's Why

by  Find-A-Code™

Medical billing codes dominate your day. They are the raw ingredients you use to do your job. But they are more than just numbers on an electronic form. They are also the life blood of the healthcare industry's billing capabilities.

There are 857 related documentation, coding and billing tips.

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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.

Modalities Used in Your Chiropractic Office 

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

Electrical stimulation, ultrasound, and mechanical traction are modalities commonly used in chiropractic offices. And they are commonly documented incorrectly or billed improperly. Learn the right (and wrong) ways to get paid for these kinds of services. Join Dr. Evan Gwilliam, certified coder, and all-around nice guy, as he answers your most burning questions about the CPT codes 97012, 97014/G0283, 97032, and 97035.

Use the Right Modifiers for Chiropractic Billing 

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

Do you really know when to use the 59 modifier? What about the AT? There are relatively few modifiers to consider when it comes to chiropractic billing and coding, but some payers have their own rules and it can be tricky to know when to use one modifier and not another. In this exciting webinar, Dr. Evan Gwilliam, a certified coder, will clear up all the questions you have about the modifiers you need to consider.

Dealing with the Little Coding Conundrums 

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

Coding and Auditing TeleHealth Services 

by  Find-A-Code™

Do you report or audit Telemedicine services now or are you considering offering them? Come and learn more about the rules and guidelines surrounding Telehealth services including, documentation requirements, eligible CPT and HCPCS Level II codes, modifiers, and the newest updates to Medicare Telehealth policies.

Proper Coding and Billing for Drugs, Biologicals and Injections 

by  Find-A-Code™

Proper Coding and Billing for Drugs, Biologicals and Injections

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