Magazine BC Advantage - ICD-10, Webinars, CEUs, articles, Auditing, AAPC, AHIMA

Coding

ICD-10-CM Coding of Chronic Obstructive Pulmonary Disease (COPD):Chronic Obstructive Pulmonary Disease (COPD) is a progressive and persistent inflammatory lung disease resulting in limited airflow. Primary causes of COPD are long-term exposure to irritating gases or particulate matter, most commonly from cigarette smoke. There are multiple factors that can contribute to the development of COPD, such as:

Coding

Demystifying EKG and Telemetry for the Non-Clinician:Electrocardiograms (EKG or ECG) and telemetry are indispensable tools in the field of cardiac health. They have revolutionized how healthcare professionals diagnose and monitor various heart conditions, from arrhythmias to heart attacks. EKGs record the heart's electrical activity, while telemetry involves wireless data transmission from a patient's heart to a healthcare provider.

Auditing

HHS Modifies Rule for Confidentiality of Substance Use Disorder Records - HHS Issues Final Rule:On February 8, 2024, the Department of Health and Human Services (HHS) announced that it had approved the modification of rules regarding the confidentiality of patient Substance Use Disorder (SUD) records. After careful consideration of public comments, the HHS determined that approval of the Final Rule would improve coordination of care, and, ultimately, the quality of patient care.

American Business Systems Celebrates 30 Years of Empowering Entrepreneurs in the Medical Billing Industry:American Business Systems (ABS), a medical billing industry leader specializing in helping aspiring entrepreneurs establish their own independent medical billing businesses, proudly marks its 30th anniversary.

Coding

Navigating Healthcare Claims and Audits for Purchased Diagnostic Testing:Navigating Healthcare Claims and Audits for Purchased Diagnostic Testing: In the complex world of healthcare, accurate reporting of services is crucial for ensuring quality patient care and fair compensation for medical providers. One significant aspect of this process involves purchased diagnostic testing, where medical tests are conducted outside the healthcare organization. In this tip, we'll delve into the essentials of healthcare claim reporting and the auditing process related to purchased diagnostic testing.

Coding

Fathom Announces Partnership with Google Cloud, Adding its Autonomous Medical Coding Solution to Google Cloud Marketplace :This collaboration will boost access and integration with best-in-class autonomous medical coding for healthcare providers.

Practice Management

Unlocking Revenue Potential: How Data Analytics Powers Smarter Revenue Cycle Management:In today's ever-evolving healthcare landscape, the pursuit of unlocking the full revenue potential of healthcare organizations stands as a paramount objective. With healthcare costs rising and the intricacies of medical billing becoming increasingly complex, the need for precision and insight in managing revenue has never been more critical. Data analytics has the transformative power in revenue cycle management to shed light on the strategies, tools, and real-world successes that can guide healthcare providers toward financial clarity and success.

Coding

Should I Report the Symptom or Confirmed Diagnoses for Testing?:Coders frequently ask questions about the guidelines surrounding coding symptoms vs. confirmed diagnoses, especially when tests are ordered during an encounter to rule out a condition, illness, or disease.

Coding

Optimizing HCC Coding for Accurate Reimbursement:Hierarchical Condition Category (HCC) codes are an integral aspect of healthcare’s ongoing transition from fee-for-service to a value-based care model of reimbursement—a transition that requires providers to better manage patient costs based on a clear, concise, and comprehensive picture of patients’ health and medical conditions.

Practice Management

Tomorrow's Doctors: Evolving Trends in Healthcare Specialty Training:If you're in healthcare or aspiring to be, specialty training is where the rubber meets the road. It's the bridge from general medical knowledge to honed expertise in a particular field. You've probably caught wind of how specialty training in healthcare is not what it used to be. New tech, evolving patient needs, and a myriad of other factors are reshaping the landscape. As healthcare evolves with technology and societal needs, specialty training is undergoing a metamorphosis, aiming to create professionals who are adept at both traditional and modern healthcare practices.

Coding

Understanding CPT Code Range 92920-93793 in Cardiology Billing :The realm of cardiology encompasses a vast array of specialized services and procedures, demanding precise documentation and accurate coding for proper reimbursement. Understanding the specific CPT codes within the range of 92920-93793 is crucial for healthcare providers navigating this complex landscape. This article serves as a detailed guide, unpacking the details of this CPT code range 92920-93793 and its applications within cardiology billing.

Coding

Missing HCC Codes Leave Money on the Table:Improper clinical documentation of one patient can mean a difference of more than $10,000 in yearly estimated healthcare costs. How much money are you potentially leaving on the table?

Coding

Big Changes Will Streamline CPT Coding for Immunization :Significant changes in the Current Procedural Terminology (CPT ® ) code set for immunizations reflect the changing nature of how COVID-19 is being addressed as actions transition from a public health emergency response to combatting emerging variants much like the flu.

Billing

Basics of Billing for New Patient Visits in 2024:New patient visits can be bustling hubs of activity, but ensuring flawless billing for new patient visits shouldn't add to the chaos. This article equips primary care providers with the latest knowledge and technical expertise to navigate the process seamlessly, maximizing new patient visit billing accuracy and minimizing compliance risks.

Coding

The Impact and Challenges of Sequencing Z Codes for Reimbursement :Every year, we get updates to the Official Guidelines for Coding and Reporting, and this year, for reporting year 2024, we received an update regarding Chapter 21 for follow-up codes Z08 and Z09. The accurate sequencing of these Z codes was emphasized in the guideline update by reminding us that they can be used for both medical and surgical treatment.

Coding

Updated ICD-10-CM Codes for Appendicitis :According to JAMA, there are approximately 250,000 cases of appendicitis diagnosed annually in the United States. Appendicitis can quickly spiral out of control when a perforation of the appendix occurs, and a patient becomes septic. Understanding the language used in medical documentation helps with the proper assignment of ICD-10-CM codes and supports testing and treatment.

Review

CPT® E/M Coding Tool:

Practice Management

Medical Practice Relocation Tips for Moving to a New Location:Roughly 40 million Americans relocate each year. In 2022 alone, the U.S. Postal Service processed over 33 million change-of-address forms. However, people aren't the only ones capable of moving – businesses can, too. If you are a healthcare provider in private practice that has decided to relocate your medical practice, the process will involve a lot more than a change-of-address form!

Coding

Update on Policy for Using Modifiers JW and JZ:JW has been a requirement since 2017; however, Medicare is using the JW modifier and JZ modifier to calculate discarded drug refunds, effective January 1, 2023.

Coding

Capturing HCCs in a Changing World:On March 31, 2023, the Centers for Medicare and Medicaid Services (CMS) released the CY 2024 Medicare Advantage (MA) Capitation Rates along with Part C and Part D payment policies. The largest key decision in the release was the finalized proposal to revise the Medicare Advantage Risk Adjustment model.

Practice Management

Decoding the Maze: Navigating Prior Authorization in Healthcare (Part 1):Picture this: You're at a hospital, and amidst the stress of an upcoming procedure, you're swamped with paperwork and concerns about the treatment's financial aspect. This scenario is all too common, and at its core often lies the concept of prior authorization.

Coding

Aetna Reimbursement Policy: Radiology Modifiers:According to provider October updates: Aetna will reduce the reimbursement rate for HCPCS radiology codes when modifiers FX and FY are appended.

Coding

Reviewing the Guidelines for Reporting ICD-10-CM Aftercare Codes:Aftercare codes are assigned to explain encounters where the initial treatment of a disease has been completed and the patient encounter is now focused on aftercare for healing and recovery. These codes may also be reported to explain long-term consequences of the disease.

Coding

COVID Vaccine Coding Changes as of November 1, 2023:Correctly coding the administration of COVID-19 vaccines had become such a huge burden for providers.

Auditing

AI Auditing: Walking Backward Toward Home:Way back in 1976, as an elementary school kid in the suburbs of Philadelphia, I came across a book in the library called 2010: Living in the Future. In my then-current world of AMC Pacers and seersucker suits, the book promised great things.

Practice Management

Choosing the Right Deductible:Often and easily forgotten is that the producer's role extends beyond simply selling insurance policies. Top shelf producers are trusted advisors not only to their clients, but carrier partners, as well. This article will focus on serving the employer. In this capacity, the producer may act as an extension of the employer's HR, finance, and executive departments. This may include advising on industry trends, policy updates, and emerging healthcare issues.

Coding

Truly Autonomous Coding Requires a Multifaceted Solution:Coding technology has come a long way since the days when Computer-Assisted Coding (CAC) was a bleeding edge feature of the more advanced encoder solutions. Today's CAC solutions are often integrated with Clinical Documentation Integrity (CDI) tools and have automated much of the coding process.

Practice Management

Decoding the Maze: Navigating Prior Authorization in Healthcare:Picture this: You're at a hospital, and amidst the stress of an upcoming procedure, you're swamped with paperwork and concerns about the treatment's financial aspect.

Introduction to Telebehavioral Health:Delivering mental health services via telehealth has increased since the COVID-19 pandemic. Both federal and state rules are constantly evolving along with the use of Artificial Intelligence (AI), creating a complex environment for compliance considerations. This article is not intended as legal or consulting advice.

Practice Management

2024 Guide: 13 Steps of Revenue Cycle Management:In the ever-evolving world of healthcare, revenue cycle management (RCM) plays a crucial role in the success of any medical practice. Efficient RCM ensures timely and accurate payment for services rendered, which can significantly impact the financial health of a practice.

Coding

The 2024 ICD-10-CM Updates Include New Codes for Reporting Metabolic Disorders and Insulin Resistance:The ICD-10-CM annual updates scheduled for implementation on October 1, 2023, include 395 new codes, 25 deleted codes, and a total of 13 revised codes. Among the newly added codes are codes that better define metabolic disorders, such as metabolic syndrome, also known as insulin resistance syndrome, dysmetabolic syndrome, hypertriglyceridemic waist, obesity syndrome, and Syndrome X.

Coding

Understanding Gastroesophageal Reflux Disease and ICD-10-CM Coding:GERD stands for Gastroesophageal Reflux Disease, a chronic condition where stomach acid flows back into the esophagus, causing a range of symptoms, such as heartburn, regurgitation, chest pain, difficulty swallowing, and a chronic cough.

Practice Management

HHS Selects the First Drugs for Medicare Drug Price Negotiation:For the first time, Medicare will be able to negotiate prices directly with drug companies, lowering prices on some of the costliest prescription drugs.

Coding

ICD-10 & Other Coding Revisions to National Coverage Determinations: October 2023 Update:CR 13166 is a maintenance update of ICD-10 conversions and other coding updates specific to NCDs.

Billing

Tips for Maximizing Your Medical Group's Revenue Through Outsourced Billing and Coding:Managing billing and coding processes can be intricate and challenging for medical groups. It requires specialized knowledge, constant attention to regulation changes, and plenty of time. Outsourcing these processes can offer numerous advantages, including maximizing revenue.

Practice Management

The Role of Artificial Intelligence in Revolutionizing Medical Billing Services for Physicians:In today's rapidly advancing healthcare landscape, medical billing has become a critical aspect of running a successful medical practice. Efficient and accurate billing processes are essential for healthcare providers to receive timely payments for their services. With the advent of artificial intelligence (AI) technology, medical billing services have undergone a revolutionary transformation. This article explores the role of artificial intelligence in revolutionizing medical billing services for physicians, highlighting the benefits and advancements brought about by this innovative technology.

Billing

The Hidden Costs of Using an Ineffective Payment Processing System:At any given time, over a billion payments are being processed online, and this includes healthcare services. That's because patients today want the ease and speed of transactions that traditional methods simply don't offer. Plus, healthcare practices have extra peace of mind knowing that modern technology gives them security protections to keep their patients' data safe. This is where a payment processing system comes in.

Practice Management

Navigating Carrier Guidelines for Optimal Practice Reimbursement:When a Medicare patient has multiple sources of insurance coverage, Medicare will only pay for services after the primary payor has processed the claim and made their payment. Medical office staff must always verify the patient's insurance coverage thoroughly-gathering all necessary information from the primary insurance, such as policy numbers, claim submission instructions, and any preauthorization requirements, etc.

Coding

E/M Scoring Questions:Evaluation and Management visits are often the "bread and butter" of an organization. Thus, correctly scoring encounters is essential to ensuring proper reimbursement. The element of "Risk" is only one of the three elements of Medical Decision Making (MDM) but understanding what is meant by all the definitions within each element is critical.

Practice Management

The Evolution of MIPS and Understanding the Upcoming Changes:In the world of healthcare, the Merit-Based Incentive Payment System (MIPS) plays an instrumental role in incentivizing providers to deliver high-quality, efficient patient care. However, staying up to date with MIPS can be a challenge as the program is subject to continuous changes and updates.

Coding

Medical Necessity and Data Under the E/M Documentation Guidelines:Whenever I audit charts under the 2021 E/M Documentation Guidelines, which now apply in all places of service, I like to start by reviewing the first and third columns. The first column is Number and Complexity of the Presenting Problem, and the third column is Risk of Complications and/or Morbidity or Mortality of Patient Management.

Coding

Coding Critical Care Services in 2023:Critical care services refer to the delivery of medical care to the critically ill or injured patient by a qualified physician or other qualified healthcare professional (QHP). Current Procedural Terminology (CPT) defines a critical illness or injury as one that "acutely impairs one or more vital organ systems such that there is a high probability of imminent or life-threatening deterioration in the patient's condition."

Billing

The Impact of Insurance Reimbursement on Radiation Oncology Practices:The healthcare landscape is intricate and continuously evolving, and nowhere is this more evident than in radiation oncology.

Practice Management

Seven Reasons to Standardize Medical Records:The electronic health record (EHR) is widely used for documenting and managing the patient's medical record. In the 1980s, the first web-based EHRs were being introduced and used in healthcare facilities because computer hardware had finally become affordable.

Security

Claim.MD Achieves TX-RAMP Level 2 Certification:Claim.MD, a leading electronic data interchange (EDI) clearinghouse helping to streamline the billing and collection process for providers, payers and software vendors, today announced that it has achieved TX-RAMP Level 2 certification, demonstrating its unwavering commitment to security and compliance. This certification further strengthens Claim.MD's position as a trusted partner in the healthcare industry.

Auditing

As CMS Focuses on Quality, There Are Monumental Changes to Reimbursement for Quality on the Horizon!:The Centers for Medicare and Medicaid Services (CMS) utilizes risk adjustment factors to estimate the cost of Medicare Advantage (MA) beneficiaries and those associated costs of providing care. Risk adjustment factor scores govern the amount paid by the health plan during the year for the beneficiary's care.

Coding

PSQIA, PSWP, and HIPAA Compliance:This article addresses patient confidentiality and security related to patient safety evaluation systems, investigations, root cause analyses, and compliance to rules and regulations. It is a basic introduction to help understand the importance of appropriately managing this type of privileged information.

Coding

ICD-10 Codes to Report Cataracts:Cataracts, a leading cause of vision loss in the United States, occur when the normally clear lens of the eye becomes clouded. This clouding obstructs or alters the passage of light into the eye, resulting in impaired vision. Ophthalmic surgeons perform safe and effective surgery to treat cataracts. Professional medical billing and coding companies can assist physicians with coding and claims submission tasks.

Coding

Understanding Skin Biopsy CPT Codes: A Comprehensive Guide:Skin biopsy plays a crucial role in the diagnosis and management of various dermatological conditions. To accurately report and bill for these procedures, healthcare providers rely on Current Procedural Terminology (CPT) codes. CPT codes are standardized numerical codes used to describe medical procedures and services. In this article, we will delve into the world of skin biopsy CPT codes. Understanding these codes can help family physicians code and bill skin biopsy procedures correctly, ensuring optimal reimbursement and proper documentation.

Practice Management

Harness the Power of Patient Reviews to Elevate Your Practice:When was the last time you made a purchase without looking at product and service reviews? Amazon, Facebook, Google, Netflix, Uber, Travelocity - powerhouse, world-changing organizations all built upon the culture and value of reviews. Healthcare is not immune to the review culture; with our consumerized patient, positive public sentiment is liquid gold and one of your most valuable assets! In fact, 86% of top performing healthcare providers are asking for reviews and feedback after every patient encounter.

Coding

The Transition to ICD-11: A Major Step Forward for Global Health:During the late 1800s, a physician from France named Jacques Bertillon was developing a method to create a consistent way of categorizing diseases. His goal was to simplify the process of monitoring and comparing mortality rates across various nations. In 1893, he released the inaugural version of the International Statistical Classification of Diseases, which is currently recognized as the International Classification of Diseases - ICD.

Coding

Overcoding: Putting a Strategic Stop to a Silent Revenue Killer:Overcoding is in the crosshairs as the Centers for Medicare and Medicaid Services (CMS) continues its quest to ferret out fraud and abuse and recoup improper reimbursements-a focus that returns $8 for every $1 spent on audits. There are no signs that they are letting up any time in the future, as the federal government has increased funding for audits and fraud investigations.

Coding

Identifying the Admitting, Principal, Primary, and Secondary Diagnoses:Knowing how to differentiate the admitting, principal, primary, and secondary diagnoses for reporting and sequencing purposes can be intimidating and confusing. The following are some commonly asked questions related to reporting diagnoses in the facility setting.

Billing

Everything You Need to Know About HIPAA Rules for Medical Billing:Medical billing companies must access protected health information (PHI) to perform their duties, making them HIPAA business associates. As this is the case, medical billing companies must be HIPAA compliant. So, what are HIPAA rules for medical billing?

Practice Management

Transforming Rural Healthcare Delivery: The Mission and Vision of the Office of Rural Health:For many rural communities, accessing quality healthcare remains a challenge. Geographic isolation, insufficient medical facilities, and a lack of specialized care providers can create significant barriers to adequate care. Recognizing these issues, the Office of Rural Health was established with the goal of improving healthcare in rural areas. This article will explore the mission and vision of the Office of Rural Health and discuss how its initiatives are transforming rural healthcare delivery.

Coding

Combination Codes Provide Greater Detail for Complicated Conditions:When ICD-10-CM was initially implemented, it was like watching the Discovery Channel, where new codes and guidelines seemed to appear, along with new guidelines for how to report them.

Coding

Identifying the Components of a High-Risk Evaluation and Management Service:Since 2021, when the Office and Other Outpatient Evaluation and Management (E/M) services coding guidelines changed to require only scoring by time or medical decision making (MDM), coders, providers, and facilities have worked hard to implement changes that would facilitate correct coding through clear documentation and well-formatted templates.

Coding

Defining Modifier 25:Yes! Considering the recent uproar caused by one payer's plan to implement a policy requiring prepayment review of documentation for all visits billed with 99212-99215, modifier 25, and a minor procedure, it is clear there is still a need to discuss this often-misused modifier.

Coding

Are You Properly Reporting Radiology Services?:It's probably not surprising that the most commonly billed imaging services are radiologic examinations of the humerus, spine, fingers, and abdomen (codes 72070, 73060, 73140, and 74019).

Coding

If a Procedure Was Not Documented, Was It Performed?:Most of us, if not all of us, have heard the statement, "If it isn't documented, then it wasn't performed." While I know this is often the perspective of payers, I cringe when I hear this, thinking about all the providers that I work with and the fact that it may not be a true statement that the procedure was not done.

Practice Management

Freestanding Emergency Center (FEC) Industry Lobbying Goes to Washington:In early February, members of the National Association of Freestanding Emergency Centers (NAFEC) went to Washington D.C. to meet with various members of Congress to gain support for two items: the continued recognition of Freestanding Emergency Centers post pandemic and for oversight of the No Surprises Act Independent Dispute Resolution process.

Review

2023 Navigator® Radiation Oncology:This industry-leading reference manual is one of Revenue Cycle Coding Strategies® most popular products, year after year.

Review

2023 Navigator® Diagnostic Radiology Billing Compliance:This comprehensive and easy-to-use medical coding book is indispensable for compliance officers, administrators, billing managers, and anyone else involved in billing compliance for radiology services.

Coding

Let's Talk Prolonged Services! Did you report all of your time?:Prolonged preventive services are provided in outpatient settings and can be provided via telehealth. Annual wellness visits and the Welcome to Medicare visit include a thorough review of the patient's health and medical history. The physician performs an exam that consists of a blood pressure check, height and weight assessment, and a vision screen. Depending on the medical history information provided by the patient and the results of the physical examination, the physician orders or performs additional tests as medically necessary.

Coding

New ICD-10-PCS procedure codes - Effective April 1, 2023:To download all of the new files, go to this CMS website: https://www.cms.gov/medicare/icd-10/2023-icd-10-pcs or see below.

Coding

2023 release of ICD-10-CM - Effective April 1, 2023:The FY2023 ICD-10-CM codes are to be used from April 1, 2023 through September 30, 2023.

Practice Management

Seven Measures Developed by the HHS Office of Inspector General (OIG) to Identify Potential Telehealth Fraud:n September of 2022, the Office of Inspector General (OIG) released a report, "Medicare Telehealth Services During the First Year of the Pandemic: Program Integrity Risks," in which they identified that approximately two in five Medicare beneficiaries used telehealth services within the first year of the pandemic to receive healthcare services from a Medicare provider. This is approximately 88 times more often than beneficiaries engaged through telehealth services prior to the pandemic.

Compliance

PSQIA, PSWP, and HIPAA Compliance:This article addresses patient confidentiality and security related to patient safety evaluation systems, investigations, root cause analyses, and compliance to rules and regulations. It is a basic introduction to help understand the importance of appropriately managing this type of privileged information.

Coding

Keys to Correct Embolization Coding: CPT® Codes 37241-37244:It is no secret that interventional radiology is one of the most difficult specialties for coders and auditors to master. In particular, coding correctly for embolization procedures can be tricky due to the multiple coding considerations involved. This article provides tips that will have you coding and auditing some of the most common embolization procedures like a pro!

Practice Management

The Crucial Role of Negotiating Payer Contracts Every 18 Months for Physician Offices:The healthcare landscape is constantly evolving, with changes in technology, patient care, and the business of medicine all occurring at a rapid pace. One area that is often overlooked but is equally critical to the success and sustainability of a medical practice is the negotiation of payer contracts.

Coding

What's Going on With the COVID Vaccines Now?:Keeping up with the changes to the COVID vaccines has certainly been a rollercoaster ride, and we now have two new twists to this exciting ride. Twist one comes from the FDA who recently pulled the emergency use authorization (EUA) for the monovalent Moderna and Pfizer-BioNTech mRNA vaccines, and instead authorized the bivalent boosters for all doses starting at age 6 months. Twist two is found in the changes taking place as part of the official end to the COVID Public Health Emergency (PHE), beginning May 11, 2023. Buckle up, and let's look at how this changes things.

Practice Management

Is the Violation Right of Access or Information Blocking? Do You Know the Difference?:The right of access and information blocking are both related to the access and exchange of health information, but they are different in several key ways. HIPAA Privacy/Security and Compliance Officers and Health Information Management professionals need to know the difference. It is important to differentiate between Right of Access and Information Blocking to ensure your organization is compliant with both rules, as well as any applicable state privacy regulations.

Practice Management

Healthcare Compliance: A Unique Opportunity to Impact the Business Side of Medicine:I have been privileged to make my entrance into the world of healthcare, in medical coding, specifically after my first career as an art historian dissolved way back in 2008 due to the recession. Mind you, I have taken all my research skills, writing, communication, and critical thinking strengths along for the ride.

Practice Management

Overcoming Self-Pay Challenges in Revenue Cycle Management:Amid the headlines of labor shortages and hospital closures, many Americans may have missed some positive recent healthcare-industry news: The U.S. reached a new, all-time low in the rate of Americans without health insurance.

Practice Management

FY24 IPPS Proposed Rule Boosts Hospital Payment Rates by 2.8%:CMS proposed a new rule for the fiscal year 2024 Inpatient Prospective Payment System (IPPS), increasing hospital payment rates up to 2.8%. Also, the newly proposed IPPS rule adopts policies that are aimed at advancing health equity.

Coding

Second Quarter 2023 Updates Are Different This Year:The second quarter of 2023 is not business as usual, so it is important to pay attention to ensure that organizational processes and training take place to avoid mistakes. Not only have ICD-10-CM coding updates been added to the usual code set updates (e.g., CPT, HCPCS, ICD-10-PCS), but the end of the COVID-19 Public Health Emergency will bring about changes that will also take place during the quarter (but not on April 1, 2023).

Coding

How to Bill Mental Health Telehealth:Billing for mental health telehealth services can be challenging due to various factors. Mental health providers must navigate different payer coverage and reimbursement policies, choose the correct CPT codes and modifiers, document telehealth services properly, comply with regulations related to telehealth, and educate patients about insurance coverage.

Coding

Dermatology CPT® Codes and Tips for 2023:Your dermatology practice performs medical and surgical services for your clients; as such, your medical billing strategy needs an understanding of both medical and surgical dermatology CPT codes.

Coding

Facility Outpatient E/M Coding:Reporting outpatient E/M services in a facility setting is a little different than other outpatient services. It is important to follow payer guidance. Novitas has provided some guidance on which codes to report based on the type of service provided. They have an FAQ page that covers both emergency department (99281-99285, G0380-G0384) and clinic visits, which states the following:

Practice Management

Empowering Your Front Desk Staff to Improve your Revenue Cycle Management :The front desk is the first point of contact for patients visiting a healthcare facility, and it plays a crucial role in revenue cycle management. The front desk staff is responsible for managing patient registration, insurance verification, appointment scheduling, and collecting payments. Empowering your front desk staff can significantly improve your revenue cycle management and boost your bottom line.

Compliance

HIPAA Changes 2023: A Return to Normalcy?:In November of 1918, the First World War (naively called "The Great War") ended. (For people who appreciate or read into symmetry, World War I ended at the 11th hour on the 11th day of the 11th month of 1918). The League of Nations, the peacekeeping body and the precursor to today's United Nations, was founded in January 1920 by President Woodrow Wilson and held its first meeting in November of that year.

Review

2023 Prolonged Code Slide Rule - Preorder:2023 has 4 new prolonged codes, as well as different codes and times for Medicare than CPT has for commercial carriers. Without this easy slide rule, it can be difficult to remember not only the needed code for each place of service but also how many minutes for Medicare or commercial insurance claims.

Review

Evaluation & Management Comprehensive Guide – 5th Edition with Cardpack Bundle:Along with the Comprehensive Guide to Evaluation & Management you will receive a set of E/M reference cards that have been updated too! You can quickly reference the new coding guidelines and make correct coding decisions. These two handy reference cards contain a coding matrix for 99201-99215 (Office) and the new prolonged E/M service code linked to it, along with the applicable guidelines.

Practice Management

The Importance of Selecting the Right EMR and PMS Software:As a healthcare organization, choosing the right electronic medical record (EMR) and practice management system (PMS) software is critical for the success and efficiency of your operations. The right software can streamline patient care, improve data accuracy and security, and reduce administrative burdens, among other benefits.

Coding

Overcoming Code Denials in Healthcare:Denial rates are rising because of numerous factors, including the increasing complexity of coding guidelines, increased workloads and staff shortage, adoption of AI and automation in payor claim reviews, increasingly sophisticated remittance processes, and more. However, taking a more granular review of your claims may help avoid significant revenue hurdles or other more serious headaches, like audits.

Practice Management

12 Tips to Grow Your Medical Practice in 2023:Do you want to expand your medical practice without collapsing? Here are 12 realistic tips to safely and effectively grow your practice in 2020.

Billing

Verno's Voice: Debt Collection:I was born into debt collection. In 1953, both my parents quit high school in their final year. In 1953, if you quit school, you were a social pariah; no one would hire you, because it was deemed that if you quit school, you would also quit your job. My parents did find work at a small mom and pop diner, but it barely paid the rent, so we moved to a run-down apartment next to the railroad tracks. The medical bills for my birth were overdue, and the debt collectors came to our apartment. In the 1950s, there were no debt collection laws, so debt collectors did everything possible to collect what was owed.

Coding

Gastroenterology CPT Codes and Tips for 2023:Since gastroenterology practices can perform both medical and surgical services, your gastroenterology medical billing strategy has to take this into account. Billing for this specialty can be challenging, but the friendly experts at NCG want to make it simple for you to boost your healthcare revenue cycle.

Billing

The Eliminating Kickbacks in Recovery Act Legality of Percentage-Based Compensation:The Eliminating Kickbacks in Recovery Act (EKRA), part of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, was passed in 2018. Since its passing, there has been very limited guidance as to how EKRA should be applied.

Billing

Biden National Cyber Strategy Poses Challenges to Healthcare:The Biden administration's newly released national cybersecurity strategy aims to bolster protections across all critical infrastructure sectors, including setting minimum security requirements, enhancing collaboration, and making other important moves.

Compliance

Everything You Need to Know About Healthcare Software Maintenance and Support:Healthcare software maintenance and support assures that all software is upgraded and is of the best quality. According to a report, the most-used maintenance strategies include preventive, reactive, and CMMS (Computerized Maintenance Management Systems). Let's look at healthcare software maintenance and support in detail.

Compliance

Is Using a HIPAA Compliance Binder Effective? :In the past, using a HIPAA compliance binder was a popular way to address compliance requirements, but it's no longer considered best practice. There are several reasons why that's the case, including a tendency to rely on outdated guidance.

Practice Management

Consensus Cloud Solutions to Showcase Healthcare Technologies that Enhance Interoperability at ViVE 2023:Consensus Cloud Solutions, Inc. (NASDAQ: CCSI), the world's largest provider of digital cloud fax technology, will be exhibiting their suite of interoperability solutions at the ViVE 2023 conference in Nashville, Tennessee, March 26-29th. Booth #1020

Coding

Dawning of a New Era: The Sun Rises on New E/M Standards in 2023 and Beyond:Well, the time is finally here! 2023 has ushered in a new standard for how we look at evaluation and management (E/M) services. Physicians, providers, coders, auditors, educators, and compliance professionals alike are finally able to utilize much more than the "bean-counting" methods set forth by the Centers for Medicare and Medicaid Services' (CMS) 1995 and 1997 ("95" and "97") E/M guidelines.

Billing

Get Reimbursed With Billing Guidelines for Audiology Services:When billing for audiology services, you need to be careful how you are billing for professional skills and technical skills. Technical component is taken care of by an experienced technician using a specific protocol under the direction of a supervising physician.

Coding

Is the End Really Near?:What is going on? We hear rumors that the end is near; well, that depends on what you are talking about - the end of what? The pandemic is not over; we are just making a transition.

Coding

2023 Coding Conundrums:We have our first bit of 2023 behind us, which means the first of the claims for the new year have been submitted. Here's the $100,000 question: Are your claims paying appropriately with the 2023 Evaluation and Management (E/M) changes that have occurred?

Coding

New Modifier Required on all Single Use Drugs:Attention providers and suppliers, there is a new modifier in town! Starting July 1, 2023, Modifier JZ - Zero drug wasted, will be required on all claims to attest there is no drug left over, if applicable. Meaning there is zero drug amount discarded, and there was no leftover drug administered to any patient.

Auditing

Choosing the Right Tool: Targeted vs. Random E/M Audits:The realm of E/M (evaluation and management) auditing is vast, and 2023 will bring more work here than before thanks to CPT's extensive revisions to its E/M guidelines for inpatient, facility, and home visit services - now in effect. Both compliance professionals and providers must always keep in mind that E/M services (which account for a third of annual Medicare Part spending) will go from being a perennial easy target to an urgent area of attention in 2023.

Coding

Top 5 Takeaways From the CMS 2023 Final Rule: Conversion Factor, MIPS, Telehealth, E/M, and Refunds for Discarded Drugs:As we walk into 2023 (or run depending on your enthusiasm for leaving 2022 behind), we are presented with the rules that will govern much of the healthcare industry's regulatory compliance standards and reimbursement guidelines. These rules are published in the Center for Medicare and Medicaid (CMS) Annual Final Rule, which was released on November 18, 2022 for the 2023 calendar year.

Billing

How to Outsource Medical Billing for Oncology Practices:There are certain billing aspects that oncology practices ought to know before hiring third-party billing companies. Oncology medical billing is complex, and medical practices need experts who can handle the revenue cycle management process.

Practice Management

Five Steps for Provider Credentialing:When your facility hires a new provider, they need to be credentialed. This process allows you to verify their qualifications and skills while getting them approved to work with insurance companies. Medical credentialing is a time-consuming and expensive process that requires complete concentration by a professional. This can use a lot of your facility's resources.

Practice Management

5 Ways in Which Healthcare Data Visualization is Transforming Healthcare:

Healthcare providers can make use of data visualization to assess past and present medical history and improve patient care and outcome.

Practice Management

The End of the PHE: Medicaid, The Omnibus Act, and What Hasn't Been Addressed:An announcement on January 30th, by the OMB (Office of Management and Budget) and the White House, stated that they plan to end the COVID-19 national emergency and public health emergency on May 11th.

Practice Management

Three Ways Medical Groups Can Leverage Digital Self-Service to Drive Growth:That medical groups and health systems share a commitment to delivering convenient, high-quality care in their respective settings isn't surprising. What is eye-opening, however, is that despite their differences in size and structure, they face many of the same business challenges, such as fending off market competitors, acquiring and retaining patients to ensure profitability, and working to alleviate staff burnout.

Coding

Medicare Fee Schedule Changes In 2023:The internet is ringing with the news of the CMS Updates Final rule for the 2023 Medicare Physician Fee Schedule. The finalized 2023 Medicare Physician Fee Schedule was announced by the Centers for Medicare & Medicaid Services (CMS) on November 1, 2022.

Practice Management

How to Establish a Business Plan for Your Holistic Practice:Opening a holistic healthcare practice is an exciting and challenging endeavor that requires careful planning and preparation. A business plan is a critical tool that can help you to organize your thoughts, set goals, and create a roadmap for your practice's success. In this article, we discuss steps on how to establish a business plan for your holistic practice and provide some tips for creating a successful strategy.

Coding

Evaluation and Management 2023 Updates:Changes to 2023 Evaluation and Management (E/M) coding will impact CDM files, coding, documentation, charge capture processes, and various information systems.

Practice Management

CMS Announces Increase in 2023 in Organizations and Beneficiaries Benefiting from Coordinated Care in Accountable Care Relationships:Recently, the Centers for Medicare & Medicaid Services (CMS) announced that three innovative accountable care initiatives will grow and provide higher quality care to more than 13.2 million people with Medicare in 2023. More than 700,000 healthcare providers and organizations will participate in at least one of the three initiatives – the Medicare Shared Savings Program and two CMS Innovation Center accountable care model tests. This growth furthers achieving CMS's goal of having all people with Traditional Medicare in an accountable care relationship with their healthcare provider by 2030.

Coding

A Long Time Coming: 2023 Changes to Inpatient Prolonged Service:It's been two years since CMS collaborated with the AMA to revamp Evaluation and Management (E/M) coding guidelines, including a rework of prolonged service codes in the office/outpatient setting.

Coding

How Does the Definition of "Problem Assessed" Change in the 2023 E/M Guideline Updates?:In 2021, the AMA defined certain terms to facilitate better understanding and scoring for MDM. For the purposes of this article, we will focus more specifically on what is meant by "problems addressed" and what that means when scoring E/M services in the hospital inpatient and observation setting.

Practice Management

Investigation of Hospitals Hiding Prices from Patients:The Federal Hospital Price Transparency Rule helps Americans know the cost of a hospital item or service before receiving it. Compliance is mandatory. The regulation aims to improve the affordability of hospital care by promoting price competition. However, a low compliance level among hospitals would compromise the operational effectiveness of this regulation.

Practice Management

Top 5 Ways Medical Practices Can Combat Inflation:Inflation is affecting many businesses, but medical practices tend to see the brunt of its effects because of the way payment structures are dictated by insurance payers. Even more worrisome, practices have had to increase wages significantly and the current job market tends to favor employees.

Practice Management

Burnout: A Threat to Our Healthcare System?:The coronavirus disease 2019 (COVID-19) pandemic has generated a substantial increase in the workload of healthcare professionals, leading to physical and mental distress among professionals, resulting in an increase in burnout.

Coding

2023 Procedure Coding Updates Are Just Weeks Away:Changes to the 2023 CPT code set include 102 new codes, 68 deleted codes, and 87 codes with revised long descriptions, as well as 36 new parent codes.

Practice Management

Digital Collaboration Maximizes Efficiency and Reduces Congestion in the Healthcare Ecosystem:CBS reports that excessive financial waste in our healthcare system ranges from $760 billion to $935 billion per year - that's more than the total for annual federal defense spending. The largest portion of this excess is administrative activities; these tasks required of physicians, their staff, and nurses are complex and devour so much time that they waste hundreds of billions of dollars each year.

Compliance

Your Patient Data Privacy Policy: Why It Matters (+ What to Include):The healthcare industry experienced the second-highest increase in cost-per-breach in 2020 - only second to the energy industry. Whether due to an internal attack, a cybersecurity hacker, accidentally publishing information, or something else, patient data privacy and security are of the utmost importance to ensure.

Practice Management

12 Tips to Grow Your Medical Practice in 2023:If you are a private practice owner, you may feel it is difficult to attract new patients. By setting a plan and sticking to it, you can set yourself up for success in 2023. Medical practice management requires the collaborative efforts of all team members.

Practice Management

Value-Based Healthcare and Evidence-Based Treatment Rank Highest:Recently, we conducted a new survey on our LinkedIn asking respondents the question, "What do you see as the most important factor that technology solutions can solve to fuel better and more efficient patient outcomes in 2023?"

Coding

The Role of the History and Examination in 2023 Evaluation and Management Services:While listening to the virtual AMA CPT/RBRVS Annual Symposium lecture by Gift Tee, BS, MPH, Director of the Division of Practitioner Services in the Hospital and Ambulatory Policy Group (HAPG) of CMS on the Update from Centers for Medicare and Medicaid Services (CMS), I was struck by something he said about the revisions to the coding and documentation framework for Evaluation and Management (E/M) Services for the 2023 CPT code descriptors.

Practice Management

To Benchmark or Not to Benchmark: That Is the Question:Curiosity is both a blessing and a curse. Wanting to know how you compare to other practices can be so enticing that we are sometimes willing to accept assumptions that are not always supported by the evidence.

Practice Management

Demonstrating the Value of Patient Access in Challenging Times:It's no secret: Most healthcare organizations today are facing significant financial challenges - and there isn't a single culprit to blame. Instead, it's a perfect storm of circumstances fueled by an uncertain economy, workforce shortages, ongoing COVID-19 recovery, and public health issues such as RSV and the impact of delayed care.

Practice Management

The Medicare Advantage Bill Was Crafted in Response to Complaints:U.S. Senators Maggie Hassan, D-N.H., and Dr. Roger Marshall, R-Kansas, have introduced the bipartisan Medicare & You Handbook Improvement Act, which is meant to ensure that when seniors assess their Medicare coverage options, they have the necessary information they need on health plan choices and supplemental insurance.

Coding

A Long Time Coming: 2023 Changes to Inpatient Prolonged Services:It's been two years since CMS collaborated with the AMA to revamp Evaluation and Management (E/M) coding guidelines, including a rework of prolonged services codes in the office/outpatient setting.

Billing

Payers Wrongly Cutting Payments to Physicians for E/M Services:Payers have been wrongly cutting payments to physicians for evaluation and management (E/M) services - often automatically through the use of claim-editing algorithms. A new AMA resource helps physicians fight back against health insurer downcoding.

Billing

A Case Study on Radiology Billing:Billing for radiology correctly requires more than just keeping track of money. It is a multi-phase process that necessitates persistently calculating money on each step. Throughout the expanding process, one needs to be tenacious and proactive to ensure collection of every cent which is due.

Practice Management

What Is a Patient Care Policy? (+ How to Write One):If you've never heard of a patient care policy before, then you might ask yourself if your medical practice needs another piece of business writing. The answer is yes; it's a good rule of thumb for your practice to have such a policy.

Coding

Modifier FT:As of January 1, 2022, CMS created a new modifier for an unrelated E/M visit during a postoperative period. It was revised as of April 1, 2022, quite possibly due to some questions on usage. Modifier FT is described as follows.

Coding

Coding and Documentation for Arterial Embolization:Arterial catheter embolization is an interventional radiology procedure that requires detailed documentation of the steps performed by the physician to maximize coding and reimbursement. The procedure places medications, embolic agents, or a radiopharmaceutical into a blood vessel to prevent abnormal bleeding, close off vessels, eliminate abnormal connections between arteries and veins, or to treat aneurysms or tumors.

Coding

Identifying Common Coding Errors for Lower Extremity Arterial Interventions:Each day, thousands of patients are undergoing one or more therapeutic interventions, the most common ones being angioplasty, stent, and atherectomy of the lower extremity arteries to treat various forms of peripheral vascular disease. This article will highlight the most common coding errors to be on the lookout for when auditing these procedures.

Compliance

Consensus Cloud Solutions Unveils Conductor Integration Platform:Consensus Cloud Solutions, Inc. (NASDAQ: CCSI), the world's largest provider of digital cloud fax solutions, recently announced the availability of Consensus Conductor, which provides seamless integration technology that supports the latest standards for connectivity while addressing a wide range of interoperability challenges from the simple to the extremely complex.

Practice Management

DME Billing Coverage Limitations and Exclusions :Durable medical equipment (DME) billing is an essential aspect of revenue cycle management in the healthcare industry. As the industry evolves, DME has grown in importance and now serves millions of patients. However, managing the billing processes and reimbursements associated with DME can be time consuming and labor intensive.

Billing

Properly Charging Patients for Missed Appointments:Patients missing their healthcare appointments without adequate notice can cost practices a lot of money, as well as deprive patients of necessary care.

Practice Management

How to Reduce Patient Collections in a Medical Office:Putting on the dreaded collections hat is a necessary evil that every medical office can relate to. You can run a tight ship, doing your very best to collect payments at the time of service, but because of the complexities of medical billing and emergent situations, there will always be times when collecting every patient's payment is an impossibility.

Practice Management

What Are SOAP Notes? (And Why They’re Important for Insurance Billing):Healthcare documentation is a critical component for your holistic practice, both in terms of delivering great care to your patients and for insurance billing purposes-not to mention the importance of having some form of documentation in the event of a legal situation.

Coding

2023 ICD-10-CM Code Changes:In 2022, there were 159 new codes; the 2023 ICD-10-CM code update includes 1,176 new, 28 revised, and 287 deleted codes - a substantial change from last year. The 2023 ICD-10-CM codes are to be used for discharges from October 1, 2022 through September 30, 2023, and for patient encounters from October 1, 2022 through September 30, 2023.

Billing

How MBC Can Help in Reducing Your Gastroenterology Billing Errors:Gastroenterology billing and coding is complex and challenging as gastroenterologists provide both medical and surgical services. Accurate, efficient billing and coding for gastroenterology services ensure the survival of the practice amidst various challenges like the COVID-19 pandemic.

Practice Management

Let's Talk about Weed (As in the Doctor):Early September marked my 33rd year on the administrative side of healthcare. This followed my 56th birthday in April when I officially entered the realm of "pushing 60."

Practice Management

DENIED! CO 22-This care may be covered by another payer, per coordination of benefits?!?:Coordination of benefits can be described as when two or more insurance plans work together to determine the order of coverage liability. This coordination between plans exists to avoid duplicate payment, which could result in a provider receiving payment in excess of the services provided and the total amount billed.

Coding

Significant Changes to Emergency Department E/M Reporting Coming in 2023:In 2021, the American Medical Association (AMA) published significant changes to the evaluation and management (E/M) code descriptions, associated times, and coding guidelines applicable to the largest and most reported code range at the time of 99201-99215.

Coding

Up-Coding and Down-Coding: The Yin-Yang of Coding Evaluation and Management Services:Can I be honest here? I am thrilled that I am finished with the 1995 and 1997 ("95 and 97") evaluation and management (E/M) guidelines for office and outpatient visits.

Compliance

Administrative Simplification Transactions Basics:The Centers for Medicare & Medicaid Services (CMS) has created a series of fact sheets to help explain how HIPAA (Health Insurance Portability and Accountability Act) electronic adopted transactions streamline health care billing through the use of standards and operating rules.

Billing

Pain Management Billing and Coding: Common Mistakes and Challenges:There is currently plenty of room to grow in pain management facilities, particularly since the American Academy of Pain Medicine estimates that over 100 million Americans suffer from chronic pain.

Billing

What You Need to Know About Physical Therapy Billing:Physical therapists, like any healthcare provider, generally don't get into the profession because they like working with numbers. But no practice is going to succeed without a good understanding of the complex medical billing system.

Coding

Avoiding Risk When Using Assistant Modifiers:Most of us are very aware of the risks that inappropriate bundling modifier usage can cause, but when is the last time we thought about how other modifiers may put us at risk?

Coding

Orthopoxvirus and Monkeypox Coding and Guidance:New Current Procedural Terminology (CPT®) codes have been created that streamline the reporting of orthopoxvirus and monkeypox testing and immunizations currently available on the United States market.

Practice Management

Medicare Patients and Stark Law: What You Need to Know:If your medical practice treats patients covered by Medicare, then you already know that there are countless regulations you need to closely adhere to in order to avoid any issues with the government.

Coding

AMA Announces CPT Update for COVID-19 Boosters Adapted to Omicron :The American Medical Association (AMA) recently announced an editorial update to Current Procedural Terminology (CPT)®, the nation's leading medical terminology code set for describing healthcare procedures and services, that includes eight new codes for the bivalent COVID-19 vaccine booster doses from Moderna and Pfizer-BioNTech.

Practice Management

Implications of the Federal Trade Commission's Report on Artificial Intelligence In the Healthcare Sector:No doubt, most people have heard of the phrase, "You are what you eat," which means that what we eat and our lifestyle choices impact our health and well-being.

Practice Management

Patients Charged Expensive Out-of-Pocket Fees as Doctors Stop Bulk Billing:Perth mother Jayme Lees has been bulk billed by her General Practitioner (GP) for the past six years, but when she took her newborn son for a check-up in June, she was hit with a hefty, unexpected fee.

Practice Management

Telehealth Here to Stay, But Technology Needs to Catch Up:Patient care in a post-COVID-19 world is significantly different for providers who are embracing virtual care options, such as telehealth and asynchronous texting.

Practice Management

Why Medical Practices Need a Mobile-Friendly Website:People worldwide are increasingly using a range of devices to access the internet. Nowadays, it's not safe to assume that all your website visitors use a desktop or laptop computer-they’re more likely to use tablets or smartphones.

Billing

Incident-To Services by Non-Physician Practitioners: What's Supported?:Incident-to is often discussed in coding and compliance circles, but when reviewing encounters, I routinely find the criteria fails to meet or support the billing of non-physician practitioners (NPPs) and/or other clinical staff (auxiliary).

Coding

The CMS Quality Payment Program: Future Impact on the Medicare Physician Fee Schedule:Have you ever wondered how Medicare decides how much to pay for an outpatient office visit? Or the monthly capitated payment we receive for caring for ESRD patients? At a very high level, the process goes something like this:

Coding

Calendar Year 2023 Medicare Advantage and Part C & D Payment Policies:On April 4, 2022, CMS finalized the 2023 MA capitation rates, as well as the Part C and Part D payment policies, in this publication: CMS CY 2023 Rate Announcement.

Billing

Elimination of Certificates of Medical Necessity & Durable Medical Equipment Information Forms:This MLN Special Edition Article is for providers, suppliers, billers, and vendors who bill Durable Medical Equipment (DME) Medicare Administrative Contractors (MACs) for services and supplies they provide to Medicare patients.

Billing

Billing and Coding: Bone Mass Measurement:The following is guidance for billing, coding, and other guidelines in relation to local coverage policy L36460-Bone Mass Measurement. This is an excerpt from the article written by Centers for Medicare & Medicaid Services.

Auditing

Provider Education: The Most Important Step of the Audit Process:You've taken the time to complete a painstaking audit of a provider, combing through their documentation on an EHR or maybe even navigating through a handful of handwritten notes.

Auditing

Modifier 25 Pre-Bill Review: Were You Ready?:After all the hype surrounding the upcoming Cigna policy regarding modifier 25 and pre-bill reviews, it seems as if Cigna is not planning on implementing the policy as planned on August 14, 2022.

Billing

Declaration of Blanket Waivers for SNFs:In a recent change to the way skilled nursing facilities (SNFs) are regulated, the Centers for Medicare and Medicaid Services (CMS) has issued a declaration of blanket waivers for SNFs.

Coding

CMS Proposes Physician Payment Rule to Expand Access to High-Quality Care:Proposed policies will expand access to behavioral health services, Accountable Care Organizations, cancer care, and dental care, and will advance health equity.

Coding

E/M Revisions to Code Descriptors and Guidelines 2021-2023:Centers for Medicare and Medicaid Services (CMS) finalized a historic provision in the 2020 Medicare Physician Fee Schedule Final Rule.

Coding

Summer Fun: Be Aware of Sunburns:Summary: As UV rays are strongest during summer months when the sun is directly overhead, spending more time outdoors can result in sunburns.

Billing

CMS Provides Four New No Surprises Fact Sheets for Patients:The No Surprises Act launched in January 2022. Many healthcare facilities are still scrambling to comply.

Coding

Appropriate Use Criteria (AUC) Penalty Phase Set to Begin:Will the requirement to use Clinical Decision Support (CDS) finally become a reality? The current timetable for the penalty phase of the AUC/CDS rule calls for it to begin on the later of January 1, 2023, or the January 1 following the end of the COVID-19 public health emergency (PHE).

Billing

Gross Collection Ratio vs Net Collection Ratio: Understanding These Financial KPIs:Your holistic practice's success and longevity within your community are predicated upon a streamlined healthcare revenue cycle-part of that comes from understanding a couple of key financial metrics that you can use to evaluate your practice's current performance!

Practice Management

Prepare for Telehealth After the End of Public Health Emergency:The state and federal Public Health Emergency (PHE) declarations related to the COVID-19 pandemic created wide latitude for providers to render services via telehealth in order to prevent the higher risk of in-person contact for patients, providers, and staff.

Practice Management

Best Practices for Recruiting Front Desk Medical Staff:As medical practices bounce back from the pandemic, many are finding it challenging to recruit and hire great employees, including front desk staff.

Coding

How Much Do You Care About the 2022 Care Management Service Changes?:Care Management Services were developed to improve quality of care and consistency in the treatment of patients with one or more chronic health conditions putting them at risk of significant acute exacerbation, decompensation, hospitalization, or death.

Coding

The Move to Single-Path Coding:Faulty and errant documentation and coding are driving outpatient reimbursement inefficiencies, costing U.S. healthcare about $54 billion annually. Unaddressed, these costs are increasing alongside outpatient revenue, growing at a year-over-year rate of 9%.

Billing

Why Health Insurance Companies Hate Price Transparency:More than a year ago, the federal government passed the Healthcare Price Transparency Act, which was primarily directed toward hospitals. Under the rule, hospitals are required to display their prices and allowed amounts in a machine-readable and consumer-friendly format.

Billing

Five Facts about Split Visits:Got five minutes? You can learn five things about the crazy 2022 rules for Split Visits. Hopefully, this will end a lot of the confusion around these relatively new rules.

Practice Management

Outsourcing Strategy 101: Crucial Questions to Ask Healthcare Billing Companies:Healthcare billing companies are excellent partners to the mainstream medical industry-hospitals and independent or group clinics.

Auditing

Navigating the UPIC Investigation from a Compliance Consultant's Perspective:Over the past year and a half, I have seen a significant increase in the volume of Unified Program Integrity Contractor (UPIC) investigations taking place in private physician practices.

Coding

CMS: Mental Health Visits via Telecommunications for Rural Health Clinics & Federally Qualified Health Centers:CMS finalized regulatory language for mental health visits in RHCs and FQHCs in the CY 2022 Physician Fee Schedule (PFS) final rule. Effective January 1, 2022, you may provide mental health visits using interactive, real-time telecommunications technology.

Coding

AMA Announces CPT Update for Pediatric COVID-19 Vaccine Candidate: Provisional Codes Assigned to Moderna COVID-19 Vaccine for Young Children :The American Medical Association (AMA) recently announced an editorial update to Current Procedural Terminology (CPT)®, the nation's leading medical terminology code set for describing healthcare procedures and services, that includes new product and administration codes assigned to the Moderna COVID-19 vaccine for children 6 months through 5 years old.

Practice Management

FACT SHEET: The Biden Administration Announces New Actions to Lessen the Burden of Medical Debt and Increase Consumer Protection:Vice President Kamala Harris announces reforms across four areas to ease the burden of medical debt, giving more American families the opportunity to thrive.

Coding

Summer Fun: Be Aware of Sunburns - ICD-10:As UV rays are strongest during summer months when the sun is directly overhead, spending more time outdoors can result in sunburns.

Practice Management

Improving the Patient Experience with Electronic Patient Statements:The most important part of any healthcare practice is helping patients. The second most important part is getting paid. Offering electronic patient...

Practice Management

Five Facts about Split Visits:Got five minutes? You can learn five things about the crazy 2022 rules for Split Visits. Hopefully, this will end a lot of the confusion around these relatively new rules.

Coding

Continuous Glucose Monitors (CGMs) - New Codes:New codes for continuous glucose monitors (CGMs) became effective on April 1, 2022. The following information is excerpted from MLN Matters MM12564 regarding CGMs. Be sure to review this information and implement policies to ensure accurate reporting/billing.

Auditing

Culture in Compliance:For years, we have talked about the culture in healthcare, especially for compliance purposes, but for many practices, that culture takes a backseat despite continued guidance.

Practice Management

Offsetting Staffing Shortage-Induced Revenue Loss:Exacerbated by pandemic-induced burnout, the Great Resignation, vaccine mandate-driven terminations, and rising retirement rates, the chronic shortage of billing, coding, and audit professionals will continue to worsen over the near future.

Coding

Understanding the Long List of Prolonged Services in 2022 and Beyond:Prolonged services have been around for a long time - no pun intended - but in recent years, the number of codes involved has grown and their requirements have changed, making them a potentially risky area for providers.

Coding

AMA Announces CPT Update for COVID-19 Booster Candidates:The American Medical Association (AMA) today announced an editorial update to Current Procedural Terminology (CPT®), the nation's leading medical terminology code set for describing healthcare procedures and services, that includes newly assigned provisional CPT codes for COVID-19 booster candidates from Pfizer and Sanofi-GlaxoSmithKline.

Practice Management

The Importance of Mental Wellbeing in Modern Healthcare Practices:Supporting the mental health and wellbeing of healthcare workers should be the number one priority of every healthcare manager and practice owner. The importance of essential workers and first-line medical staff is evident now more than ever.

Practice Management

The Road to Professional Success and Recognition!:The Professional Association of Health Care Office Management, Inc. (PAHCOM, pronounced "PAY-COM") has been providing efficiency concepts, productivity, and networking knowledge since 1988.

Coding

Substance Use Disorder Treatment Incentive Program Receives Go Ahead from the OIG:Creating incentives for individuals participating in a substance use disorders (SUD) program has always been challenging due to concerns over violating Federal laws such as the Anti-Kickback Statute (AKS) and the Beneficiary Inducements Civil Monetary Penalties.

Coding

Considering the Impact of Diagnosis Codes in the E/M Encounter:It has been nearly seven years since the United States implemented ICD-10-CM, and along the way, we have become better at infusing clinical documentation with the details that allow for assignment of high-specificity ICD-10-CM codes.

Practice Management

Using Software to Grow Your Medical Billing Company:Here's a simple truth: the faster you can get your customers paid, the more popular your medical billing company will be. Now here's another one: no matter how effective your team is, you will only ever be as efficient as your software allows to grow your medical billing company.

Billing

Part 1: Managing Denials Is Important to Good A/R Hygiene:Revenue cycle management includes tracking claims, making sure payment is received, and following up on denied claims to maximize revenue generation. Several metrics can help you determine whether your revenue management cycle processes are efficient and effective.

Coding

Pinpointing Correct Coding for Anesthesia in Abortions:Medical terminology related to abortions can be puzzling, but it is essential to understand the differences. Having a clear comprehension of several abortion terms is a vital component to achieve successful coding.

Coding

Coding for a Performance of an X-ray Service vs. Counting the Work as a Part of MDM:When x-rays are audited on the same date as an E/M encounter, we have one of three decisions to make about the work that went into the radiological exam when the practice owns x-ray equipment and does their own interpretations internally.

Coding

Are Excludes1 Edits Causing Problems?:We've heard some comments about payer edits that are citing Excludes1 instructional notations as the reason for denials. Excludes1 notations have been around since the beginning of the implementation of ICD-10-CM, but only recently have these types of edits become more common.

Practice Management

No Surprises Act Compliance:The Department of Health and Human Services published three parts to the No Surprises Act towards the end of 2021, which took effect January 1, 2022.

Practice Management

8 Tactics to Improve Revenue Cycle Management for Your Practice:Whether you're part of a larger hospital or run your own private practice, improving revenue cycle management means improving your bottom line.

Coding

Prolonged Services Billed As a Split/Shared Visit:Previously, prolonged services were not allowed to be billed as a split or shared visit. However, Medicare's 2022 Medicare Physician Fee Schedule Final Rule has updated that ruling to allow add-on codes for prolonged services to be reported as a split or shared visit.

Practice Management

Insulate Your Revenue Cycle Management Process from the Surprises of the No Surprises Act:Last year, the U.S. government announced an interim final rule (IFC) related to the Surprise Billing Act. The rule defines the No Surprises Act's requirements for group health plans, carriers and payers, medical service providers, and other ancillary services.

Coding

2022 Acupuncture CPT Codes for Insurance Billing:The world of insurance billing is complex, and even more so for holistic practices. Accurate coding and billing practices ensure a streamlined reimbursement process so your practice can get paid and deliver the best care to your patients.

Coding

March is National Kidney Month: Know How the Kidneys Support Your Health:Summary: National Kidney Month provides the opportunity to spread awareness about kidney disease, tests to detect the condition, and prevention measures.

Coding

SDoH Improves Reimbursement and Risk Scores:Social Determinants of Health (SDoH) refers to the conditions in which people are born, live, and work that continuously shape their specific health outcomes.

Practice Management

Coding for a Performance of an X-ray Service vs Counting the Work as a Part of MDM:When x-rays are audited on the same date as an E/M encounter, we have one of three decisions to make about the work that went into the radiological exam when the practice owns x-ray equipment and does their own interpretations internally.

Coding

How to Document Split/Shared Visits in 2022:Medicare is making big changes to its policies for billing split/shared visits. While the main policy shifts take place in 2023, there are important changes to the rules for split/shared services in 2022 that must be followed for these services to be covered and billable under the physician.

Practice Management

How Anomaly Detection Can Fight a Nearly $300B Healthcare Issue:In healthcare, just as in life, no one likes losing money-particularly when you don't know why it's happening.

Billing

No Surprise Billing Act: What You Need To Know:The No Surprise Billing Act may be the most poorly written, difficult to understand set of regulations I have encountered in my legal career. Stark is much, much easier to understand. Much of the guidance out there is misleading, if not entirely wrong. Here is a short explanation of what you need to know.

Practice Management

Employee Training: An Investment That Can Benefit Healthcare Organizations Long After the Employee Has Moved On:Interview with Revenue Cycle Management Experts, Taya (Shawntea) Moheiser and Kem Tolliver:

Practice Management

Challenges for 2022:Welcome to a brand-new year! It looks like it is stacking up to be a very interesting and possibly one of the most challenging for the medical billing industry. There is an overabundance of issues facing us in 2022 and beyond; we need to develop a strategy to ensure we continue on the pathway of success.

Coding

AMA Announces CPT Update for Third Dose of the Pfizer Pediatric COVID-19 Vaccine:The American Medical Association (AMA) recently announced an editorial update to Current Procedural Terminology (CPT®), the nation's leading medical terminology code set for describing healthcare procedures and services, that includes a new vaccine administration code for a third dose of the pediatric COVID-19 vaccine developed by Pfizer.

Coding

Auditing Time-Based E/Ms Under 2021 Guidelines:The 2021 E/M guidelines' more permissive rules for time-based coding is a potential watershed moment for physicians who want to spend less of their time documenting E/M notes.

Billing

Pathology Billing Services: All You Want to Know:Pathology, being the medical science dealing with the cause-and-effect theory of diseases, is an important sector. Similarly, the medical billing and coding process is an important part of all medical practices, including pathology.

Coding

Pre-Op Visits: Are They Medically Necessary?:Many facilities will require a preoperative history and physical within 30 days of a procedure. Does this requirement from the facility support the medical necessity of an E/M visit? The answer is maybe.

Coding

Mastering Remote Monitoring Compliance in 2022:It's our favorite time of the year again - coding and regulatory compliance update season! As I'm sure many of my compliance colleagues can relate, this is the time of the year when we get inundated with "Can I pick your brain?" requests about the latest and greatest coding/compliance changes and what their impact will bring for revenues. In 2022, remote therapeutic monitoring is officially the star of the show!

Coding

Cracking The Code: How to Get Paid from the HRSA Uninsured COVID-19 Portal:There are not many positives that are generally born out of a pandemic, but for the COVID-19 pandemic, there have been a few, and one of them is the creation of the HRSA Uninsured portal. I call it a provider "godsend" as it has allowed providers to treat uninsured individuals who reside in the United States, whether full-time or part-time (here on a work visa as well), without having to worry about how their patients will pay for COVID-19 related services.

Auditing

Don't Sleep On Small Claims Denials:Are you ever tempted to just sweep those small claims denials under the rug? Do you sometimes wonder if it is worth the time and effort to figure out why a code, which will end up yielding $30, is being denied? Does it feel like it takes years to understand a denial and find a solution - leaving you to question if you really know what you are doing? I've had many of those moments.

Coding

ICD-11 Is Almost Here: Don't Wait, Update Your HIT Software Now:The International Classification of Disease, or ICD, is the most critical classification and terminology tool for cataloging injuries, diseases, and causes of mortality around the globe. As such, it is paramount that this standard evolves with the rapid changes in the healthcare landscape.

Coding

Changes in RPM for 2021! Now, Wait for It... New RTM Codes for 2022:Remote physiologic monitoring and clinical data monitoring is a relatively new concept thriving and growing as an essential component for telehealth services. According to global consumer trends, a company called Dynata reported, "Among the 39% of people who consulted a healthcare professional, two-thirds used telemedicine, many of them for the first time (84%)."

Compliance

4 Ways to Ensure Healthcare Data Security at Your Practice:In recent years, healthcare practices across the country have accelerated their digital transformation efforts to modernize their operations, bake more efficiency into their workflows and processes, and deliver stronger patient experiences.

Practice Management

Why Quality Documentation Matters:If you work with provider claims in a medical office, then you have probably heard the phrase, "If it isn't documented, it wasn't done."

Practice Management

Talking the Talk, Walking the Walk - An interview with Shannon DeConda:Sean Weiss, a DoctorsManagement Partner and Vice President of compliance, spoke to Shannon DeConda, President of NAMAS (National Alliance of Medical Auditing Specialists), as well as a Partner in DoctorsManagement.

Coding

Coding and Billing of Molecular Pathology and Genetic Testing:Genetic testing has grown exponentially over the last decade. The elimination of patent protection on human genes, the proliferation of next-generation sequencing (NGS) technology, and the rapid discovery of gene-disease connections have all contributed to this trend.

Coding

Changes to Nursing Home Visitation COVID-19 (Revised) and COVID-19 Survey Activities:The Centers for Medicare & Medicaid Services (CMS) is continuing to promote health and safety and address the impacts of the COVID-19 public health emergency (PHE) on nursing home residents and their families by issuing memos that revise guidance for nursing home visitation and address the backlog of complaint and recertification surveys.

Practice Management

Maximizing Revenue and Relationships in the Age of Patient Consumerism: Modern Solutions to Boost Revenue Collection:Maintaining financial stability is a challenge for any healthcare provider's office, but especially in the industry's current age of patient consumerism. The increases in regulation and the transparency of medical care processes have given rise to healthcare consumerism, wherein newly empowered patients have control over their healthcare experience.

Auditing

Auditing Infusions, Hydrations, and Injections:If your facility and/or practice is providing infusion, hydration, and injection services, they should be included in your annual compliance auditing plans to ensure proper coding guidelines are being followed and documentation education is not necessary to assist with any loss of revenue gaps.

Compliance

Ransom Disclosure Act - Proposed Bill Will Require Victims to Disclose Ransom Payments within 48 Hours:Ransomware attacks increased by 62% worldwide and 158% in North America between 2019 and 2020. The FBI received approximately 2,500 ransomware complaints last year, up 20% from 2019, which identified losses of over $29 million.

Coding

Five Major ICD-10-CM Changes That Can Affect Your Organization:On October 1, 2021, the ICD-10-CM code changes became effective. This means that claims to certain health insurance payers must be updated to reflect the changes as of this date.

Coding

New COVID-19 Vaccine Codes: October Update:Recently, new Current Procedural Terminology (CPT®) codes for a ready-to-use vaccine product (tris-sucrose formulation) from Pfizer and its administration were added to previously established vaccine codes.

Coding

AMA Announces CPT Update for Pediatric COVID-19 Vaccine Candidate:The American Medical Association (AMA) today announced that the Current Procedural Terminology (CPT®) code set has been updated by the CPT Editorial Panel to include vaccine and administration codes for pediatric doses of the COVID-19 vaccine developed by Pfizer.

Billing

Modesto Looks to Join Other Fire Agencies that Bill Insurance for Responding to Calls:The Modesto Fire Department wants to bill insurance companies when its firefighters respond to car accidents, medical emergencies, fires, and other calls for service.

Coding

AMA Announces CPT Update to COVID-19 Vaccine Booster:The new CPT code for the booster dose of the Janssen COVID-19 vaccine joins unique CPT codes previously issued to COVID-19 vaccine booster doses from Moderna and Pfizer.

Coding

Not All Remote Services are Telehealth: Know Your Codes!:A year and half into the coronavirus pandemic, confusion still remains over a variety of remote services that are often lumped into the same category as telehealth but have their own unique codes and billing guidelines.

Compliance

HIPAA, COVID-19 Vaccination, and the Workplace:The Privacy Rule2 does not prohibit any person (e.g., an individual or an entity such as a business), including HIPAA covered entities and business associates, from asking whether an individual has received a particular vaccine, including COVID-19 vaccines.

Practice Management

How Can Changes in Telemedicine Financially Impact Your Practice?:The rapid evolution of telehealth services has helped keep medical practice virtual doors open to meet their patients' health needs during the pandemic. But with new utilization comes cautionary areas from a billing standpoint, and it's important to stay current on updates and compliance protocols to promote revenue growth and avoid financial loss.

Auditing

Ciox: Not a Bleach, But Not to Be Ignored:In my role as a compliance consultant specializing in carrier audit response, a lot of items are brought to my attention on a daily basis, with the bearer of said items asking questions

Coding

When is it Proper to Bill Nurse Visits Using 99211?:When vaccines or injections are given in the office, coding can often get confusing; for example, is it correct to report a nurse visit using 99211 and an E/M office visit reporting 99202-99215?

Auditing

Acute Uncomplicated vs Complicated Illness or Injury:When selecting Number and Complexity of Problems Addressed, the complication of treatment required should not be considered. The Risk of Complications of Patient Management is where the treatment options are considered in code selection.

Coding

New Administration Codes Effective Now for Third Doses of Pfizer and Moderna COVID-19 Vaccine:The American Medical Association (AMA) today announced that the Current Procedural Terminology (CPT®) code set is ready for the rollout of third doses of the Pfizer and Moderna COVID-19 vaccines. The CPT Editorial Panel has expedited approval of a new administration code that is unique to a third dose of the current COVID-19 vaccine from Moderna. A new administration code for a third dose of the current COVID-19 vaccine from Pfizer was announced by the AMA on July 30.

Billing

Billing Dental Implants Under Medical Coverage:Implants can be costly to the patient and the provider, and it is crucial to understand how to bill a patient's medical insurance to ensure there is adequate coverage for the best treatment. Implants are commonly billed in a dental office under a patient’s medical benefits.

Compliance

5 Cybersecurity Threats to Healthcare During the COVID-19 Pandemic:Digital processes and experiences persist in healthcare as the COVID-19 pandemic continues. For patients, this means paying more bills online and using virtual care options when medical attention is needed but not life-threatening.

Practice Management

MIPS - What Practices Need to Know to Avoid Financial Penalties:By law, CMS is required to structure the MIPS program such that 1 out of 2 clinicians will be penalized each year.

Auditing

Getting Serious About Compliance:By now, most health systems, practices, and providers should know that the Office of Inspector General (OIG) has been stressing the importance of creating and abiding by a compliance plan since the passage of the patient Protection and Affordable Care Act in 2010.

Coding

Chronic Pain Coding Today and In the Future:Properly documenting and coding chronic pain can be challenging. As is commonly the case with many conditions, over the years, there has been a shift in the identification of different types of pain, including chronic pain. Understanding where we are now and where we are going will help your organization prepare for the future by changing documentation patterns now.

Practice Management

The Power of Collaboration:Gone are the days of Norman Rockwell, Mayberry, and an apple pie for the good doctor as a token of appreciation for tending to little Bobby's banged up knee. Today's medical practice faces an onslaught of regulation, liability, and the newcomer to the party: cybersecurity.

Billing

HHS Announces Rule to Protect Consumers from Surprise Medical Bills:Announcement is the first in a series of regulations aimed at shielding patients from increased financial hardships stemming from surprise medical bills.

Compliance

Medical Office Safety Planning: Become Aware and Commit to Prepare:Nearly two million American workers report having been victims of workplace violence each year, and the number has only grown since the start of the pandemic. While workplace violence can strike anywhere and at any time, the risk of assault can be prevented or minimized if employers take appropriate precautions.

Coding

When is it Proper to Bill Nurse Visits using 99211:When vaccines or injections are given in the office, coding can often get confusing; for example, is it correct to report a nurse visit using 99211 and an E/M office visit reporting 99202 - 99215

Practice Management

How to Properly and Safely Terminate an Employee:As a Medical Office Manager, there are few actions as uncomfortable as firing an employee. Yet, after verbal warnings, write-ups, and other corrective actions, you know when this time has come to gather your documentation and make difficult decisions about how and when to proceed.

Auditing

As Pandemic Eases, OIG Ramps Up Audits:With Americans having widespread access to effective vaccines, the COVID-19 pandemic is finally fading into the background for most practices, but the issue of compliance is once again rearing its multi-faceted head.

Coding

Diagnostic Coding for Gastroparesis: A Chronic Syndrome of Gastrointestinal Tract:

Stomach muscles controlled by the Vagus nerve move the food via the Gastrointestinal (GI) tract. Disruptions can occur to the normal functioning of the stomach muscles if any specific damage to the Vagus nerve occurs.

Coding

Evaluation and Management - Series Four:This is the fourth in the Evaluation and Management Series for Office/Outpatient Visits 99202-99215.

Coding

Evaluation and Management - Series Three:This is the third in the series for 2021 Evaluation and Management for Office/Outpatient Services and Prolonged Care.

Billing

Case Study: Managing Patients, Payments, and a Pandemic:The COVID-19 pandemic has accelerated demand for contactless experiences that are both digital and convenient across the entire range of patient interactions. However, one of the strongest preferences expressed by healthcare consumers-for online systems to receive and pay bills-has been largely unmet because of legacy mechanisms that require patients to interact with staff and decipher often-confusing paper statements.

Coding

Since When did Dental Claims Require Diagnosis Codes?:The objective of the Accountable Care organization is to integrate and consolidate patient care management to improve patient outcomes. Changes and coordination of dental and medical care are already becoming more apparent when dental offices are being required to bill a patient's medical plan for dental visits due to an accident, trauma, sleep apnea, cancer treatment, or oral surgery.

Compliance

Take Your Data Back: Empowering Healthcare Practices, Systems, and Providers:It's safe to say: today's data in healthcare is big. Physicians, practices, and systems generate massive amounts of data that capture not only detailed patient care, but also corresponding billed claims to insurance carriers, radiology images, electrocardiogram readings, clinical trial data, and so much more.

Compliance

Evaluating the Promise of Telehealth: Pandemic Physician Practice Lifesaver Gives Way to Billing, Regulatory Scrutiny:During the worst of the global pandemic, telehealth likely saved many physician practices from financial ruin. Telehealth also kept patients from risking their lives trying to access routine medical, occupational, and mental healthcare.

Practice Management

Clean Claims: Part VI of the Back to Basics Series:Charles R. Swindoll, American author and radio personality, famously said, "The difference between something good and something great is attention to detail." When we think of revenue cycles, he is absolutely correct!

Practice Management

Shining Light on the Physician Open Payments Program (f/k/a Sunshine Act) and False Claims Act Violations:As part of its obligation to implement Section 6002 of the Affordable Care Act-the Physician Payment Sunshine Act

Coding

DERMATOLOGY ON OIG WORK PLAN:Dermatology practices have been specifically named in a recent project added to The Office of Inspector General (OIG) Work Plan. The project is evaluating whether Dermatology practices are overusing modifier 25 in order to report E/M visits when minor procedures are performed.

Compliance

Best Practices for Managing the Insider Threat in Healthcare:The effects of the COVID-19 pandemic have forced changes in many aspects of society. Two areas that have seen significant change involve how people work and obtain healthcare. Remote work and healthcare solutions were adopted wherever possible to slow the spread of the virus by limiting face-to-face contact.

Coding

The Coder: The Hidden Revenue Generator:Businesses must reduce expenses and increase revenue to maintain growth and a competitive position. The medical field is a business with multiple added issues. Businesses face the expenses of rapidly increasing technology, an aging population, an ever-demanding expectation, and changing payer rules that risk delays, denials, and audit exposure.

Coding

Important Changes to Shared/Split Services:As you may be well aware, a split or shared E/M encounter refers to a face-to-face E/M encounter where an encounter is performed by both a nonphysician practitioner (NPP) (e.g., midlevel, QHP, NP, PA, CNS) and a physician. Reporting of split (or shared) services has always been wrought with the potential for incorrect reporting when the fundamental principles of the service are not understood.

Practice Management

Justice Department Announces New COVID-19 Medicare Fraud Enforcements:The U.S. Department of Justice (DOJ) on May 26 announced law enforcement actions for several COVID-19-related Medicare fraud schemes totaling $143 million. The actions involved the exploitation of Centers for Medicare and Medicaid Services (CMS) policies designed to increase access to care during the COVID-19 pandemic.

Compliance

5 Ways To Minimize HIPAA Liabilities:Last year was historic for HIPAA enforcement. The HHS Office of Civil Rights collected a record $23.5 million in settlements and judgments against providers guilty of HIPAA violations. To avoid becoming part of that unwanted statistic, it's important to pay extra close attention to five key areas of HIPAA vulnerability.

Coding

PCS Coding for Ankle Fracture - Look Deeper Into the Codes:If you're looking for ankle fractures in ICD-10-PCS, you may need to look a little deeper. Let's take a look at coding an ankle fracture such as a trimalleolar fracture. PCS coding can be confusing as it is nothing like CPT coding; with CPT we can simply code an ankle fracture.

Practice Management

Tips for Better Revenue Cycle Management in a Medical Office:How would you characterize the success of your medical office? Is it a steady flow of patients, low denials, providers that take an active role in the business, a great clinical and administrative team? How about the financial health of the practice? It's hard to guide the ship in the right direction when you are too busy plugging holes in the galley.

Coding

Use of - Time - in Evaluation Management and Coding:The time has come for you to consider the "new time" method to determine the evaluation and management (E&M) coding for your office and other outpatient services. I use the phrase "new time" to differentiate it from the "old time" concept you are accustomed to working with.

Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Anthem Community Insurance Company, Inc. (Contract H3655) Submitted to CMS:Under the Medicare Advantage (MA) program, the Centers for Medicare & Medicaid Services (CMS) makes monthly payments to MA organizations according to a system of risk adjustment that depends on the health status of each enrollee.

Compliance

Information Blocking and Patient Access to Data:April 5th 2021 was a major day in the history of patient data access. On that day, providers, vendors, and health information networks were required, under federal regulation, to make patient data available electronically to patients.

Auditing

OIG Plans for Onslaught of Risk Adjustment Audits Claiming 9.5% Error Rate in Code Assignment:According to an Office of The Inspector General Report, the Centers for Medicare & Medicaid Services (CMS) estimate that 9.5% of all payments to Medicare Advantage organizations are improper due to unsupported diagnoses submitted by the organizations themselves.

Coding

CPT code 91304:CPT code 91304 will be effective for use on the condition that the Novavax COVID-19 vaccine receives approval for emergency use authorization, AMA said in the press release.

National Women's Health Week: Promote Healthy Choices:Women are different from men and so are some of the health concerns they face. Besides having reproductive health needs and issues, women are at higher risk of being diagnosed with certain diseases than men.

Auditing

Auditing for Success: Part V of the Back to Basics Series:If the words "medical record audit" conjure up images of high anxiety and pounding headaches, this Back to Basics article is especially for you. For some managers, having their medical records audited is a high stress event.

Coding

Evaluation and Management Services in 2021 - Unraveled: Part One:This is the first in a 4-part series of explaining the components of Evaluation and Management Services 99202-99215 for 2021. The series will include time, number of management options addressed, amount and/or complexity, and analysis of data and risk.

Practice Management

Understanding the Importance and Benefits of Diversity for the Healthcare:Diversity and inclusion are terms that have been used widely in a variety of contexts, but these concepts have only been intertwined into the discussion in healthcare in the recent past.

Practice Management

Combating Pandemic Fatigue with Efficiency and Clarity:For several months, most people have had to direct significant time and effort toward restructuring their work and personal lives to survive and accommodate the ongoing pandemic.

Practice Management

Why Will Medicare Administrative Contractors be Holding Claims Up?:When Congress passed the expansive American Rescue Plan Act last month, most Americans were focused on the direct payment provision of the bill.

Practice Management

How Patient Appointment Reminders are Changing the Healthcare Industry:Patient appointment reminders are changing the healthcare industry. In the past, providers have had to work hard to make sure their patients make it to their upcoming appointments.

Coding

Q/A: For E/M, How do I Count Tests Ordered in One Department and Performed in Another?:Question: I am in an ENT office as part of a large clinic with separate practices including audiology, CT, and allergy, all billing under the same TAX ID. Sometimes tests are ordered which are done in other departments that my office does not bill for, would those be considered an outside source

Billing

Avoid These Top 5 Medical Billing Mistakes:Even the most organized healthcare organizations can still fall victim to the most common medical billing mistakes in the industry. Providers who have in-house billing services know the administrative burden that comes with it.

Coding

When Denials Attack: Outpatient E/M Services Denied with 2020 Rationale:We now collectively find ourselves one calendar quarter into the new frontier of 2021 outpatient E/M services.

Practice Management

8 tips to stay up-to-date with clinical innovations:Medical innovations and technological breakthroughs are rapidly evolving. This includes new and emerging treatments, devices, drugs, and other technologies that can make a real difference in patients' lives.

Coding

Four Telehealth CPT Codes Removed From CMS Medicare Coverage List:Here are the four CPT telehealth service codes that were taken off:

Coding

58% of Improper Payments due to Medical Necessity for Ventilators:Proper documentation not only protects the provider, the payer, and the patient, it protects the integrity of the entire healthcare system.

Practice Management

Information Blocking: Everything Providers Should Know to Ensure Compliance:In December 2016, Congress passed the 21st Century Cures Act (often simply called the "Cures Act"). Woven within the Cures Act is Section 4004 titled "Information Blocking."[1] The purpose of this section is to prohibit any action or practice that interferes with or prevents access to electronic health information (i.e., information about a patient's medical history or treatment).

Billing

Why Will Medicare Administrative Contractors be Holding Claims Up?:When Congress passed the expansive American Rescue Plan Act last month, most Americans were focused on the direct payment provision of the bill.

Billing

Avoid These Top 5 Medical Billing Mistakes:Even the most organized healthcare organizations can still fall victim to the most common medical billing mistakes in the industry. Providers who have in-house billing services know the administrative burden that comes with it.

Practice Management

CDI From a Different Perspective:Let's take a look at CDI from an outside and engineering perspective. I am not a CDI expert. In fact, let's say I'm dangerously knowledgeable of CDI. However, that doesn't disqualify me to evaluate the system and make recommendations.

Coding

Why Reporting E/M Based on Time May Not Be Beneficial:Just like math teachers who require students to show their work so they can see how the student reached their answer, providers are also required to "show their work" through the documentation process in the medical record.

Billing

The Pain of an Unfaithful Billing Partner:In the vast majority of business and industry, the entity itself takes full responsibility for invoicing (billing) its customers or clients. Hospital-based physician practices are uniquely different.

Coding

How to Properly Report Prolonged Services Using 99417 or G2212:Prolonged Evaluation & Management codes underwent big changes in 2021, including the creation of a new prolonged code (99417), reportable only with codes 99205 or 99215.

Billing

Consolidated Appropriations Act Brings New Relief for Providers:After the release of the Final Rule December 2, 2020, physicians across the country were feeling the pinch of a 10% reduction in the MPFS.

Practice Management

Chasing Patient Payments: Learn How to Reduce Your Costs:Patients today, struggling to afford expensive high deductible health plans, rising co-pays, and in-network fees, sure do miss the glory days of $10 co-pays and well covered, affordable health insurance.

Compliance

Relaxing of the PHI Protections Introduced for Public Comment:In early January, the Department of Health and Human Services (HHS) submitted a 357-page proposal for publication to the Federal Register detailing proposed changes to the Privacy Rule under the HIPAA & HITECH Act standards.

Practice Management

CMS Supports the State of Texas After Winter Storm:CMS announced recently after severe winter storms affected Texas that support efforts are in progress following the Texas PHE, retroactive to February 11, 2021. CMS has been working to ensure that hospitals and other healthcare facilities can maintain operations and provide care to patients despite any effects of the winter storm.

Coding

Most recent changes to the CPT® Category I New Vaccine Codes Long Descriptor document:Addition of February 27, 2021 effective date for codes 0031A and 91303. Guidelines and parenthetical notes are only effective for codes that have received FDA Emergency Use Authorization (EUA) approval.

Coding

COVID-19: Revised Clinician Codes Accepted with CS Modifier:Effective March 18, 2020, the Families First Coronavirus Response Act requires Medicare Part B to cover beneficiary cost-sharing for provider visits when a COVID-19 diagnostic test is administered or ordered.

Compliance

5 Ways To Minimize HIPAA Liabilities:Last year was historic for HIPAA enforcement. The HHS Office of Civil Rights collected a record $23.5 million in settlements and judgments against providers guilty of HIPAA violations.

Billing

Critical Care Billing: It's the Little Things:Critical care billing is relatively simple. Documentation requires three items -

Coding

Why Reporting E/M Based on Time May Not Be Beneficial:Just like math teachers who require students to show their work so they can see how the student reached their answer, providers are also required to "show their work" through the documentation process in the medical record.

Coding

February Is American Heart Month - Focuses on Cardiovascular Health:The 2021 campaign acts as the perfect platform to educate people about the different types of cardiovascular disease. Coronary heart disease (CHD) (also called coronary artery disease (CAD) is regarded as one of the most common forms of heart disease that affect people.

Practice Management

Interview with Administrator of the Centers for Medicare & Medicaid Services (CMS), Seema Verma:The PFS final rule continued CMS's historic efforts to reduce burden and compensate providers for the important work of managing their patients' complex conditions. Last year, CMS increased payment rates for evaluation and management visits, reflecting the most significant revision in payment to the E/M codes since they were instituted.

Coding

AMA Announces Update to COVID-19 Vaccine CPT Codes:The American Medical Association (AMA) announced that the Current Procedural Terminology (CPT®) code set is being updated by the CPT Editorial Panel to include vaccine and administration codes that are unique to the COVID-19 vaccine candidate under development by Janssen Pharmaceutica, a division of Johnson & Johnson.

Coding

E/M 2021: A New Year Brings Some Big Changes:After a year filled with new regulations, new rules, new financial models, new viruses, and new ways of interacting remotely with patients, New Year's Day brings one final present: a package of new guidelines for E/M coding.

Practice Management

Surviving Your Shift: Seven Things Healthcare Workers Can Do to Make It Through the Workday During COVID:Mark Goulston, MD, and Diana Hendel, PharmD, share simple strategies and hacks to help frontline workers manage traumatic stress and stay calm and centered at work.

Practice Management

Get Ready: 1135 Waivers, Licensing Extensions Ending Soon:HHS recently extended the Public Health Emergency (PHE) into January 2021, keeping the 1135 waivers - including licensing requirements - in place, for now.

Coding

Documenting Bronchiolitis - A Common Pediatric Respiratory Infection:Regarded as a common lower respiratory tract infection in young children and infants, bronchiolitis causes inflammation and congestion in the small airways (bronchioles) of the lung.

Coding

Better late than never: Stimulus bill saves pain of conversion factor cut, also delays G2211:The 2021 Physician Fee Schedule (PFS) had included the largest one-year reduction to the Medicare conversion factor (CF) in more than 20 years, but it won't actually take effect because the CF is being increased as a result of provisions in the recently passed stimulus legislation.

Coding

CPT Code Changes for Radiology in 2021:Efficient reporting and proper reimbursement for radiology services depend on understanding the CPT codes for this specialty.

Compliance

Relaxing of the PHI Protections Introduced for Public Comment:The Department of Health and Human Services (HHS) this week submitted a 357-page proposal for publication to the Federal Register detailing proposed changes to the Privacy Rule under the HIPAA and HITECH Act standards.

Coding

AMA Announces Additional CPT Codes for COVID-19 Vaccines:The American Medical Association (AMA) today announced that the Current Procedural Terminology (CPT®) code set is being updated by the CPT Editorial Panel to include immunization and administration codes that are unique to the COVID-19 vaccine under development by AstraZeneca and University of Oxford.

Coding

CLARIFICATION: CMS Releases 2021 Final Rule:At long last, CMS has published its Medicare Physician Fee Schedule (PFS) final rule, and while some of the provisions will be widely felt across many specialties, there are no major or unexpected deviations from the proposed rule. The agency typically releases the PFS final rule at the end of October or in the first two weeks of November.

Coding

CDT and CPT - The Same but Different!:Reporting a CPT code for an evaluation of a patient is based on time and if the patient is a new or established patient. Evaluation and Management codes are different than other codes, so it is important to understand how they are used.

Practice Management

All The Ways MHealth Is Changing Healthcare:A few years ago, the World Health Organization (WHO) touted mHealth-healthcare supported by digital mobile devices-as a new technology to aid in the delivery of telehealth, enhance the efficiency of call centers in hospitals, and help healthcare professionals respond to natural disasters.

Billing

Coronavirus Vaccine Update - Billing Codes:The American Medical Association approved two coronavirus vaccine CPT Codes, 91300 and 91301. Two codes are being used to better track, report, and analyze data for the planning and allocation of vaccines for coronavirus.

Practice Management

Top Healthcare Trends for 2021:The new year is here! 2021 is expected to bring enormous satisfaction around the world. As 2020 didn't turn out to be a fair game, everyone's hope is toward 2021.

Practice Management

How to Improve the Patient Experience in 2021:The patient experience has been deeply impacted by the state of the world in 2020. The pandemic changed how we view patient care forever, and as it continues to unfold, we will learn what the future holds.

Compliance

Part II - OSHA and HIPAA :There has never been a better time than the present to look closely at our practice operations to see where we need to focus our efforts for system process improvements.

Practice Management

Part I - Emergency Preparedness:As our nation and the rest of the world are still reeling from the effects of COVID-19, medical office managers are tasked with making sure that our practices are prepared for the next emergency that will undoubtedly occur.

Coding

COVID-19 Testing: False Positives are Definitely a Negative!:The assisted living facility (ALF) went on lockdown, and we all were waiting to see if our loved ones would become symptomatic.

Practice Management

Will Someone Please Take Care of My Patients?:There was a time many years ago when a patient followed the direction of their physician and accepted the referral they were given to see a specialist.

Practice Management

3 Ways Automation is Taking Excess Workload Off Physicians and Preventing Burnout:Patients place their trust in physicians to help them assess their health, obtain treatment, and simply be well every day.

Practice Management

Monitor Collections to Improve Practice Bottom Line:As the healthcare industry continues to change, one area that demands constant attention is practice collections.

Practice Management

Staying Inspired on the Front Lines of Healthcare: 7 Things to Do When You’re Struggling:The life of a healthcare professional has never been easy. Now, though, it’s hard in a way that would have been unimaginable before.

Coding

AMA Announces Vaccine-specific CPT Codes for Coronavirus Immunizations:The American Medical Association (AMA) today published an update to the Current Procedural Terminology (CPT®) code set that includes new vaccine-specific codes to report immunizations for the novel coronavirus (SARS-CoV-2)

Coding

Prepare Now for Gray Areas in 2021 E/M Rules:It's not even 2021 yet, but gray areas have already surfaced in the 2021 E/M documentation guidelines, as more and more coders and auditors read the fine print. The 2021 guidelines, which will apply only to outpatient/office visit codes 99202-99215, are being implemented in part to eliminate so-called

Practice Management

One of The Best Strategies for Risk Adjustment Medical Coders: Query the Physician or Other Healthcare Provider:Medical records report the care a patient received in a chronological order and are used to record pertinent findings and observations about the patient's health history. Medical record documentation assists physicians and other healthcare professionals in evaluating and planning the patient's immediate treatment and monitoring the patient's healthcare over time. Therefore, the medical documentation is essential and must be clear and concise.

Billing

Strategies to prevent revenue loss in Gynaecology Billing!:What's the main strategy used for Obstetrics and Gynecology billing procedures

Practice Management

The Financial Impact Of COVID-19 On Healthcare:The financial impact of COVID-19 poses yet another threat to an already strained healthcare system. Even prior to the pandemic, healthcare costs were a major challenge.

Billing

How Covid-19 increased value for Telemedicine billing?:Do you think the current pandemic has added more value for telemedicine services

Practice Management

How Value-Based Care Can Impact Mental Health:Value-based care has revolutionized the healthcare industry. This model rewards providers for achieving positive outcomes with their patients and clients. It promotes helping a patient reduce the impact of chronic disease or achieving overall positive results rather than the traditional fee-for-service model.

Coding

Focus Providers on Clinically Relevant History and Exam, and Concise Medical Decision Making:It's fair to say the 2021 changes to the E/M documentation guidelines ease the documentation burden on the rendering provider for certain aspects of the note.

Practice Management

How Digital Patient Engagement Solutions Improve the Patient Experience:A digital patient engagement solution can improve the patient experience. The growing use of digital solutions are helping providers reach their patients now a deeper level.

Coding

New Codes for Cytokine Release Syndrome (CRS):Cytokine release syndrome (CRS), sometimes referred to as a cytokine storm, is a systemic inflammatory response triggered by a variety of reasons such as infections, certain drugs, or after treatment with some types of immunotherapy, (e.g., monoclonal antibodies and CAR-T cells).

Coding

All you need to know about Telemedicine Coding:It's confusing to understand what are the telemedicine codes applicable for the services rendered. Though telemedicine is booming in the current scenario, it's very crucial and essential to learn about telemedicine coding for quicker reimbursements.

Practice Management

Branding Your Physician Practice:Never before has the public been more aware of medical technology and what it offers; nor have healthcare practitioners had such opportunities for practice growth.

Coding

Step by step guide to handle Dental Coding:Did you know that dental coding remains as a crucial area for many dental practices? It also counts the ability to code various procedures for proper reimbursements. To be clear at the point, accurate coding is often critical and also confusing. Dental coding involves different set of codes unlike medical billing.

Coding

Big Changes are Coming in Payment and Documentation Guidelines:The Centers for Medicare and Medicaid Services finalized their Fee Schedule, which included some significant changes to reimbursement and documentation requirements for evaluation and management, also known as E/M office visits.

Practice Management

Office of Inspector General Says Medicare Advantage Organizations are Denying Services Inappropriately:We attended the recent virtual RISE National Conference and had the opportunity to listen to presenters share their knowledge about risk adjustment and HCC reporting and data validation.

Practice Management

Contracting and Credentialing: The Often-Neglected Keys to Practice Success:Independent practices have been facing unprecedented challenges, especially in today's pandemic-based reality

Practice Management

Proper Phone Etiquette Can Be a Rude Awakening:It happens to all of us. We call a business and hope to get something done. Instead, the result is annoying, frustrating, and a time sap. Let's face it. Sometimes you just want to throw your phone against the wall.

Practice Management

Why Practices are Switching to Digital Patient Intake Forms:A comprehensive collection of patient data is essential to the patient-provider relationship. The collection of patient health information helps providers get an idea of who their patient is and how to treat them.

Coding

AMA announces new CPT codes as COVID-19 advancements expand:The American Medical Association (AMA) today published an update to the Current Procedural Terminology (CPT®) code set that includes two code additions for reporting medical services sparked by the public health response to the COVID-19 pandemic.

Coding

CMS to Require Positive COVID-19 Test Results for 20-Percent Medicare Add-on Payment:The Centers for Medicare & Medicaid Services (CMS) started rolling out post-payment audits again, as of Aug.

ICD-10

ICD-10 MS-DRGs Version 37.2 Effective August 01, 2020:In response to the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) is implementing 12 new procedure codes

Coding

COVID-19/coronavirus codes:86328 Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

Practice Management

What Does the Future of Patient Engagement Look Like?:The future of patient engagement is Artificial Intelligence or AI. While patients hold some of the responsibility for how involved they are in their care, providers play an essential role.

Coding

Coding Injections for Pain Management:Coding for pain management can get confusing. How many injections, the location, and when to use a modifier are all common questions. This article will cover some of the most common injections used in pain management.

Practice Management

Contracting & Credentialing: The often neglected keys to practice success:Independent practices have been facing unprecedented challenges, especially in today's pandemic based reality.

How to switch your Medical Billing Services to Best Revenue Cycle Management Companies:Is your medical billing service the main reason for revenue loss? If so, then you should probably look to shift your billing services to one of the best revenue cycle management companies that boosts your revenue without any hassle.

Practice Management

How Cloud Computing Is Connecting People Amidst the Covid-19 Pandemic:What was initially brushed off as an abnormal kind of flu soared into a global pandemic that has now affected almost every corner of the world.

Practice Management

Considerations for Reopening Physician Practices:As some states have begun relaxing their stay-at-home orders and are gradually reopening businesses, you may be preparing to reopen your practice as well.

Practice Management

3 Ways to Automate Front Office Tasks:Healthcare front offices are a hive of nonstop, vitally important activity. Reception duties, appointment scheduling, coding and billing, and collection of patient information are just a few of the critical responsibilities shouldered by front office personnel.

Practice Management

Getting Your Practice Back on Track:The COVID-19 pandemic has changed the face of business, and while it has certainly been a challenge to keep up with the ever-changing regulations (that are likely to continue for a little longer), exciting new opportunities have also been created, such as the expansion of telemedicine.

Coding

Use the Correct Diagnosis Codes and Revenue Codes to Get Paid for PAD Rehab:The initial treatment in rehabilitation for patients suffering from Intermittent Claudication (IC) is Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD).

Practice Management

Social Distancing, The Wave of The Future:The Coronavirus Pandemic has already made changes to our way of life, with some being for the better, and some for the worst.

Compliance

5 Ways the Patient Portal Benefits Providers During a Pandemic:The use of digital and virtual medical services has skyrocketed during the coronavirus pandemic.

Coding

Medical Necessity, MDM, and 2021 E/M Changes:

By now everyone has heard that we will no longer have to score history and exam components to determine an EandM code level for the office/outpatient CPT codes 99202-99215, beginning January 1, 2021.

Practice Management

How Private Practice can Thrive during COVID 19 and Beyond:From the early stages of the COVID-19 pandemic, healthcare providers have been reaching out to us expressing some of the most difficult decisions they have ever been faced with; Practices are struggling to keep their doors open as costs mount, and revenue has fallen significantly.

Practice Management

How Healthcare AI can prepare for the Future Pandemic:In the future, artificial intelligence (AI), that can sense or predict a disease outbreak (pandemic) from stopping its early outspread, will dominate the healthcare industry. In the early decades, there was a time when people lacked medical services and technology in a disease outbreak.

Billing

Improve Patient Billing Experience in a Medical Practice:While many practices often think about revenue cycle management from a dollars-collected standpoint, looking at the patient's satisfaction with their financial experience is critical, too.

Coding

Use the Correct Diagnosis Codes and Revenue Codes to Get Paid for PAD Rehab:The initial treatment in rehabilitation for patients suffering from Intermittent Claudication (IC) is Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD).

Coding

CMS- Reminder COVID Assessment and Specimen Collection:On March 1, 2020, new codes and rules were released to bill for COVID-19 symptom and exposure assessments, as well as specimen collection.

Coding

2021 E/M Changes: Defining the Differences:The hype surrounding next year's implementation of new guidelines for documenting and coding Evaluation / Management (E/M) services has revolved around the virtual elimination of the history and physical exam as key components of code selection.

Compliance

Secure Payment Processing to Protect Patient Privacy:Secure-Payment-Processing-to-Protect-Patient-PrivacyHIPAA's Privacy and Security Rules specify 18 data elements that an individual could use as a means to determine a patient's identity.

Coding

COVID-19 Diagnostic Laboratory Tests: Billing for Clinician Services:Physicians and Non-Physician Practitioners (NPPs): Here are several reminders related to billing for COVID-19

Compliance

5 Ways To Minimize HIPAA Liabilities:Last year was historic for HIPAA enforcement. The HHS Office of Civil Rights collected a record $23.5 million in settlements and judgments against providers guilty of HIPAA violations. To avoid becoming part of that unwanted statistic, it's important to pay extra close attention to five key areas of HIPAA vulnerability.

Practice Management

Finding the Positive in the New Normal - Walking Early into 2020:During the rapid pivot to telehealth services during the COVID-19 pandemic, one of the biggest priorities has been staying on top of the array of CMS and private payer rules to ensure these services were payable.

Coding

A Closer Look at 2021 Outpatient and Office E/M Coding:If you code evaluation and management (E/M) services, you've probably already heard that significant changes are ahead in 2021, specifically for office visits.

Coding

Where is the CCI Edit with Modifier 25 on E/M?:If you are not seeing a CCI edit when reporting an E/M code with a certain procedure, it may be that there is no edit. CMS does not have a CCI edit for every CPT code, however, there are still general coding rules that must be followed.

OIG Strategic Plan: Oversight of COVID-19 Response and Recovery:

The emergence of coronavirus disease 2019 (COVID-19) has created unprecedented challenges for the Department of

Health and Human Services (HHS) and for the delivery of health care and human services to the American people. HHS

leads the Federal public health and medical response during public health emergencies.

Coding

Where is the CCI Edit with Modifier 25 on E/M:If you are not seeing a CCI edit when reporting an E/M code with a certain procedure, it may be that there is no edit. CMS does not have a CCI edit for every CPT code, however, there are still general coding rules that must be followed.

Billing

Packaging and Units for Billing Drugs:To determine the dosage, size, doses per package and how many billing units are in each package, refer to the NDC number.

Coding

Medicare Administrative Contractor (MAC) COVID-19 Test Pricing May 19, 2020:

On March 5 and February 13, CMS announced new Healthcare Common Procedure Coding System (HCPCS) codes for healthcare providers and laboratories to test patients for SARS-CoV2.

Coding

Coding and Compliance Audits During COVID-19:Over the past month I have heard comments wondering why we would continue to audit during the COVID-19 public health emergency (PHE).

Practice Management

Back to Basics - A Series Presented by your PAHCOM National Advisory Board:As our nation and the rest of the world are still reeling from the effects of COVID-19, medical office managers are tasked with making sure that our practices are prepared for the next emergency that will undoubtedly occur.

Practice Management

Opening Up America Again - CMS unveils Flexibilities for Resuming Non-emergent Care:Following the outbreak of the COVID-19 pandemic in the U.S. a month ago, the Centers for Medicare & Medicaid Services (CMS) issued an array of temporary regulatory waivers and new rules to provide the nation's healthcare system with maximum flexibility to deal with this public health emergency.

Billing

Best Practices to Keep Your Remote Work Strategy and Cash Flow Moving Forward:

Many of us have had to change the way we work to serve clients at warp speed over the past few weeks. Our ability to do so by pivoting quickly is proof of our inherent resilience.

Practice Management

In response to COVID-19, RxVantage adds Virtual Meetings to connect healthcare providers to life science experts:

Free service builds on the company's commitment to making it easier for HCPs to engage the precise life sciences expertise, information, and resources they need.

Compliance

AHIMA's Perspective on Information Blocking Rule:Earlier this month, the Office of the National Coordinator (ONC) finalized the long-awaited information blocking rule in the 21st Century Cures Act.

Coding

Transitional Care Management:

There are three kinds of care for a Medicare patient after being an inpatient.

Billing

Everything You Need to Know About Co-Pay Accumulators:Since last year, CMS has proposed rules that would limit or eliminate the practice of applying the value of discount coupons for brand-name pharmaceuticals to patients' insurance deductibles.

Practice Management

COVID-19 & Medical Practices:Updating Protocols for Rep Engagement and Communication:As the world enters uncharted territory with COVID-19, we at RxVantage would first and foremost like to thank you for all that you do every day to keep us, our families, our friends, and our communities healthy and safe.

Practice Management

Ways to Introduce Telehealth to Patients:

The following recommendations must be adapted to the developmental age of the patient:

Practice Management

The 3 Greatest Obstacles Facing Private Practices and the Simplest Way to Solve Them:

We all know that the need to maximize profits and volume has depersonalized the healthcare industry.

Practice Management

Setting The Scene: Telehealth:

Minimize any potential distractions in view of the camera in your workspace. Similarly, encourage caregivers to minimize distractions in the room where the patient will be completing the session.

Compliance

FBI Warns of Teleconferencing and Online Classroom Hijacking During COVID-19 Pandemic:As large numbers of people turn to video-teleconferencing (VTC) platforms to stay connected in the wake of the COVID-19 crisis, reports of VTC hijacking (also called "Zoom-bombing") are emerging nationwide.

Practice Management

How Poor Payer Reimbursements are Affecting Practices During the COVID-19 Pandemic:

Most physicians who have been practicing for a few decades remember the days when private payer reimbursements dwarfed Medicare reimbursements. That dynamic has long since flipped, starting with the 2008 recession.

Coding

Special COVID Laboratory Specimen Coding Information:

With all the new laboratory test codes that have been added due to the current public health emergency (PHE), there are a few additional guidelines CMS has released about collecting samples to perform the testing. Please keep in mind that these guidelines are by CMS and may or may not apply to other commercial payer policies.

Practice Management

Trump Administration Issues Second Round of Sweeping Changes to Support U.S. Healthcare System During COVID-19 Pandemic:

At President Trump's direction, and building on its recent historic efforts to help the U.S. healthcare system manage the 2019 Novel Coronavirus (COVID-19) pandemic, the Centers for Medicare & Medicaid Services today issued another round of sweeping regulatory waivers and rule changes to deliver expanded care to the nation's seniors and provide flexibility to the healthcare system as America reopens.

Coding

That Is How We've Always Done It:

Over the years I have found that one of the main risks to an organization are employees who get comfortable in their positions to the point where the explanation for or response to an audit variance is "that is how we have always done it."

Coding

ICD-10 Codes to Document Lobar Pneumonia this COVID-19 Season:

Pneumonia refers to an infection that inflames the air sacs in one or both lungs whereas Lobar pneumonia refers to a form of pneumonia that affects a specific lobe or lobes of the lung.

Practice Management

5 Ways the Patient Portal Benefits Providers During A Pandemic:

The use of digital and virtual medical services has skyrocketed during the coronavirus pandemic. The ability to communicate with and treat patients remotely is essential to the fight against COVID-19 and tools like telehealth and the patient portal have proven themselves extremely valuable.

Practice Management

How to stay calm during COVID-19 Pandemic:It can be more hazardous and perilous for the world to get back to it's early routine. The devastating problems and crisis that the world is heading through was never predicted.

Practice Management

What Is Block Scheduling for Medical Practices?:Every medical practice is always searching for ways to be more efficient and provide the best care possible.

Practice Management

The Tele-front: How Telehealth is Helping Fight COVID-19:

The need to connect with physicians does not stop amidst a global pandemic. The use of telehealth is helping to bridge the gap between patients stuck at home and their providers during this time and is acting as a critical tool in the fight against COVID-19.

Practice Management

The importance of CDI during the Covid-19 Pandemic and Beyond:

Capturing the complexity of care with CDI will be more important than ever.

Practice Management

CMS Issues Recommendations to Re-Open Health Care Systems in Areas with Low Incidence of COVID-19:

The United States is experiencing an unprecedented public health emergency from the COVID-19 pandemic.

Practice Management

80 New Telehealth Services Now Covered for Medicare Members:The Centers for Medicare and Medicaid Services (CMS) has taken action to prepare the US healthcare system for the surge in patients, related to the coronavirus pandemic.

NEWS ALERT - CMS COVID-19:Here is a summary of recent Centers for Medicare & Medicaid Services (CMS) actions taken in response to the 2019 Novel Coronavirus (COVID-19), as part of the ongoing White House Task Force efforts.

Coding

ICD-10-CM Diagnosis Coding for COVID-19:The Centers for Disease Control and Prevention (CDC) released its ICD-10 guidelines for COVID-19, using the newly adopted code U07.1. You can find the CDC’s guidance document here.

Practice Management

CMS Suspends Contract-Level RADV Audits Temporarily:Centers for Medicare and Medicaid Services (CMS) announced to all of the Medicare Advantage Organizations and Part D Sponsors that effective immediately, it 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.

Coding

CPT Coding Guidance on New Lab Code for COVID-19:The Addition of one Category I Pathology and Laboratory code (87635) for severe acute respiratory syndrome coronavirus

Coding

New CPT, HCPCS and ICD-10-CM Codes for COVID-19:

There are seven (7) new codes for reporting COVID-19. All of these codes are effective at this time for reporting COVID-19 testing procedures and testing results.

Practice Management

CMS Implements Broad Regulatory Flexibilities to Respond to COVID-19 National Emergency:CMS has announced several temporary regulatory changes to support the healthcare industry during the COVID-19 public emergency.

Compliance

HIPAA and COVID-19 Exposure - A Critical Read!:

I have just been notified by one of my clients and I am furious! A patient who was thoroughly screened on the phone and by essential staff prior to their face-to-face with the physician and answered "No" to all of the questions but during the visit slipped up during a casual conversation and told the provider they were on day-2 of a mandatory quarantine due to working in a nursing home and being exposed to patients confirmed with COVID-19.

Coding

CMS is no longer requiring POS 02 for telehealth services during this Public Health Emergency:

Just released March 31, 2020 (TODAY) CMS is no longer requiring POS 02 for telehealth services during this Public Health Emergency, however report the place of service consistent with what would have been reported. Each claim should include reporting of the 95 modifier.

Practice Management

Physicians Assistants and Telehealth/Telemedicine:

There has been much discussion over the past several days that CMS omitted PAs from Telehealth/Telemedicine service because they were not qualified to render the services. But it appears that guidance is wrong.

Coding

ICD-10-CM Official Coding Guidelines - Supplement Coding encounters related to COVID-19 Coronavirus Outbreak:Introduction The purpose of this document is to provide official diagnosis coding guidance for health care encounters and deaths related to the 2019 novel coronavirus (COVID-19) previously named 2019-nCoV.

Practice Management

COVID-19 Healthcare Planning Checklist :

Planning for a potential emerging infectious disease pandemic, like COVID-19, is critical to protecting the health and welfare of our nation.

Billing

Demystifying Price Transparency and Patient Billing:Competitive pricing is one of the most important aspects of a capitalist economy.

Coding

Risk Adjusted Coding: Improvement Activities and Promoting Interoperability Performance Measures of MIPS 2020:

MIPS is the program that will determine Medicare payment adjustments. Using a composite performance score, eligible clinicians (ECs) may receive a payment bonus, a payment penalty, or no payment adjustment. Improvement activities account for 15% of the total MIPS score and promoting interoperability accounts for 25%. Both proportions are unchanged from 2019.

Compliance

Third Party Risk Management and the FTC's "New & Improved" Data Security Orders:

Cybersecurity and the related technical, administrative, and physical safeguards, which are required under a plethora of law ranging from the Health Insurance Portability and Accountability Act (HIPAA) to the California Consumer Protection Act (CCPA) to the Federal Trade Commission's Data Security Orders (FTC's Data Orders), is receiving heightened attention from regulators.

Coding

Who Knew? There are Three Types of Add-On Codes:Using add-on codes with HCPCS/CPT is not as simple as 123! Although there are three different groups of add-on codes assigned by CMS

Billing

5 Ways to Improve Patient Retention Rates in the Digital Age:

As we enter 2020, providers are struggling now more than ever to maintain their patient retention rates. Millennials are transitioning into a stage in life where finding a quality physician is important to them.

Coding

Five Changes in CPT® Coding to Know Before 2021:Busy physicians like you have long been asking CMS to revise and simplify its laborious E/M documentation requirements.

Billing

CMS Develops Additional Code for Coronavirus Lab Tests:Today, the Centers for Medicare AND Medicaid Services (CMS) took additional actions to ensure America's patients, healthcare facilities and clinical laboratories are prepared to respond to the 2019-Novel Coronavirus (COVID-19).

Auditing

2021 E and M Changes - Diagnoses in the MDM :

The year 2021 will bring significant changes to how we determine the level of evaluation and management services in the outpatient setting.

Billing

Single-Center Study Raises Larger Issues about Proper Billing:Two CMS codes for advanced care planning - 99497 and 99498 - were used less than 20 times at a tertiary care center in Iowa in a nearly 3-year period.

Coding

ICD 10 Codes for Some of the Worst Epidemics in the U.S:

As news and updates regarding the recent outbreak of novel Coronavirus (2019-nCoV) is circulating all over the world, the World Health Organization (WHO) on January 31, 2020, declared the new coronavirus as a global emergency.

Coding

Kidney Care Choices: Show Me the Money!:We've heard absolutely nothing about the proposed mandatory ESRD Treatment Choices model, so our attention today turns to Kidney Care Choices

Compliance

6 Steps to Start Writing and Managing Your HIPAA Policies and Procedures:

Policies and procedures are the backbone of your HIPAA compliance program. They direct your entire team on how to carry out the standards of the HIPAA privacy, security, and breach notification rules.

Practice Management

Many Choose to Believe Mistruths:Perhaps you told your children that if they go swimming within 30 minutes of eating that they could cramp up and die

Practice Management

AHIMA Leads the Way on Data Collection Best Practices for LGBTQ Patients:The American Health Information Management Association (AHIMA) welcomes and supports the November 2019 call by the American Medical Association (AMA) for fully inclusive electronic health records (EHRs) for transgender patients.

Practice Management

8 Tips to Establish High Levels of Patient Satisfaction at Your Practice:

Patient satisfaction is vital to the growth and success of your practice. The industry is changing and so is the way your patients continue to be happy with their medical care. Here are eight important steps to take to make sure your practice is maintaining high levels of patient satisfaction in 2020.

Coding

ICD-10-CM Official Coding Guidelines: Supplement Coding Encounters Related to E-Cigarette, or Vaping, Product Use Introduction :

The purpose of this document is to provide official diagnosis coding guidance for healthcare encounters related to the 2019 healthcare encounters and deaths related to e-cigarette, or vaping, product use associated lung injury (EVALI).

Coding

American Medical Association Approves New Category III CPT Codes for Coaching:

The National Board for Health and Wellness Coaching (NBHWC), a nonprofit subsidiary of the National Board of Medical Examiners (NBME), announces the American Medical Association's (AMA) approval of new Category III Current Procedural Terminology (CPT®) Codes for health and well-being coaching effective January 1, 2020.

Coding

PFS Final Rule for 2020 :

As the Final Rule was released earlier this month, we have updated our summary to include most anticipated topics for the upcoming years.

Billing

4 Biggest Patient Billing Challenges:The healthcare industry has no shortage of challenges, and revenue cycle management is no exception.

Coding

Risk Adjusted Coding: A Closer Look at MIPS Implementation in 2020:

There are four components to the Medicare Incentive Payment System (MIPS): Quality (45% of total score), Promoting Interoperability (25% of score), Improvement Activities (15% of score), and Cost (15% of score).

Coding

CPT 2020 Changes to Psychiatry Services:As of January 1, 2020, CPT made changes to the health and behavior assessment and intervention codes (96150-96155) and therapeutic interventions that focus on cognitive function (97127).

Auditing

OIG Compliance 101 - Ensuring the Next Generation is Prepared:

Each day our industry gains new members who are eager to learn and make a difference in the organizations in which they work.

Auditing

EM Changes for 2021 Help is Out There:the hardest part of our job going forward will be in shaping documentation of assessments

Billing

VA: How UCR Charges are Determined:How does the VA determine charges billed to third party payers for Veterans with private health insurance

Billing

How to Increase Patient Payment Collections in 2020:Providers everywhere are relying heavily on patient payments to sum up the majority of revenue in their practices in 2020.

Billing

3 Software Features Practices Need In Order To Cut Administrative Costs:Reducing healthcare costs has been a top priority

Coding

ICD-10-CM Official Guidelines for Coding and Reporting FY 2020:These guidelines have been approved by the four organizations that make up the Cooperating Parties for the ICD-10-CM: the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), CMS, and NCHS.

Coding

2019-2020 Influenza (Flu) Resources for Health Care Professionals :All health care professionals who order, refer, or provide flu vaccines and vaccine administration to Medicare beneficiaries and submit bills for these services to Medicare Administrative Contractors (MACs).

Auditing

Why is HIPAA So Important:Some may think that what they do to protect patient information may be a bit extreme.

Auditing

Medical Necessity and The False Claims Act:With so many things to consider regarding why compliance needs to be established

Auditing

Auditing for Reimbursement:

One may believe that audits are performed primarily for compliance, but there is more that can be gleaned from an audit.

Coding

Creating a Winning Billing Team with Microsystems:At the heart of every medical office is a team of people who have the tasking job

Practice Management

Communication Can Make or Break Your Practice:Communication has always been pivotal to the success of any business

Practice Management

If You're Going To Make It Make Sure You Keep It:one of the things that continues to concern me is employee theft within a medical practice

Practice Management

Do You Trust Your Employees Skepticism the Professional Suicide:The work we do significantly impacts the lives of so many in healthcare

Billing

Motivating Billing to Achieve Excellence:Excellence in billing performance involves training, management, and motivation.

Auditing

New DOJ Guidance on Evaluating Corporate Compliance Programs:The DOJ's guidance document sets forth topics and questions to address three fundamental questions that prosecutors ask when evaluating compliance programs to guide its investigation:

Auditing

You CAN Charge Medicare More Than You Charge Some Patients:there is no governmental requirement that a clinic have a uniform charge for all payers

Auditing

But All My Friends are Doing it:Just because friends or colleagues are doing something doesn't mean it's the right

Auditing

Lost in a Pile of Numbers Are Your Doctors Who They Say They Are:one of my primary projects is predicting the likelihood that a particular provider may be audited

Practice Management

Medical ID Theft:Think about the information your medical insurance carrier or local hospital has about you and your family

Auditing

Anthem is Changing their Timely Filing Requirements for All Plans Including Medicare Advantage:Anthem has been very busy sending out notices

Practice Management

5 Ways to Minimize HIPAA Liabilities:Last year was historic for HIPAA enforcement

Practice Management

Adapting to Patients as Consumers:Few healthcare professionals can deny that the way we view patients

Auditing

What about Midnight Billing for Time Across Calendar Days:the calendar day is defined as lasting from midnight to midnight

Auditing

What to Look for When Auditing Smoking Cessation Services:These services are unlikely to create a financial windfall

Auditing

Extrapolation Policies Apply to RADV Audits:Risk Adjustment is a program that was implemented to identify and support Medicare

Auditing

Small Breaches Can Be Subject to Large Penalties :We may have heard about the large fines issued by the Office for Civil Rights

Auditing

HIPAA Changed Again Are You Compliant:The most common violations that providers encounter will occur under Tier One or Tier Two.

Coding

RT and LT Modifier Usage Change (effective 2019-03-01):According to Noridian Medicare, there are new changes required when reporting the RT and LT modifier(s)

Auditing

Conducting a Fraud Investigation Part 1 Taking a Common Sense Approach:I thought I would create a post that would really ensure understanding

Auditing

Auditing Hospitalist Services:The inpatient side of coding and auditing can be enormously complex

Auditing

I Know What We’re Doing is Wrong I Need My Paycheck:Knowingly submitting false statements or making misrepresentations of fact to obtain a federal health care payment

Auditing

An Update on the DHS OIG's Effort to Combat Fraud & Abuse:The fall edition of the Semiannual Report to Congress covers OIG activities

Compliance

Are Smart Speakers HIPAA Compliant:Smart speakers are now woven into the technological fabric

Practice Management

2 Ways Online Patient Intake Forms Create Efficiency:Providers are painfully aware of patients who experience frustration in the waiting room

Practice Management

Know the Rules Business Associate Agreement Management Are You Doing It:there are a number of events that could bring you under the watchful eye of HHS

Billing

Maximizing Revenue and Relationships in the Age of Patient Consumerism Modern Solutions to Boost Revenue Collection:Maintaining financial stability is a challenge for any healthcare provider's office

Auditing

What Do You Need to Know About Contact from a Federal Agent:Here are some basic principles everyone should know

Auditing

The Myth about Pass Fail Rates for Providers:leadership wants a general idea of what their compliance risk looks like

Practice Management

IT’S NOT ABOUT THE CHANGE IT’S ABOUT THE TRANSITION:Aristotle discovered that every change implies duality

Coding

PROVIDER COMPLIANCE TIPS FOR ORDERING LOWER LIMB ORTHOSES:Physicians and other practitioners who write prescriptions for lower limb orthoses

Auditing

Auditing Ophthalmology and Optometry Exams:Having this knowledge in your pocket allows you to have a great opening discussion

Practice Management

RPA Conversations from the Floor:we have developed relationships with many others in the nephrology

Auditing

Auditing Chiropractic Services:Chiropractic is unique among healthcare specialties

Auditing

Overview of AMAs E&M Revisions for 2021:The AMA is allowing comments for reconsideration until midnight Central Standard Time on Monday

Auditing

Prolonged Services :I find in my own audit reviews that the prolonged service code set is often mistreated

Billing

Picture This: Mobile Payments Remove Billing Inefficiencies:The inefficiencies and costs associated with paper billing
are obvious.

Practice Management

Nephrology News Roundup:Secondhand Smoke Exposure Tied to Kidney Disease

Auditing

Voluntary Repayments:cShould you volunteer to repay money from Medicare or other federal healthcare programs

Practice Management

Volume Meets Value The Ship Sets Sail:it’s finally March and the accompanying college Hoops Madness is just around the corner

Practice Management

Health at Your Desk Eye Strain:you have been woken up by a headache at some stage of your life

Practice Management

Quality Still the MIPS Heavyweight in 2019:That parachute post is a tough act to follow

Practice Management

CMS Finalizes New Policies for Medicare Drug Plans:These policies demonstrate their understanding of the magnitude of our nation’s opioid epidemic

Auditing

How to Correctly Unbundle NCCI Code Pair Edits:An NCCI code pair consists of two codes representing procedures

Practice Management

Humans and AI Better Together:Early healthcare gains from AI leverage capacity that machines have that people don’t have

Practice Management

CMS and ONC Proposed Rulings Share Your Data or Pay the Price:For most in the health IT industry

Auditing

How to be an Effective Compliance Officer:Being a Compliance Officer can often feel like a thankless job

Auditing

Revenue Cycle Management Considerations for Auditors:By analyzing key elements and reviewing applicable guidelines

Practice Management

MIPS The Dark Side of the Moon:it’s time to fill that void

Auditing

Attestations Teaching Physicians vs Split Shared Visits:The only difficulty will be trying to find out if your commercial payers decide to follow CMS

Practice Management

Virtual Reality Meets Peritoneal Dialysis Training:The conference has a general nephrology track

Auditing

Medical Necessity vs Documentation for Inpatient Services :Many of the notes we are provided for review include so much information

Auditing

Medical Student Documentation CMS Relaxing of the Rules:Medicare Claims Processing Manual to allow the teaching physician

Coding

DRG Big Bang Launched the Modern Age of Coding 35 Years Ago:It also positioned medical record coding as a strategic financial function for hospitals and physicians

Billing

Courts Recognize Irreparable Injury Caused by Medicare Appeals Backlog:As providers and suppliers with pending requests for Office of Medicare Hearings and Appeals

Practice Management

Fatal Errors That Managers Make:Rarely do I ever hear a manager say

Practice Management

USRDS A Data Picture:I attended some informative and interesting sessions

Practice Management

2018s Biggest Trends in Healthcare Marketing:Many healthcare practices launched patient portals a decade or so ago

Practice Management

Tips for Strong Patient Retention Strategies:Research shows that losing an existing patient is exponentially more expensive than acquiring a new one

Practice Management

2019 QPP Final Rule Overview:The first week of November was a busy one for the Centers for Medicare and Medicaid Services

Practice Management

Features to Look Out for in an EHR:

EHR systems act as a bridge between quality healthcare and streamlined workflows

Coding

Home Health Industry Must Prepare for Critical Changes in Payment and Data Reporting:Home health coding professionals face numerous challenges

Practice Management

Is Your Organization Prepared for the Unexpected?:Anyone who watches or reads the news knows that disaster can strike without warning

Practice Management

5 Tips to Ensure Patient Payments Without Damaging Patient Provider Relationships:Engage patients earlier in the revenue cycle

Auditing

What is Virtual Communication G0071:This visit descriptor is Virtual Communication and is not indicated as a telehealth service

Coding

Q&A: Coding Mixed Cardiogenic and Septic Shock:Refer to the documentation within the code book. If you open the book to the R57 code grouping

Practice Management

Seriously Use a Parachute:The parachute article came to my attention through email

Practice Management

Nephrology News Roundup:Dialysis Reimbursement Policies Poor

Practice Management

MIPS Cost Category Unpacking a Mystery:Can you believe it will be Christmas Eve in 2 weeks

Billing

3 Ways to Automate Front Office Tasks:Billing headaches increase

Practice Management

Human Enhancement Just in Time for Christmas:The iRobot Roomba replaces old fashioned vacuuming

Auditing

Auditing looking between the lines:When given the task of auditing a group of charts

Billing

People Process and Technology Three Avenues for Better Claims Performance:Everyone Is Part of the Claims Staff

Coding

Medical Coding and Combating Fatigue:Collaborative efforts have fostered the development of multiple measures.

Billing

Pricing for ASCs and APCs:To bill for a service in an ASC setting

Review

Review:The Risk Adjustment Coding and HCC Guide

Practice Management

Thanksgiving Leftovers Advanced APMs and the 2019 QPP Final Rule:Can you believe Thanksgiving is now in the rearview mirror and Christmas is less than a month away

Practice Management

7 Free or Low Cost Ways to Increase Practice Efficiency:It is a question that practice managers ask themselves daily

Practice Management

2019 QPP Final Rule Overview:The first week of November was a busy one for the Centers for Medicare and Medicaid Services

Auditing

Billing 99211 Its not a freebie:It seems like a simple code to bill

Billing

Todays Patients Unsure and Confused About Medical Bills:Pricing and billing transparency matters more than ever within the healthcare industry.

Practice Management

MIPS Hardship Exception Trick or Treat:We are approximately 2 months away from the end of year 2

Auditing

Using a Billing Company versus Hiring a Biller When Starting a Medical Practice:The option I do not recommend is the option that requires hiring a biller.

Auditing

We've Always Done It This Way and Other Challenges in Education:This is one sentiment that we all have had at one time

Practice Management

Ethical Dilemmas The View from a Tower of Ivory:Have you ever come across the following technique that attorneys sometimes employ when litigating a case

Practice Management

Data Catches the Flu Why Vaccinations Matter:Have you been caught up in the fun and excitement of Halloween preparations and missed the start of the 2018

Practice Management

What to Expect from AHAs New Center for Health Innovation:The Center especially focuses on how to create beneficially disruptive innovation within the healthcare industry

Auditing

Prolonged Services Its Not Just About Time:One way of looking at this is to take note of the threshold times

Practice Management

The Big MIPS HAP CMS Finds Errors in MIPS Payment Calculations:The biggest culprits that caused calculation errors were the application of the following items

Auditing

When to Use Modifier 25 and Modifier 57 on Physician Claims:it is important to know the distinctions between these two modifiers.

Practice Management

Negotiating Payer Contracts:Payer contracts can be negotiable.

Practice Management

4 Laws that Impact Drug Testing of Healthcare Employees:Employees that abuse drugs in the workplace cause major disruptions

Auditing

The Potential Impacts of a Flat Rate EM Reimbursement on our Industry:Proposed Reimbursement Model Change

Billing

Bilingual It Means Provider Care Language vs ICD 10 Language:Payers need documentation to support that charges are appropriate

Billing

Rhizotomy Procedures :The CPT coding choices for a rhizotomy procedure reflect the methods chosen to destroy the nerve

Practice Management

Understanding the Legal Implications Involving Management Services Organizations:Management Services Organizations

Practice Management

Advanced APM Update Proposed Rule and Beyond:September has been a very busy month in the Advanced Alternative Payment Model world.

Practice Management

Where Are We on the Digital Health Road:Imagine a model of health care that's always available and driven by data so you’re continuously collecting data off your body, about your environment, your nutrition, and activity…

Coding

Using Modifiers 96 and 97:The Affordable Care Act (ACA) requires coverage of certain essential health benefits (EHBs), two of which are rehabilitative and habilitative services and devices.

Practice Management

Pros and Cons of Healthcare Consumerism:Our health is our most precious asset, and it is both empowering and reassuring to have authority over our healthcare decisions.

Practice Management

:Shadows are falling and I been here all day

Practice Management

All Along the Watchtower Pathways to Success:There must be some kind of way out of here

Practice Management

Meeting in the Middle Patients Contribute to QPP:How are patients accessing health information today

Billing

Are incident to services worth the risk:Incident to billing offers two key benefits

Auditing

Getting the Right Eligibility Information for Payment Your Rights and Health Plans Requirement:We need timely and accurate patient information to bill health plans and receive appropriate payment.

Auditing

When Medical Necessity and Medical Decision Making Don't Match:Determining Medical Necessity

Practice Management

3 Benefits to Switching to E Statements:Despite of the leaps and bounds the healthcare industry has taken in the direction of going digital

Practice Management

QPP 2019 Proposed Rule Promoting Interoperability:I was floored by the substantial changes that were proposed

Compliance

Offshoring Medical Records - Why You Should Care?:Your Medical Information Could Be in India, Pakistan, and/or the Philippines!

Practice Management

Practice Management Make it a Priority Before its Too Late:New mandates and requirements are coming faster than ever before

Practice Management

Success The Only Definition That Matters Is Yours:Focus on the following three steps to improve upon your current situation

Billing

Risky Business The CMS HCC Risk Model:Instead we are going to spend some time with a risk adjustment model

Billing

The New Medicare Cards:In an effort to help protect beneficiaries from fraudulent use of their social security numbers

5 Minutes with

5 Minutes With Janet Selover:My father was a dentist and my mother managed his practice

Practice Management

My Secrets to Marketing to Doctors Part II:It might be easier for you to write some articles for various medical publications

Compliance

GDPR One Privacy Law Not to Overlook:Nuances of GDPR

Practice Management

The National Practitioner Data Bank NPDB:The NPDB is a black list reminiscent of the McCarthy blacklist of the 50s

Billing

Continuity in Credentialing:Why is it so important to have the same individual be responsible for this important task

Compliance

Five Most Common IT Compliance Errors Found in Small Offices:The following list discusses five of the most common IT compliance errors

Practice Management

Health at Your Desk Dealing with Difficult Co Workers:You may be confused by the title of this article

Practice Management

CEO Note:13.4

Practice Management

The 2019 QPP A Summertime Intro:This year the QPP content was combined with the annual physician fee schedule NPRM, leading not only to an awkward title, but a tome chock full of intrigue.

Auditing

Ensure Personal Quality An Auditor's Approach to Research:We often associate research with a large amount of time

Practice Management

Entering the Voice Era From Scribes to Scribble:These days the years seem to roll around really fast

Auditing

The Importance of Policies:With a growing awareness of just how many organizations do not have published policies

Practice Management

Is Subscription Medicine the Wave of The Future:Subscription memberships are all the rage.

Auditing

Auditing Incident to Services:Incident to billing offers two key benefits

Practice Management

The Murky World of PBMs:Thus began my odyssey into the world of pharmacy benefit managers, while standing at the counter of the local branch of a national pharmacy chain last weekend.

Practice Management

Machine Learning Algorithms A Clinician and Data Analyst Partnership:Machine learning and other data science techniques are used in many ways in healthcare.

Practice Management

The Money in MIPS:Due to these high numbers of participation one would think there’s a lot of money in the pot.

Auditing

Provider-Based Facilities and Split Billing Is Your Facility Being Reimbursed for All Work Performed?:Are you stumped by billing guidelines for provider based facilities

Practice Management

Three Ways Bundled Payments Can Be a Success:The bundled payment model has many upsides

Billing

EM Code Changes in CPT 2018:It is that time of year again!

Practice Management

Hendrick Health Says Investment in Employee Training Pays Off in Terms of Loyalty and Improved Patient Care:Investing in employees through education translates into higher retention

Billing

Routine Waiver of Patient Out of Pocket Expenses:Medical billers often encounter the dilemma of a physician who wants to be the hero

Billing

So You Want to Be a Practice Management Consultant:Don't Quit Your Day Job

Practice Management

Advertiser / Partner Spotlight: eBridge:eBridge, Inc. is a hosted document management and workflow solution that is ideal for billing and coding professionals

Auditing

Auditing Therapy Evaluation Codes Not So Quick:New evaluation codes for physical therapy

Practice Management

Health at Your Desk: Better Snacking:Snaccident (n): Eating an entire pizza/box of chocolates/family size bag of chips by accident.

Practice Management

GDPR:GDPR also addresses the export of personal data outside the EU

Practice Management

Say NO to Capping Cost of Care in California:A conversation with Dr. Bryan Wong

Practice Management

MIPS Are we really improving quality of care Survey says:I recently attended a seminar offered by a local functional medicine doctor.

Auditing

TKAs to Outpatient What We Have Learned with Q1:The release of the 2018 Final Rule for the Outpatient Prospective Payment System

Auditing

The Devil is in the Data Details:As an auditor who has reviewed thousands and thousands of encounter documents for level of service

Practice Management

Saving Time and Money with Automated Insurance Eligibility Verification:The healthcare revenue cycle contains multiple potential pinch points for the parties involved

Practice Management

Promoting Interoperability What’s in a Name:Promoting Interoperability

Practice Management

FHIR Revisited:Usable data elements with FHIR

Auditing

Critical Care Documentation:Critical care documentation should showcritical need for the patient AND immediate action by the provider.

Practice Management

Change: Had enough?:The transition from winter to spring is one that I look forward to every year

Practice Management

What Do Patients Expect in 2018:Evolutions in technology continue to merge with a trend toward consumerism in healthcare.

Practice Management

Nephrology News Roundup:Future dialysis patients could grow their own artificial veins

Practice Management

HIMSS Highlights from Dr. Sharif:Why do you go to HIMSS

ICD-10

Maximizing Resources for ICD-10 Coding Audits :

Practice Management

6 Simple Ways to Reduce the Administrative Burden in a Practice:When a small practice attempts to do everything themselves, problems will almost certainly arise.

Practice Management

Consider Going Green in Your Practice!:According to the Healthier Hospitals Initiative, Safer Chemicals, Accessed Oct 25, 2012

Auditing

The Comprehensive Error Rate Testing Program:With nearly a million physicians in this country, how do auditing organizations determine whom to audit

Billing

Increase Revenue by Outsourcing Medical Billing:Many practices are starting to weigh the benefits outsourcing medical billing compared to keeping it in-house.

Practice Management

Health Information Exchange and Trusted Exchange Frameworks:In the past 2 years Massachusetts has made big changes in transportation

Coding

The Coder as the Last, Best Hope for the Right DRG :If the story doesn't make sense, there is probably something missing. There are a variety of reasons why the DRG might not tell the story of the patient encounter.

Billing

Targeted Probe and Educate TPE:

Have you ever been caught in the avalanche of paperwork

Practice Management

Managing a Medical Practice:A practice manager's job is to make sure the whole practice runs smoothly.

Practice Management

Trusted Medical Assistant Writes Fraudulent RX for Narcotics:Why it is important to terminate the Medical Assistant

Review

Medicare RBRVS 2018:Payment rules and relative values for 2018 CPT codes

Billing

The Truth about ZPICs: Why Oversight is Needed:Zone Program Integrity Contractors

Review

InHealth 2018 Physicians Fee and Coding Guide:Updated fee range for virtually every 2018 CPT Code

Practice Management

Health at Your Desk The Importance of Good Posture:It's common knowledge that sitting and staring at the computer screen for extended periods of time causes a number of health problems

Practice Management

Compliance: What is it and Why is it Important:Compliance. It is one of the buzz words in healthcare that is heard all the time but what is it really, and why is it so important

Coding

Q and A: Coding Mixed Cardiogenic and Septic Shock:QandA: Coding Mixed Cardiogenic and Septic Shock

Practice Management

Using a 2015 Certified EHR in MIPS Year 2:Happy New Year! You may have noticed my short absence from the blog-but I had good reason.

Coding

Important CDI and Coding Updates:COPD and Pneumonia The requirement for code J44.0

Coding

The 12 Claims of Christmas Part 1:It's the most wonderful time of the year again!

Coding

The 12 Claims of Christmas Part 2:Thanks for joining us for part 2

Coding

Important CDI and Coding Updates:COPD and Pneumonia

Auditing

Is Your Practice in Need of a Wellness Visit?:Is your practice busier than ever

Coding

Medicare Outpatient Observation Notice MOON:MOON was developed to inform patients of their status

Billing

Coding and Billing Chronic Lyme Disease:Lyme disease awareness month is during May

Coding

How to Properly Report Prolonged Evaluation and Management Services:Have you ever had a patient take more time with the provider than they were scheduled for

Practice Management

Developing a Revenue Cycle Game Plan:Why It's Important and How to Get Started

Practice Management

Patient Satisfaction Surveys Important or Not:When was the last time you asked your patients how you and your practice were doing

Review

Coders' Desk Reference for 2018:The Coders' Desk Reference for Procedures is a comprehensive resource for all 2018 CPT® codes.

Practice Management

Caffeine Naps:It appears that caffeine takes about 20 minutes to process in your body.

Coding

ASK THE EXPERT - MAB:In an excision we numb the patient with Lidocaine. Do we code the admin for the Lidocaine, 96372, or not

Review

Risk Adjustment Documentation and Coding:Risk adjustment practices consider chronic diseases as predictors

Coding

SPECIFIC MODIFIERS FOR DISTINCT PROCEDURAL SERVICES:The primary issue associated with the -59 modifier is that it is defined for use in a wide variety of circumstances,

Coding

Four Final Rules Affecting CMS Payments for 2018:It's a season for changes. CMS just finalized four rules which directly impact the following payment systems

Practice Management

MIPS ELIGIBLE MEASURE APPLICABILITY (EMA) – NEW RESOURCES:Quality is one of four performance categories under the Merit-Based Incentive Payment System (MIPS).

Billing

Avoid Denials and Mitigate Risk Under the CMS CERT Program:Insufficient documentation is by far the most common reason for denying a claim or improperly paying a claim.

ICD-10

Your Quick Guide to ICD-10-CM 2018 Myocardial Infarction Official Guideline Changes:Start With MI Code Updates

Practice Management

Road Map to MIPS:Are you planning to participate in MIPS? Take a look at our infographic to learn more about how it might impact your reimbursement.

Practice Management

5 Time Savvy Tips for Compliance Officers:Complex regulations and mandates make compliance management a necessity.

Auditing

PFSH Documentation: Q and A:Included with a NAMAS membership is the ability for members to submit their auditing questions to our auditing team for input.

Coding

CMS Proposes to Revise Evaluation & Management Guidelines:According to the recently released 2018 Physician Fee Schedule Proposed Rule

Auditing

Coding and Auditing: Acronyms and Abbreviations - When they fall into the grey:When the record could mean too many things

Practice Management

The Interoperability Gap:What does interoperability really mean

Practice Management

Tom Price Deplanes: What This Means for MACRA:Both discoveries involved a lot of tears and cleanup.

Practice Management

Educating Practice Managers on Revenue Cycle Management:Responsibility for these updates often falls to practice managers

Practice Management

The HITECH Act: Then, and Now:In retrospect, HITECH was audacious in its aspirations.

Auditing

Responding to The Letter:It is frustrating enough to receive a letter demanding medical records from your group.

Coding

Telehealth Implications in Mental Health: An Overview:Many mental health professionals at this time are hesitant to enter telehealth

Practice Management

Professional Liability Basics Compliance Enforcement:When reviewing what a professional liability policy may cover in terms of a government investigation

Review

2017 Plain English Descriptions for DENIAL CODES:Denial Codes

ICD-10

ICD-10-CM Coding Advice for Healthcare Encounters in Hurricane Aftermath:This document is intended to be used as a guide to help coding professionals when coding healthcare encounters of those individuals affected by a hurricane.

Practice Management

Exclusive interview with Dr. David Nilasena - Chief Medical Officer at the CMS Dallas office:Probably the most important thing that I do is to serve as a liaison and point of contact for the clinicians and providers in our five state region for a variety of CMS programs.

Auditing

Global Surgical Package: When to Bill and When Not to Bill, That is the Question:The global period is defined by the number of global days assigned to a CPT code.

Practice Management

A Foolproof Way to Avoid a MIPS Penalty in 2017!:Happy Labor Day! It's a day where you can take things easy and try to let the worries

Coding

Medicare Out Patient Observation Notice (MOON):MOON was developed to inform patients of their status when they are not inpatient

Practice Management

Raising the MIPS Low-Volume Threshold: Good News or Bad?:A few weeks ago we had some fun with Quality Payment Program (QPP) numbers

Auditing

The Incredible Disappearing Consultation:In January of 2010, CMS ceased payment of CPT codes for consultations (99241 through 99245 for outpatient, and 99251 through 99255

Auditing

Case Law Update: Just Because HIPAA Does Not Provide a Private Right of Action, Doesn't Mean that Other Avenues Exist:Simply stated, the Health Information Portability and Accountability Act

Coding

USE Code: XW0DX82:

To Report the Life-Saving Antidote for some forms of Chemotherapy

Utilize Section X codes to ensure the New Technologies are tracked, proven and develop into permanent codes

Practice Management

Is Your Practice Staffed Correctly?:Many physician practices struggle long and hard with finding just the right number of members

Auditing

Auditing Vaccines:Auditing vaccines can be difficult

Coding

Medicare ACO Track 1 Model:Advanced Care Coordination through Episode Payment Models

Compliance

Twelve Thousand This article is based on actual events. Names have been changed. :We are currently at the stage where the owner of the company thinks that by making grand proclamations or maybe even a few threats that Randy and I will suddenly see the light

5 Minutes with

5 Minutes with… Manny Oliverez, CPC CEO & Co-founder Capture Billing | Medical Billing Services:I have always loved being a business owner.

Practice Management

Professional Liability Policy Basics:When you begin your search for professional liability insurance

Review

ICD-10-CM Expert for Physicians:Ensure your practice has the official ICD-10 code manual that has everything

Review

Principles of CPT® Coding – Ninth Edition:

This best-selling educational resource

Billing

The QPP in 2018: Fun with NPRM Numbers:It’s been just over a month since CMS released the notice of proposed rule making

Compliance

Patient-Driven Health IT:I regularly read Dr. John Halamka's Geekdoctor blog to keep up with the latest health IT (HIT) news. Dr. Halamka, Beth Israel Deaconess CIO

Coding

CPT Codes 2017: Get a Jump on July's New Category III Eye Codes:Midyear Category III CPT code updates sometimes get overlooked, but that's a mistake you don't want to make.

Coding

TeleHealth and You:Before we can go any further, let's familiarize ourselves with some important definitions.

Practice Management

10 Pillars of Success for Healthy Practices:Incorporating any of these improvements into your practice can help boost employee satisfaction

Compliance

Facts about 5 HIPAA Compliance Myths:All covered entities must abide by HIPAA Privacy and Security Rules.

Coding

CLAIM ADJUDICATION PROCESS:Claim adjudication is the process used by a payer to decide if a claim should be reimbursed. Although each payer has its own multistep process for approving claims, the process is generally the same for all payers.

Billing

June and the QPP:Let’s start at the beginning of the month.

Auditing

DOJs Newest Evaluation Criteria for Investigating Compliance Programs:Here is a summary of the topics and questions that the DOJ finds relevant

Practice Management

Demystifying Price Transparency and Patient Billing:Competitive pricing is one of the most important aspects of a capitalist economy.

Coding

Inpatient Compliance: Split/Shared Services:In the inpatient setting, a physician can combine his/her documentation

Billing

Improving billing and collections department efficiency:To operate the billing department effectively and efficiently, practices need to recognize

Practice Management

NEW MEDICARE CARDS TO BE ISSUED TO MORE THAN 57.7 MILLION AMERICANS:As a follow up to a CodeTrends article late last year, the Centers for Medicare

Auditing

DOJ's Newest Evaluation Criteria for Investigating Compliance Programs:The Department of Justice (DOJ) recently published a guidance document titled

Practice Management

Virtual Reality Making Breakthroughs in Healthcare:Pain management during difficult procedures

Practice Management

Physicians Speak Out On Healthcare Reform:Healthcare reform has dominated much of the political conversation

Coding

NGS Changes E/M requirements for Expanded Problem Focused and Detailed Examinations:On March 16, 2017 National Government Services (NGS)

Billing

Nephrology News Roundup:CDC data estimate that more than 20 million people in the United States have chronic kidney disease with varying levels of seriousness.

Practice Management

Are Doctors Talking About Patient Financial Responsibility?:In an ideal world

ICD-10

End of ICD-10 Grace Period: What the Data Reveals:We're well into the new year, and just over six months into the post-ICD-10 grace period.

Practice Management

How Telehealth Benefits Rural Health Centers Part 2 :Today we're going to discuss reimbursement

Practice Management

Patients Texting Doctors: The Pros and Cons:Modern business is all about convenience.

Auditing

The Big Myth If it isn't written, It wasn't done:This tip may contradict everything you've heard before.

Practice Management

How Telehealth Benefits Rural Health Centers :It’s becoming more and more clear that people living in rural areas and our veterans are the types of patients that will benefit the most from the increasing use of telehealth.

Practice Management

Chronic Care Management for Rural Health Centers Part 2 :Last week we discussed some clear benefits that Chronic Care Management services can have for patients living in rural areas.

Practice Management

Should Physicians Care About Health IT?:Most things in life require balance.

Auditing

Diagnosing, Documenting & Coding for Radiculopathy:Radiculopathy can be an unpleasant condition, but diagnosing, documenting and coding for it does not have to be.

Practice Management

Healthcare Practices Should Heed Warnings by FBI:Digital healthcare security has become a primary concern in the last few years

Billing

Intravenous Form of Sensipar® Has Been Approved by the FDA:This is the first medication that has been approved to treat secondary hyperparathyroidism in 12 years.

Practice Management

Chronic Care Management for Rural Health Centers :Let's start this conversation by taking a quick look at what Chronic Care Management is

Practice Management

Marijuana Laws Impact Your Organization’s Drug Testing Policies:The growing trend in marijuana laws have presented a unique challenge for employers-the conflict between federal and state laws leave most employers in a daze.

Billing

Insurance Column with Fox Point:As we discussed in the previous insurance column, a medical billing organization's exposure is not just the potential of a billing error.

Practice Management

Calendar Year 2017 – Changes to PT & OT:Well we knew this moment would come sooner or later after all the commotion over ICD-10 was over.

Practice Management

Health at Your Desk: Stretching:Stretching is extremely important as it helps us maintain flexibility and range of motion in our joints.

Billing

Drop Down List Getting You Down?:As a healthcare professional, there are two challenges that can impact not only your productivity, but your organization's revenue.

Billing

To QP, or Not to QP: Is That the Question?:Yes, I know Mr. Shakespeare would not be happy with that title

Practice Management

What is the Digital Health Revolution?:For centuries, the healing arts were steeped in mysticism and suspicion.

Billing

BILLING CPT CODE 99497:On March 20, 2017 The Centers for Medicare and Medicaid Services (CMS) released MLN MATTERS MM10000

Coding

WHY USE MODIFIERS?:Modifiers are extremely important to medical coding.

Billing

What’s the difference between a Claim Denial and Claim Rejection?:Insurance claim denials and rejections are one of the biggest obstacles affecting healthcare reimbursements.

Billing

5 Tips for Handling Patients Who Don't Pay :Dealing with past due accounts is never easy within any industry.

Billing

Hybrid Models Making Concierge Medicine a Win for Physicians:One of the most popular options is a hybrid version of concierge medicine.

Billing

Assistant-At-Surgery Services:An "assistant at surgery" is a physician who actively assists the physician in charge of a case in performing a surgical procedure.

Practice Management

Chronic Care Management: The Updates for 2017 :By 2017 CMS realized that there were both non-complex and complex chronic care management services that were provided.

Auditing

Sanction Screening and Evaluating Employee Suitability the New "Seventh Element" of Compliance!:The recently issued Resource Guide for Measuring Compliance Program Effectiveness, the product of roundtable discussions by Office of Inspector

Practice Management

Things to Look for When Choosing a Revenue Cycle Management Vendor/Partner:Revenue cycle management for any business can be complicated

Practice Management

How to Engage Your Patients in Telehealth :With more than 90% of healthcare practices considering adding telehealth services to their practice

Coding

The State of Coding:It's hard to imagine that it's been more than a year since ICD-10

Billing

5 Tips for Handling Patients Who Don't Pay:Dealing with past due accounts is never easy within any industry.

Practice Management

Knock, Knock. Who's There? OSHA Inspector:An impromptu OSHA inspection is certainly not a joke to most organizations.

Practice Management

How Do Patients Search for Physicians Online?:For many consumers, the search for the right physician-or physicians-to meet their healthcare needs can be both stressful and challenging.

Practice Management

20 Telemedicine Statistics Private Practices Should Know :In 2017, telemedicine is going to rock the healthcare industry.

Practice Management

MACRA Madness: Avoiding a Bad Outcome:The annual two-week slump in office productivity comes to a close tonight as the Madness known as the NCAA men's college basketball tournament crowns its champion

Auditing

Consultation or Transfer of Care, What are the Differences?:According to 2017 Current Procedural Terminology (CPT), a Consultation is a type of E&M service

Practice Management

Is Adding Telehealth to my Practice Complicated? :Telehealth is clearly one of the top buzzwords in the healthcare industry for 2017.

Compliance

Creating a BYOD Policy for Your Practice:After realizing they were fighting a losing battle, the majority of employers gave up years ago on trying to ban personal devices from the workplace.

Auditing

Documentation: Carrying Forward or Ineffective Use of Templates:I often receive questions such as the below from our members regarding

Practice Management

3 Creative Ways to Engage Patients While They Wait:More than one study has linked a lack of patient satisfaction to extended patient wait times.

Auditing

Ashby's Law of Requisite Variety; A Lesson in Preparedness:Have you ever wondered why grandparents have so much more fun with their grandchildren than they did with their children?

Auditing

Using Software to Stay Ahead of the Compliance Curve:Making compliance an integral part of your healthcare organization can seem daunting amidst sophisticated healthcare laws.

Practice Management

What is Population Health Anyway? :Population HealthPopulation Health seems to be quite the buzzword these days.

Billing

A Quick Guide to Smooth Healthcare Payment Reconciliation:End of the month reconciliation is a time both dreaded and feared by business office professionals across the world

Practice Management

Opioids and Low Back Pain – Changing the Paradigm :With more than 30 percent of Americans experiencing an episode every year, it’s no surprise that low back pain is a leading reason for physician visits.

Practice Management

BRINGING IN A NEW ASSOCIATE Future Friend or Foe? :An open, trusting, fully transparent long term partner Friend relationship is the goal.

Billing

Opting Out of Medicare:It seems that more and more medical providers have chosen to opt out of Medicare and dis-enroll from PECOS.

Auditing

Getting Serious About Your Practice's Compliance:Perhaps your practice has been a bit slow to adhere to the OIG's guidance on implementing a voluntary compliance program.

Practice Management

Telehealth: The Global Growth of Telehealth Explodes :If you’re in the healthcare industry on any level, you’re probably aware that telehealth has continuously gained traction in the last decade

Billing

Guide to Choosing Patient-Friendly Financing Options for Your Practice:The healthcare industry has changed drastically in the last decade, with more pronounced changes in the last five years with regard to patient responsibility.

5 Minutes with

5 Minutes With... Kelly O'Brien, CMRM:I was born and raised in the Greater Boston area

Compliance

Ransomware:Ransomware is a type of malicious software, known as malware

Billing

Successful Insurance Reimbursement:Does your office experience a rejection rate in insurance denials that's higher than you'd like it to be

Practice Management

3 Ways to Satisfy MIPS Reporting in 2017:You have several options to guarantee that your Medicare payments

Practice Management

Health At Your Desk: Get Those Healthy Habits Started Today!:For those of us who have roles that require us to sit at our desk all day

Review

Code of Medical Ethics:The American Medical Association created the Medical Code of Ethics in 1847

Billing

Billing Errors:A medical billing organization's exposure is not just the potential of a billing error

Compliance

A Costly Lesson in Untimely Reporting of a HIPAA Breach:Presence St. Joseph Medical Center, a hospital of Presence Health Network

Auditing

Weekly Auditing and Compliance Tip:As an auditor, you may be asked to audit encounters that occur in various multispecialties.

Practice Management

10 Tips for Managing Medical Practice Staff:Keeping your practice running smoothly and efficiently is a full-time job.

Coding

Using Time Span Codes:The date of service (DOS) is the reference point for determining the frequency of code submission and subsequent reimbursement during that period

Practice Management

Avoiding and Preventing Embezzlement:It is estimated that approximately one in six physicians will be the victim of embezzlement at least once during their practice's lifetime

Practice Management

How Telehealth Relates to the MIPS Payment Track :As of January 1st, of this year, CMS implemented the Quality Payment Program (QPP) under MACRA.

Practice Management

Trump says ACA repeal may take a year; Price confirmed for HHS:The repeal and replacement of the Affordable Care Act (ACA) could take up to a year -a sudden

Practice Management

Opioid Addiction: A Physician's Perspective:Whether emotional or physical, pain is something most of us avoid as much as humanly possible.

Practice Management

Using Automated Communication to Enhance Patient Experience:Great patient care shouldn’t end when your patients walk out the door.

Auditing

Prescription Drug Management: Is it a Level 3 or a Level 4?:If you place four auditors around a table and place a typical established patient visit in front of them

Auditing

Documentation: Carrying Forward or Ineffective Use of Templates?:I often receive questions such as the below from our members regarding E&M scoring

Compliance

Dashboard Reporting: One Size Does Not Fit All:Dashboard reports are intended to provide pertinent information to leaders throughout the healthcare organization.

Practice Management

Don't Believe Everything You Read About Telehealth :There's no escaping the reality of some dramatic changes that are happening to our healthcare landscape this year.

Practice Management

Restless Patients? 3 Ways to Improve Patient Wait Times:Most people, including healthcare providers, consider long wait times for hospital emergency rooms (ER’s) to be an unavoidable byproduct of normal ER operation.

Review

WIN ME!!! ICD-10-CM 2017 Chronic Disease Coding Cards: Multiple Specialties:ICD-10-CM 2017 Chronic Disease Coding Cards: Multiple Specialties

Practice Management

Understanding MACRA and the Quality Payment Program Part 10 :y now you should have a good grasp of what MACRA and the Quality Payment Program mean for your practice moving forward.

Practice Management

Best Practices in Revenue Cycle Management:While great care is a necessity-and the core goal-for any practice, a clear and free-flowing revenue stream is also essential for your practice to thrive.

Billing

Abbreviations 101: FQHC vs RHC:Over the last several decades, the number of Federally Qualified Health Centers

Auditing

Profit Depends on Efficiency:To us, the most fascinating thing about process improvement within a medical practice is how it has a clear clinical counterpart:

Practice Management

Understanding MACRA and the Quality Payment Program Part 9 :Part of the Understanding MACRA series provided you with a look at the different advanced alternative payment models (APMs) and explained them in more detail.

Billing

Bundles and Caps: What Are You Wearing?:I’ve been spending some time watching the debate over whether or not US health care would be better off in a bundled payment environment or in a capitated payment environment.

Coding

Population Health:The health outcomes of a group of individuals, including the distribution of such outcomes within the group

Practice Management

Understanding MACRA and the Quality Payment Program Part 8 :Part 7 of the Understanding MACRA series provided you with a high overview of the APMs payment track.

Billing

A Quick Guide to Smooth Healthcare Payment Reconciliation:End of the month reconciliation is a time both dreaded and feared by business office professionals across the world.

Practice Management

Mobile Health: Growing Engagement and New Responsibilities:This week I'm blogging about an M-word

Practice Management

Adjusting Your Collection Strategies to HDHPs:High Deductible Health Plans (HDHPs) are recent and growing trend in healthcare that is probably here to stay

Practice Management

Price Transparency is Now The Law in Florida:More than any other industry, healthcare is almost notorious for its lack of price transparency.

Auditing

Focus on Clinical Documentation to Improve Coding and Audit Results:Auditors spend their day surrounded by the end-product of the health care process

Practice Management

MACRA: A Summary of the Final Rule:Recently, the 2,204-page Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) final rule was released.

Compliance

9 Surefire Steps to Lockdown Your Cyber Security :The next few sentences are a little trickier; there is really no good way for someone to hear that their data has been stolen.

Billing

Revenue Cycle 101: Reduce your Denials with These Tips:Your practice seems to be doing everything right.

Practice Management

Better Office Communication Leads to Stronger RCM:According to a recent Physicians Practice study, one of the top five reasons for denied medical claims is a lack of adequate documentation.

Practice Management

Quality Benchmarks: How to Estimate Your MIPS Quality Score:I was going to write about something other than MIPS but I truly couldn't resist. The temptation was just too great-especially after Dr. Terry Ketchersid really shook things up with his latest blog on MIPS and the ACI hardship exception.

Practice Management

Understanding MACRA and the Quality Payment Program Part 4:In Part 3 of this series, we walked you through the Cost Category of the MIPS Payment Track for MACRA's Quality Payment Program (QPP).

Auditing

DOJ Announces $4.7billion in False Claims Act Recoveries: But What Does That Really Mean:The Department of Justice (DOJ) recently announced that it had recovered $4.7 billion in False Claims

Billing

7 Strategies for Better Patient Payment Practices:Collecting patient payments is not always the most fun part of the job.

Practice Management

Understanding MACRA and the Quality Payment Program Part 3:In Part 2 of this series, we walked you through the Quality Category of the MIPS Payment Track for MACRA's Quality Payment Program (QPP).

Billing

Medical Billing Denials are Avoidable:The formal definition of a medical billing denial

Practice Management

Understanding MACRA and the Quality Payment Program Part 2 :In Part I of this series we walked you through determining your eligibility under MACRA's Quality Payment Program In Part 2 we'll begin breaking down the MIPs payment track so that you understand each category and the way it is scored.

Practice Management

Analysis: Don't expect Trump to save physicians from MIPS:The Affordable Care Act (ACA) has gotten most of the attention after the election of Donald J. Trump

Compliance

Are Your HIPAA Practices in Compliance?:If you've been involved in healthcare for more than a month, you've heard the term ‘HIPAA compliance'

Practice Management

2017 MEDICARE PARTS A & B PREMIUMS AND DEDUCTIBLES ANNOUNCED:The Centers for Medicare & Medicaid Services (CMS) announced the 2017 premiums for the Medicare inpatient hospital (Part A) and physician and outpatient hospital services (Part B) programs.

Practice Management

MIPS score of 3 is enough :Did you know that getting a MIPS score of 3 is enough to avoid a penalty in 2019

Practice Management

AHA GIVES PRESIDENT-ELECT TRUMP A WISH LIST:The American Hospital Association (AHA) recently sent a letter to President-elect Donald Trump who has vowed to repeal

Coding

Grace Hopper and the Hour of Code Project:In the Acumen blog last week Diana Strubler tackled the Quality portion of the MIPS composite score, otherwise known as the

Practice Management

Quality: The Monster of MIPS:I think it's time to finally tackle the part of MIPS that I've been avoiding. It's the category that Dr. Ketchersid deemed the overnight MACRA sensation due to its large impact on your MIPS score. It's also arguably one of the more confusing categories to understand.

Practice Management

MIPS Tip Tuesday:Do you know how to predict your quality score in MIPS

Practice Management

Global period, key changes in 2017 fee schedule final rule:There are fewer reporting requirements in the 2017 Medicare Physician Fee Schedule (PFS) final rule, thanks to CMS significantly relaxing its global surgical period reporting requirement, according to an exclusive analysis by The Business of Medicine.

Practice Management

3 ways to satisfy MIPS reporting in 2017:You have several options to guarantee that your Medicare payments won't take a hit in 2019 under the new Merit-based Incentive Payment System (MIPS), according to an exclusive analysis of the MIPS final rule by The Business of Medicine.

5 Minutes with

5 Minutes with... Amber Winkler, MHA, PCMH CCE:After graduate school, I worked in healthcare for about 5 years before starting Clarify in 2011.

Review

HBMA Conference Review:Recently, Melissa Gilchrist from our company attended the 2016 Healthcare Billing and Management Association (HBMA) Healthcare Revenue Cycle conference in Atlanta, GA.

Practice Management

MIPS Tip Tuesday:Did you know that not all clinical practice improvement activities (CPIAs) are treated equally

Coding

Patient-Centered Medical Home:Before I started graduate school, I was a billing associate at a private pediatric office.

Billing

Penalties Doubled in August 2016: False Claims Act and OSHA:August 2016 was an important month, with penalties increasing for violations of the False Claims Act and OSHA.

Billing

Revenue Cycle 101: Online Carrier Access:We should all be utilizing carriers' online accesses. But the reality is that there are a large number of small to mid-sized practices that are not utilizing this free resource

ICD-10

FREE Webinar: ICD-10-CM - 2017 Updates - 1 CEU:Participants can expect to have an excellent understanding of the changes and updates occurring with ICD-10 in 2017

Practice Management

How to Reap the Economic Payoff from EHR Technology:History teaches us that new inventions do not automatically and immediately generate greater productivity.

Billing

Revenue Cycle 101: Expiration of Medicare Flexibilities:

The new Expiration of Medicare Flexibilities rule that takes place on October 1, 2016 is defined

Practice Management

DOJ’s Commitment to Holding Executives Accountable for Healthcare Fraud:Last year, the Department of Justice (DOJ) released a policy memorandum

Coding

Helping Practices Develop a Sound Revenue Cycle Strategy :Managing the flow of funds in your revenue cycle is one of the most essential and challenging tasks in operating a successful practice.

Practice Management

CMS Announces the MACRA / QPP Final Rule:Much to our surprise, CMS was two weeks earlier than promised when they issued the Final Rule for the Quality Payment Program (QPP) that is part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Auditing

Auditing Same Day Psychotherapy and E/M Services: The Time Trap :A problem-focused E/M service and the provision of psychotherapy on the same date of service are both separately payable, when medically necessary.

Billing

E/M 101: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.

Billing

Three Things To Avoid During Patient Collections:Accounts receivable nightmares happen. Most practices have weathered periods of soaring bad debt or collections numbers at some time in their history-and every one of them will tell you how hard it is to get those numbers back under control.

Practice Management

Telemedicine Statistics That Will get the Attention of Your Practice:Telemedicine enables providers to extend their reach, and improve their efficiency and effectiveness, while still maintaining high quality care and attention to patient safety.

Practice Management

5 Ways to Better Communicate With Patients :Communication is a vital part of the healthcare experience.

Practice Management

New Alternate Exclusions for 2016 Meaningful Use :Last year, CMS published their final rule for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs for 2015-2017

Practice Management

In Healthcare, What We Don't Want Is a Lack of Communication:Having both current and accurate data can help fuel expansion of referral networks through marketing.

Practice Management

CMS relents, will reduce 2017 MIPS reporting burden:You can expect CMS to soften the impact of its MeritBased Incentive Payment System (MIPS) for 2017. There will be four options given to providers for complying with MIPS on Jan. 1, 2017, which is when performancemeasuring begins for 2019, the first MIPS payment year.

Practice Management

How Consumer Demands are Changing Healthcare :One of the most profound shifts occurring in healthcare today is a new spotlight on consumers-their preferences, their opinions, and their experiences.

Practice Management

PQRS: Understanding How the 2017 Negative Payment Adjustment Affects You :According to an announcement made by CMS on October 3rd, 2016, they have begun distributing letters to Physician Quality Reporting System

Practice Management

CMS Announces a Pick Your Pace Approach to MACRA in 2017 :clinicians everywhere can be heard breathing an enormous sigh of relief

Practice Management

Concierge Medicine: Redefining the Doctor-Patient Relationship :The relationship between doctors and patients in U.S. healthcare has been slowly changing throughout the last decade.

Practice Management

Webinar: OSHA Compliance for Medical and Dental Offices:OSHA Compliance: OSHA for Medical and Dental Offices is for new hires and for annual employee training,

Practice Management

How EHRs Can Help Eliminate Claim Denials With Eligibility Verification:Making sure that a patient's medical insurance is up-to-date and active at the time of an office visit is

Practice Management

CASE STUDY: WEHRMAN HEALTHCARE MANAGEMENT SOLUTIONS SAVES CLIENTS MONEY:The Challenge: A paper-based billing workflow meant clients were paid more slowly-and the billing company was wasting time.

Practice Management

In a Value-Based Payment World, HCC is the new RVU:Before I was an independent healthcare consultant I was a medical practice executive for large health systems.

Practice Management

CMS Announces a Pick Your Pace Approach to MACRA in 2017:Universally, the clinician community wants a system that begins and ends with what's right for the patient.

Compliance

HIPAA Settlements Cost Hospitals Big Time :HIPAA SettlementsCybersecurity has become a major topic of discussion in healthcare over the last few years, particularly

Practice Management

Strategies for Small Practices Adapting to Healthcare Industry Changes:Priorities in the healthcare field have shifted greatly in the last decade.

ICD-10

ICD-10: CMS Requires More Specificity Beginning October 1st :Believe it or not, it's already been 11 months since ICD-10 was instituted by CMS.

ICD-10

WEBINAR: ICD-10-CM Diabetes:Each participant can expect to have an excellent understanding of Diabetes coding and documentation requirements under ICD-10-CM.

Practice Management

Population Health:The health outcomes of a group of individuals, including the distribution of such outcomes within the group

Practice Management

Medical Practice Management & MACRA: Are You Ready?:The Medicare Access and CHIP Reauthorization Act's goal is to move the system toward alternative payment models and value-based reimbursement.

Practice Management

Why is There Still So Much Paper in Healthcare? :At some point in the last 10 years, most industries across the world underwent a Paperless Revolution, of sorts-a period of transition when records and communications moved from paper-based to digital.

Compliance

How to Handle a HIPAA Data Breach :Repeated incidents of hacking and theft of personal health information (PHI) rocked

Practice Management

Workplace Violence Preparation In Your Practice:Have you ever been in a situation in which you sensed impending danger

Practice Management

Safeguarding the Practice from Embezzlement:Whenever money is involved, inevitably the green-eyed monster gets involved too. Jealousy and greed go hand in hand with money.

Billing

Consumerism in Healthcare Drives Price Transparency in your Practice: Three Tips to Deliver:Consumerism remains one of the biggest buzzwords in healthcare.

Billing

The Key to Good Practice Management Reporting: One Fee-Schedule:There has always been long standing controversy on whether or not a practice should bill using one fee schedule or maintain multiple fee schedules to match their payer contracts.

Coding

CMS Issues Final Rule on Reporting and Returning Medicare Overpayments :Section 6402 (a) of the Patient Protection and Affordable Care Act (PPACA), enacted on March 23, 2010, established a new Section 1128J(d) of the Social Security Act

Practice Management

Revenue Cycle 101: Determining Insurance Order:When patients have multiple insurance coverages, at times it can be difficult to determine which one is primary, secondary, and tertiary.

Practice Management

Why keep PQRS reporting on your priority list?:As a result of MACRA legislation, the Physician Quality Reporting System (PQRS) will be discontinued and MIPS (the merit-based incentive payment system) will take its place in 2017

Practice Management

Clinicians and Exceptions in MIPS :The Merit-Based Incentive Payment System requires qualifications that physicians and other practitioners must have in order to be included in this payment program.

Auditing

History of Present Illness :Per Medicare's 1995 and 1997 documentation guidelines

Practice Management

5 Things You Probably Don't Know About E-Prescribing:The days of paper scripts are quickly fading away as electronic prescriptions become much more popular. In New York, e-prescribing is now mandated, and Minnesota also has passed a law that requires prescriptions to be sent digitally.

Compliance

How Healthcare Providers Can Benefit From Integrating Systems :Recent legislation has motivated many healthcare organizations to rethink their approach to medicine.

Compliance

Healthcare Fighting Back Against Ransomware:The concept of thievery isn't all that complicated. In fact, it's an old and obnoxious tradition that companies and individuals have been battling for centuries.

Practice Management

Updates to the 2016 OIG Work Plan:Fighting fraud, waste and abuse continues to be the focus of the Department of Health and Human Services (HHS) and the Office of the Inspector General (OIG).

Compliance

Maintaining Information Privacy in a Big Data Environment:It's becoming increasingly important for healthcare organizations to share, analyze, interpret and respond to patient health information.

Compliance

HIPAA Security Breaches: Taking a Proactive Approach:Gone are the days when paper charts could be kept in a file cabinet under lock and key. Today, health care facilities are becoming more frequent targets of massive data breaches.

Practice Management

Revenue Cycle 101: Insurance Basics:Navigating the world of healthcare insurance policies is, at best, confusing.

5 Minutes with

5 Minutes With... Shannon Guanche, CPC, CPC-I:Can you tell us a little bit about yourself and how you got started in the healthcare industry?

Practice Management

Physicians Wary of MACRA's Potential to Hasten the Demise of Independent Practices:Two-thirds of independent practices now deliberately selling out to hospital systems and larger groups or closing down by 2019

Auditing

Electronic Medical Records: Is Your EMR Making You Look Like a Bad Doctor?:

Practice Management

Overthinking Overpayments from Medicare:Since passage of the Affordable Care Act, compliance officers and attorneys have struggled to comply with the new rule requiring notification and repayment of Medicare overpayments within 60 days.

Billing

Eligibility: What You Need to Know:Protect the financial livelihood of your practice through coverage verification and balance collection.

Practice Management

DOL Releases Final Overtime Rule:The U.S. Department of Labor (DOL) issued the long-anticipated final overtime rule on May 18 and included an exempt employee threshold of $47,476-less than the proposed rule's $50,440 but slightly more than double the old threshold of $23,660.

Practice Management

PQRS: Choosing Quality Measures That Make Sense :Now that you've chosen your reporting mechanism, the next task at hand is to select which measures you will choose for reporting. So what exactly is a qualitymeasure

Billing

Pass-Through Billing and Shared Labs:Pass-through billing is an arrangement between a physician practice and a reference laboratory that allows the physician practice to submit specimens to the reference lab for testing, pay that laboratory directly, and then bill the payer (insurance or patient) for the test, usually at a higher fee.

Billing

Modernizing Patient Payment Collection:Collections of patients' outstanding bills, those charges not covered by health insurance plans, are set to challenge medical practices across the country, if they haven't already.

Coding

Why are Evaluation and Management Services Being Scrutinized?:The OIG Work Plan is released annually, delineating areas of risk for fraud and abuse and how they intend to investigate them.

ICD-10

DOCUMENTING SPECIFICITY FOR ICD-10 CODING:Specificity in documentation allows the most accurate ICD-10 codes to be assigned. Correct coding allows the office to paint a more accurate picture of the patient's diagnosis.

Practice Management

10 Most Effective Features of a Family Practice EHR :The family practice is the first point of treatment for most individuals who require healthcare.

Practice Management

Physician Burnout - What You Need to Know:Stress and burnout is an epic problem in the medical industry, especially among physicians.

Coding

Revenue Cycle 101: Physical Therapy 15 minutes = 1 Unit:Coding physical therapy services can be tricky if you don't know the ropes, but if you know the facts about timed codes and supervision requirements, it can make your life a lot easier.

Practice Management

Overpayments: Reporting and Returning Deadline:The long awaited ruling on reporting and returning overpayments is now

Practice Management

5 Ways Mobile Apps Will Improve Your Healthcare Practice :In today's world of technology, everybody moves at such a quick pace it makes it hard for any industry to keep up with the times and healthcare is no different.

Billing

Why Your Billing Process Could Be Hurting Your Bottom Line:In 2016 most practices are looking for ways to increase their bottom line. Providers everywhere are looking for new processes that can be easily implemented to decrease cost, while increasing efficiency.

Practice Management

Meaningful Use and the Physician Quality Reporting System: Do you need a Consultant?:If you are one of the many healthcare providers who have received incentive payments thanks to the Meaningful Use (MU) program, then you were probably relieved to find out that the deadline for your 2015 attestation was extended to February 29th, 2016

Practice Management

The Growing Role of Consumers in Healthcare Payments:The U.S. healthcare payments market is expected to reach an estimated $5 trillion per year as a total of both payer and consumer payments by 2022 . However, more than 30 percent of those dollars are considered to be wasted due to inefficient payment processing and antiquated paper-based billing and administrative processes .

Practice Management

Meaningful Use Ends In 2016?:Due to the challenges of implementing Meaningful Use, it is unsurprising the Center for Medicare and Medicaid Service (CMS) is finally rethinking the plan.

Coding

Revenue Cycle 101: Superbill / Charge Master Reviews:Does your office complete yearly code/Superbill reviews when the new codes come out? If you’re not doing it themselves internally

Practice Management

Medicare Secondary Payer:Medicare Secondary Payer (MSP) is the term generally used when the Medicare program does not have primary payment responsibility - that is, when another entity has the responsibility for paying before Medicare.

ICD-10

ICD-10 Transition Moves Forward:On October 1, 2015 health systems across the country transitioned to the International Classification of Diseases, 10th Revision

Billing

Is Patient Collections the Next Big Thing in Medical Billing?:ICD-10 has gone surprisingly well. There are no guarantees, but the medical billing world hasn't exploded and claims are getting paid.

Coding

HCC Coding:Hierarchical Condition Category (HCC) is a risk adjustment model implemented by CMS in 2004 to estimate predicted costs for Medicare beneficiaries based on disease and demographic risk factors

5 Minutes with

5 Minutes with... Brad Justus:5 Minutes with - Brad Justus

Compliance

Protecting the Patient's Right to Privacy When Responding to Subpoenas for Medical Records:Once a provider obtains the necessary written assurances, it must release the medical records on the date specified in the subpoena.

Practice Management

Revenue Cycle 101: Determining Insurance Order:When patients have multiple insurance coverages, at times it can be difficult to determine which one is primary, secondary, and tertiary.

Coding

All of My Codes are Unspecified:When you are an auditor, you look for unspecified codes.

Practice Management

4 Myths About the Healthcare EFT Standard, Debunked:While it's been in effect since January 2014, the Healthcare EFT Standard via ACH is still a source of confusion for many medical providers.

Compliance

Learning from the HIPAA Violations of Others:The past can be useful in guiding our future actions, and it's generally considered wise to learn from our past mistakes.

Billing

Natural Language Processing: A Silver Bullet for Equitable Reimbursements:You're a healthcare provider. Now, imagine you have two patients waiting for you.

Practice Management

You're Managing the Practice but Are You Leading the Team?:Most discussions of practice management surround the day-to-day operations of the practice and how to improve the bottom line.

Coding

Scribes and Coding Professionals - A Natural Partnership:As healthcare organizations and practices continue to adopt electronic medical records, physicians and health system executives are learning that they are incredibly valuable, but have unfortunate limitations. One of those limitations is that documentation is much more cumbersome inside an EMR which drastically reduces a provider's productivity.

Practice Management

3 Steps to a Paperless Office Part II:Last week we began the series by telling you the first step to a paperless office, which is electronic faxing

Practice Management

Tip: Tired of Bounced Checks in your Practice:I have a solution for you.

Practice Management

3 Steps to a Paperless Office: Part 1:If your office continues to rely heavily on paper documents, chances are your staff is continuously sidetracked by inefficiencies that could be easily avoided.

Practice Management

Collections: Collecting money has become harder than ever!:If your client's accounts receivables are sitting at a reasonable number that likely means you're doing a solid job running the business side of a medical practice.

ICD-10

ICD-10 Reality Check: The First 30 Days:The headlines would lead one to believe all is well post-ICD-10.

ICD-10

Why Hundreds of Practices Breezed Through ICD-10 but You Didn't :Do you remember being in high school and getting irritated with the kid in class who always made it seem so easy and never struggled with anything?

Auditing

First Healthcare Compliance Survey: Current state of healthcare compliance management:During the latter two weeks of September 2015, an online survey was conducted by Marketing Matters on behalf of First Healthcare Compliance to learn more about the current state of healthcare compliance management from those involved in compliance.

ICD-10

ICD-10: Understanding initial, subsequent and sequelae - subsequent vs sequela:Now that ICD-10-CM is finally here, you will need to familiarize yourself with new concepts such as initial, subsequent, and sequelae classifications for diagnosis codes - subsequent vs sequela

Practice Management

Data Conversions Are Never Easy:Data Conversions are never easy, so why do them

ICD-10

What a Bumpy ICD-10 Transition Actually Means :If your practice is still experiencing bumps during the transition from ICD-9 to ICD-10 then you might need to take a deeper look at why.

Practice Management

Switching to the Healthcare EFT Standard: 4 Ways to Ease the Transition:Healthcare electronic funds transfers (EFTs) via ACH-the Healthcare EFT Standard-can make practice management easier and more affordable-and switching doesn't have to be difficult.

Practice Management

Medicare's Chronic Care Management Program is Good News for Patients and Providers:This innovative program from CMS aims to improve care of patients with chronic diseases and increase practice revenue.

Compliance

Revenue Cycle 101: HIPAA: Notice of Privacy Practices (NPP):I know; HIPAA is old news. And all of your offices are presenting your patients with a HIPAA NPP already.

Practice Management

Medical Scribes: How an Ancient Profession Offers Unexpected Patient and Practice Benefits:It's no secret that the emergence of electronic health records (EHRs) has drastically changed the landscape of healthcare.

ICD-10

ICD-10: Most private payers won't offer grace period like CMS:Most commercial payers will not offer a oneyear grace period for ICD-10 codes like CMS, DoctorsManagement has learned

Practice Management

What Meaningful Use Stage 3 Means for Eligible Professionals:In April of 2015, the Centers for Medicare & Medicaid Services (CMS) published its vision and final recommendations for Meaningful Use Stage 3

Practice Management

3 Productivity Drains on Modern Medical Practice Management :The Modern Medical Practice is faced with a long list of problems which can make it difficult to stay focused and productive.

Practice Management

Revenue Cycle Management: Stop Your Practice From Crumbling :Do you know the parable about the wise man who built his house upon the rock vs. the foolish man who built his house upon the sand

Billing

The #1 Way to Reduce Your Billing Staff's Stress :We know the front office of almost every healthcare practice in the world is under a lot of stress

ICD-10

Documenting the Patient Record:For documentation purposes and continuity of care, it has always been important for providers and clinicians to document the entire story.

Billing

Revenue Cycle 101: Patient Credits:How does your office deal with patient credits - More importantly, does your office deal with patient credits - at all

ICD-10

Now Is The Time To Ensure Proper ICD-10 Coding: Coding for Obstetrics and Related Conditions:As we count-down to October 1, 2015 and the implementation deadline grows closer, we all need to ensure proper coding in all aspects. This article will take the complexity of coding for Chapter 15: Pregnancy, Childbirth, and the Puerperium

Practice Management

The #1 Need in Physician Practices Today And It's Not an EHR!:In working with thousands of physician practices over the past 5 years, I've found one need that is almost universal.

ICD-10

ICD-10 Readiness: Why Physicians Dont Need to Worry:With ICD-10 right in front of us, it's more important than ever to accurately assess the billing cycle within your practice.

ICD-10

E-Book: ICD-10 READINESS IN SIX STEPS:As it looks right now, ICD-10 is coming. For all of the naysayers who have depended on another delay and intentionally avoided getting ready, its time to face the music.

ICD-10

The CMS ICD-10 Announcement: What It Means to Your Practice:First, the game-changing announcement below means that a sigh of relief is in order. Some of the anxiety surrounding potential financial disaster with the coming of ICD-10 should be abated

ICD-10

CMS to Implement Over 320 ICD-10 Codes for Primary Causes of End Stage Renal Disease for Patients with End Stage Renal Disease:To help support the transition from ICD-9 codes to ICD-10, and to help ensure that all Medicare-certified dialysis facilities and transplantation centers throughout the United States and U.S. territories have the codes needed when reporting patient data, in 2014

ICD-10

ICD-10 Quick Start Guide:This guide outlines 5 steps health care professionals should take to prepare for ICD-10

ICD-10

What you need to know about SGR fix and ICD-10:The long-maligned SGR formula - which would've instituted a 21% cut for 2015 - has been replaced with a series of automatic positive 0.5% adjustments through 2018.

Billing

Happy Patients Who Pay More Bills:Collecting more from your patients while also keeping them happier? Sounds too good to be true. This article shows you a few ideas that could help make this a reality for your practice.

Practice Management

The #1 Need in Physician Practices Today And It's Not an EHR:In working with thousands of physician practices over the past 5 years, I've found one need that is almost universal.

Practice Management

How to Identify Who Sent Your Healthcare EFT Payment:Healthcare providers interested in cost savings and other benefits are converting to electronic payments at a steady clip.

Auditing

EKG Interpretation in E/M Auditing:EKGs: Do you get 2 points for MDM (amount and/or complexity) or 1 point for order/review?

Practice Management

5 Reasons Why Doctors Hate Their EHR Software :Over the past 5 years, I've done almost nothing other than speak with one medical practice after another about how they document their patient vists and why they hate the EHR software they use to do it.

ICD-10

ICD-10 Readiness Step 5: Getting Paid Equals Increased Documentation:There's a saying that medical coders have that will be important for all healthcare providers to remember once ICD-10 takes effect:

Billing

Top 8 Tips to Achieve Patient Billing Success:The process really is painless for all involved. After the claim has been processed by insurance, any patient responsibilities - like copays, coinsurances, or deductibles - are then charged directly to the patient's credit card.

Billing

Billing injections on the same day as an E/M service :Physicians often reflexively attach what they believe to be an appropriate E/M code to a claim on the same date the patient receives an injection.

ICD-10

HCCs: What Are They... And What Do They Mean?:In the changing world of Medicare Advantage plans, HCCs are taking the place of ICD-9-CM codes as well as setting the stage for the incoming ICD-10-CM codes. To know where we are going, first we have to know where we have been. This article will introduce you to the HCC history, background, and models that Medicare Advantage plans are now using to service chronic care patients.

Billing

Important New Concerns for Billing Companies, Providers, and Suppliers:The goal of Final Rule 6045-F is to strengthen the integrity of the Medicare program and curtail the enrollment of fraudulent providers.

Practice Management

Medicare Overpayment Demands: The Financial Timeline and Options:The process of Medicare contractors such as Zone Program Integrity Contractors (ZPIC) and Recovery Audit Contractors (RAC), issuing adverse medical review findings and Medicare Administrative Contractors (MAC) subsequently demanding repayment of alleged overpayments can be very daunting for providers.

Coding

Qualitative Drug Screen Testing 2015 Change in CPT Codes:The Centers for Medicare and Medicaid Services has changed the CPT guidelines for reporting qualitative drug-screen testing in a physician's office

Billing

Making sure your Practice gets Paid:Deductibles! How do you protect your practice from the risk of not being paid, while protecting your patients' finances?

Practice Management

G0402: Medicare Preventive Visit:Medicare covers a one-time Initial Preventive Physical Examination (IPPE), also referred to as the Welcome to Medicare visit.

Practice Management

What new RAC changes mean for providers:In last month's The Business of Medicine newsletter, we gave you an overview of some sweeping changes being made to Medicare's Recovery Audit Contractor (RAC) program that are intended to address provider concerns about RAC demand letters placing an unreasonable burden on the provider community.

Billing

5 tips to properly bill for teaching physicians:Services that involve residents and teaching physicians will always be crucial for teaching hospitals and similar facilities, but their complexity has made them a top audit target.

Practice Management

Lessons from inside a collection agency:I recently started working for Transworld Systems, one of the nation's largest collection agencies, after being a practice manager and practice management consultant for several years.

Billing

Top Tips for Correct Anesthesia Billing... The First Time, Every Time:Anesthesia can be a complicated and sometimes daunting task to fulfill. There are several modifiers that can lead to unsuccessful payment of actual services being performed by your Anesthesiologist.

Compliance

Solving the Healthcare EFT Standard Enrollment Challenge for Providers:The HIPAA healthcare electronic funds transfer (EFT) standard for claims reimbursement is EFT via ACH (NACHA CCD+Addenda), which works similarly to Direct Deposit. Money is sent electronically from a health plan directly to the provider's bank account and is required to carry the TRN Reassociation Trace Number that allows for automated reconciliation of the EFT via ACH payment with the Electronic Remittance Advice (ERA).

Practice Management

The Best Bosses Are... What Every Employee Wants From You as a Leader:Being overburdened by the responsibility of having to figure out what others want and need of you is a familiar feeling shared among leaders

HIPAA

Solving the Healthcare EFT Standard Enrollment Challenge for Providers:The HIPAA healthcare electronic funds transfer (EFT) standard for claims reimbursement is EFT via ACH (NACHA CCD+Addenda), which works similarly to Direct Deposit. Money is sent electronically from a health plan directly to the provider's bank account and is required to carry the TRN Reassociation Trace Number that allows for automated reconciliation of the EFT via ACH payment with the Electronic Remittance Advice (ERA).

Compliance

The Rising Tide of Medical Identity Theft:In March 2014, Nightly Business Report (NBR) released a feature story titled, Medical ID Theft.

Coding

2015 RVUs: Epidural injections, ultrasound studies see big gains:You can expect to see payment boosts for a number of frequently billed epidural injection codes in 2015, according to our analysis of the 2015 Medicare Physician Fee Schedule, which contains the new relative value units (RVUs) being used for CPT codes. RVUs, and thus payments, are also going up for the technical component (TC) of several ultrasound exams.

Practice Management

Rounding Providers: What Are You Leaving Behind?:Provider rounding can be very hectic, to say the least. For the most part, they're unscheduled and unplanned encounters, with a wide array of medical situations and risks, and sometimes

Coding

5 keys to critical care coding:Critical care is the most highly compensated E/M service, but it's also the most highly scrutinized by payers.

Coding

G0402: Medicare Preventive Visit:Medicare covers a one-time Initial Preventive Physical Examination (IPPE), also referred to as the "Welcome to Medicare" visit. IPPE is a unique benefit available only to patients newly enrolled in the Medicare Program and must be received within the first 12 months of the effective date of their Medicare Part B coverage.(This is a one time benefit.)

Billing

Errors and Ommissions Insurance for a Billing Company: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

Billing

Making sure your Practice gets Paid:Deductibles! How do you protect your practice from the risk of not being paid, while protecting your patients' finances?

Billing

Billing for Rounding Encounters: You Dont Know What You Dont Know:What I see as a common thread, when discussing RCM and billing for rounding encounters, is a very reactive approach to managing the process.

Billing

Healthcare Providers Switching Payments to EFT, Thanks to New Standard:A new healthcare electronic funds transfer (EFT) standard went into effect at the beginning of the year, and many healthcare professionals are reaping the benefits of the time and money savings it can provide.

ICD-10

Don't Let the New ICD-10 Catch You Off Guard:

Coding

Coding Radiographs of the Thumb:If you've ever taken piano lessons, you know that the thumb is considered the first finger of the hand. However, when you are coding an x-ray of the thumb, you will find that this is considered part of the hand and not a finger.

ICD-10

Debunking Myths and Misperceptions of ICD-10:In today's social, shareable society, myths spread faster than ever. Fortunately, old-fashioned facts still trump inaccurate and misleading information.

ICD-10

ICD-10 Delay: What you told us (Survey results):By now you have processed the news that H.R. 4302 - Protecting Access to Medicare Act of 2014 was passed and signed into law by President Obama on April 1st, 2014. No, it wasn't an April fool's joke; this bill made it all official, that amongst many things, ICD-10 is delayed to October 1st, 2015.

Practice Management

Exclusive Interview with Marilyn Tavenner (CMS):You have an extensive background in healthcare with the various positions that you have held. How do you think that having these experiences in such diverse areas of healthcare gives you an advantage in your current role as Administrator of the Centers for Medicare and Medicaid Services?

ICD-10

Preparing for ICD-10 While In an ICD-9 World:Unless you are living under a rock or plan on retiring, you are probably aware of the United States adopting ICD-10 and are beginning to worry about what this means for you and your organization. Although ICD-10 is not mandated to be implemented until October 1, 2014, the impact on physician office coding, billing, and collections will be profound and requires immediate attention.

Compliance

HOW TO SURVIVE HIPAA's NEW OMNIBUS RULE:First, know the facts. Read the information below, which covers the basics of the new rule. Second, learn how the new rule will affect your medical practice by attending one of our upcoming FREE webinars. Click here or scroll down to register.

Practice Management

Eight Exercises for a Healthy Practice:Conventional wisdom suggests that healthcare is "recession-proof," yet medical practices are as susceptible to economic cycles as other small businesses. There are ways, however, to maintain the health of your practice in light of declining revenues, growing accounts receivable, and tighter cash flows within the practice.

Billing

Trends in Billing and Coding for Allied Health Care Education:During my thirty-year career in allied health care, I've witnessed many exciting changes in the industry. These next two years are no exception, as we continue the migration from paper records to electronic health records (EHR), the implementation of ICD-10, and exciting new job opportunities for allied health care students and those already in the field. As Program Chair for Medical Assisting and Medical Insurance Billing and Office Administration (MIBOA) for Ross Education, LLC, one of my goals is to ensure that students are prepared for the changes ahead.

ICD-10

Face to Face with&Lee Barrett:My role as Executive Director is the most exciting time I have ever had in a role. There is a significant amount of work, information dissemination, collaboration, and research needed today due to the frenetic pace of change and keeping up with the healthcare reform regulatory requirements and their potential impact to our accreditation programs. We have a committee designated to reviewing and staying abreast of national regulatory requirements and a dynamic, diverse, and very balanced commission representing the majority of the accreditation stakeholders that we provide programs for.

Billing

Interested in becoming a Billing and Coding Instructor?:By: Jennifer Sater
On the Job at Ross: What It's Like to be a Medical Billing and Coding Instructor?

ICD-10

ICD-10 and Sports Medicine:Sports medicine will be a challenge for the provider to ensure accurate and anatomical documentation.

Coding

Continuing education units How do I earn my CEUs with BC Advantage MAGAZINE?:BC Advantage offers all of its magazine subscribers FREE access to our online CEU center where they can earn up to 12 CEUs per year.

ICD-10

Face to Face: Chuck Buck:In the post-ICD-10 world, it would appear that many healthcare providers will be challenged with the daily implementation of ICD-10, particularly as it relates to reimbursement which, in turn, impacts revenue, cash flow and profitability.

ICD-10

FREE E-book: ICD-10 Public Health:

Billing

Do you have what it takes to work from home?:In today's times, self-employment and the home-based medical billing business appears to be the saving grace of those raising families or those looking for a new direction in their careers. The big question is - are you the type of person who has what it takes to work from home?

Practice Management

FACE 2 FACE with... Sean Weiss CCP-P, CCA-P, CPC, CPC-P:Currently I serve as Vice President and Chief Compliance Officer. I work collaboratively with our editorial staff (Part B News, Medical Practice Compliance Alert, Product Managers, etc.) and senior executive team to ensure we are producing products of the highest quality and generating curriculums for our conferences and webinars that cannot be duplicated by any other company our size within the industry.

ICD-10

FREE E-book: ICD-10-CM Guidelines:Preparing for ICD-10-CM, your 22 page overview of ICD-10-CM to help you get started The intent of this guide is NOT to scare you. This guide does NOT provide any information regarding ICD-10-PCS. I will leave ICD-10-PCS to the appropriate coding associations/organizations. The intent of this guide is to help you and to calm your fears.

ICD-10

FREE E-book: ICD-10 Cardiology:

Coding

ICD-9-CM Updates:Changes to the ICD-9-CM (diagnostic) code set for 2011 include many relatively simple additions to better diagnostic accuracy. Examples include:

Practice Management

FACE to FACE: Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, CPMA, CEMC, COBGC, CPCD, CCS-P:BC Advantage asked the new President/CEO of The Academy of Professional Coders (AAPC) about her thoughts on the current state of the industry, what industry professionals should be looking to achieve in the future and more...

Coding

Developing a Relative Value-Based Fee Schedule:The resource-based relative value scale was implemented by CMS--or HCFA, as it was known at the time--for the Medicare physician fee schedule in 1992. In 2002, it transitioned wholly to a resourced-based methodology. Relative value units are updated annually. The conversion factors are driven by government budgetary requirements. Specialty societies and individuals are invited to submit comments and participate in relative value unit (RVU) evaluations.

Practice Management

Repower Your Resume in 2011:What will 2011 hold for you? Is it a new job, career path or perhaps you're considering expanding your professional potential by adding a certification (or two!) to your name? Do you plan on attending any conferences or listening to any webinars? There are a lot of choices out there and it's hard to find out about what's happening throughout an entire year. So we asked the associations that have approved our online CEU Center to provide CEUs to you what was happening with them in 2011. Make sure you visit their websites and see how they can help you.

Practice Management

Everything Old is New Again: Physician Hospital Integration:Hospitals are once again in the market for physician talent. Hospitals are buying physician practices and entering into employment arrangements with physicians at unprecedented rates. But how does such a transaction unfold?

Auditing

Compliance Audits: Preventive Medicine for You Practice:Imagine the patient who doesn't come to your practice until he is very ill. He's hospitalized, undergoing extensive procedures at a great cost. The sad part? His condition could have been prevented if he had come in for regular preventive care.

Coding

Audit-proof your practice: Be prepared for RACs and MICs:Ready or not, Recovery Audit Contractor (RAC) audits are a permanent program for Medicare providers. Although physician practices have long faced the possibility of an audit by the Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG), the RAC audit program has taken this exercise to an entirely new level. Since CMS announced that it had recovered more than $1 billion in overpayments to providers, it has expanded the original pilot program to all 50 states as of January 1, 2010. This translates to a substantial increase in the likelihood that practices billing for Medicare fee-for-service will be audited.

Coding

Consultations for Medicare are now a four-letter word - Gone!:While CMS will continue to recognize telehealth consultation G-codes for payment consideration, it stopped recognizing the CPT consult codes effective for dates of service on and after January 1, 2010. The November 25, 2009 edition of the Federal Register contains the 2010 physician fee schedule final rule and includes a fascinating discussion on this topic.

Coding

3 ways Congress could still kill ICD-10:As the U.S. House of Representatives inked the latest episode in the sustainable growth rate saga, many eyes of the industry were watching to see whether anything related to ICD-10 landed among that bill's pages.

Practice Management

CMS finalizes changes to physician supervision requirements for hospitals:CMS adopted a new standard for direct supervision of therapeutic services provided "in a hospital" or on-campus outpatient department as part of the 2010 OPPS final rule, released October 30.

Practice Management

2010 - GET EXCITED!:With 2009 drawing to a close, what resolutions are you going to make for 2010? Has further education and job security entered your mind in these tough economic times? Well it should!

Billing

Web-based medical claims clearinghouse enables orthopedics practice to slash days in AR:It's not unusual for a practice management (PM) system vendor to form a partnership or even share ownership with a clearinghouse service. Often, it's a good thing for both parties.

Billing

Succeeding with technology: Best practices medical groups can learn from billing services:With every passing year, the application of information technology is becoming increasingly more critical to the practice and business of medicine to ensure fiscal health-especially as reimbursement levels decline while operational costs increase. For medical groups and billing services alike, reliance on the wrong information management systems can present substantial barriers to growth, if not survival. However, selecting the proper practice management system can better position your organization for expansion, added services and additional IT endeavors, such as electronic medical records.

Practice Management

AAPC President Reed Pew Discusses Health Care Issues:AAPC President and CEO Reed Pew addressed a crowd of nearly 2,000 medical coders and health care professionals at the AAPC annual conference held in Las Vegas in early April. This year, more than ever, medical coders and health care professionals alike are recognizing the importance of staying current in their education and understanding all of the changes that are taking place in the health care industry. In his annual conference address, Pew addressed many of the topics that are weighing heavily on the minds of health care professionals across the country.

Rethinking claims editing:Loss of revenue due to preventable claim rejection is a persistent industry problem with a disproportionately negative impact on cash flow. Just considering the hard dollars - and not issues like staff productivity and overhead - medical practices and their billing services are leaving quite a bit of money on the table.

2009 Physician Fee Schedule Rule Addresses Anti-Markup, Stark, IDTF, And Other Issues:On October 30, 2008, the Centers for Medicare & Medicaid Services (CMS) put on display a copy of its 2009 Final Physician Fee Schedule Rule for Calendar Year 2009 (Final Rule), which is scheduled for publication in the Federal Register on November 19, 2008. In addition to adjustments in the amounts to be paid under it, the Final Rule addresses significant Medicare payment policy changes in a number of areas.

Compliance

HBMA ASKS, IS YOUR MEDICAL INFORMATION AT RISK?:SECURITY FAILURES, COMPUTER CRIME AND PRIVACY BREACHES
At the Healthcare Billing and Management Association's (HBMA) Fifteenth Annual Spring Meeting at Disney's Contemporary Resort, top rated speaker, Randy Johnston spoke to a record attendance providing outstanding computer security and technology advice at his "Computer Abuse in the Medical Practice" session.

Practice Management

Free Tools You Can Use to Prepare For A Recession And Maximize Your Website Traffic Through Tough Times:As many businesses are finding out the hard way, discussions about whether we are in a recession or not doesn't impact the hard fact that we are clearly in economic down times. Many business owners, particularly small business owners, have begun reaching out for free tools and ideas for marketing on the Internet. That's why the team at TGR has created a list of "Ten Free or Low Cost Ways to Use the Internet to Help Your Business in Down Times." These Internet marketing ideas, tools and technologies are immediately available online to maximize your website traffic and help businesses weather the current tough economic climate.

What's on in 2008? Get excited about your association!:2008 is just around the corner and everyone is gearing up for a great year. BC Advantage asked the major industry associations about their plans for the coming year!

Choosing the right software application for your practice or billing company:Choosing a software application to help manage our practice or billing company can be a daunting task. With so many software packages available on the market, which is best suited for your needs now and in the future?

Face to Face with Karen Zupko:Karen Zupko is the CEO of Karen Zupko & Associates, Inc. a Chicago-based practice management consulting and training firm with clients nationwide. Karen Zupko & Associates (KZA) has built a respected reputation since 1985 assisting hundreds of clients in many areas. Working on the philosophy that it is better to help clients create management solutions than to call a practice management "doctor" every time a minor problem arises has built KZA to where it is today.

FACE TO FACE: Judith Hart-Killelea:Hart Associates, named in the top 100 women-led business in Massachusetts by the The Center for Women's Leadership at Babson College in 2005, has been in business for over 25 years providing services to multi-specialty groups and physician practices as well as the billing services for the Childhood Lead prevention Program for the State of Massachusetts.

Practice Management

Don't undervalue yourself!:Tips for presenting your services to potential clients

Face to Face with AAPC's Reed Pew:The AAPC has endured an interesting year and with the appointment of Reed Pew as the new Executive Director of the AAPC, the team at BC Advantage wanted to ask the questions many in our industry have been thinking.

Medicare to try `pay for performance':WASHINGTON · After years of trying to rein in the runaway cost of the Medicare program, Congress has decided to use a carrot instead of a stick to change doctors' behavior.

Inclusive Denials:Experiencing a denial from an insurance company with little explanation is frustrating for all billers and coders. Appealing denials takes time and experience and sometimes results in further denials and then loss of revenue. Steve Verno shares some of his wisdom with dealing with appeals to BC Advantage.

Practice Management

Las Vegas Conference to present a full-range of physician and staff topics:Hundreds of physicians, practice administrators, billing and coding professionals from all over the country are expected to participate in this year's Medical Practice Coding and Compliance Summit in Las Vegas this November. The goal: finding workable solutions for today's reimbursement and regulatory challenges. The summit will be held at Harrah's on the Las Vegas Strip on November 9 and 10, and is jointly presented by Practice Management Institute and The CMC Group, L.L.C.

Electronic Medical Records use by Office-based Physicians in 2005:The National Ambulatory Medical Care Survey (NAMCS) recently released data regarding the use of Electronic Medical Records (EMR) by office-based physicians during 2005.

Latest on Medicare Payments, Policies and Practices:New Hospital-Issued Notice of Noncoverage: The Centers for Medicare & Medicaid Services (CMS) has introduced model language for a new Hospital Issued Notice of Noncoverage (HINN). HINN 11, as the new notice is called, may be used as a liability notice for fee-for-service inpatient hospital beneficiaries who are due to receive specific diagnostic or therapeutic procedures that are separate from treatment covered/paid/bundled into the inpatient stay.

Coding

CEU Survey Results:We had an excellent response to our survey with 642 readers taking the time to answer our questions. We offered two $50 gift cards to Target to the participants and we are pleased to announce those two winners.

Setting provider fees:Consultants charge physicians and hospitals between $5,000 and $25,000 to set fee schedules for the procedures they perform. Since it is illegal for physicians to discuss their fees with other physicians, it is often a difficult task to figure out exactly what to charge patients for the procedures performed.

Automated efficiency:A survey conducted early this year, showed hospital and insurance executives agreeing that an automated medical claims and payment process could reduce the costs of health care and benefit patients

Helping to diagnose hospital bills:SOLVE A RUBIK'S CUBE blindfolded? No sweat. Explain quantum mechanics to a room full of second-graders? Not a problem. Drive from Renton to Bellevue on Interstate 405 at 8 a.m. on a weekday in 15 minutes? Come on, think up a tougher challenge than that. All right, here's one: Decipher a hospital bill. Most of you would opt for the cube and a blindfold rather than try to explain the arcane coding and indecipherable pricing mechanisms of the typical hospital bill.

Requirements for the Payment of Medicare Claims - A Selection of Some Important Criteria:In addition to national and local coverage determinations (NCDs and LCDs), there are certain principles that apply to all Medicare claims. These are rooted in the Medicare laws and regulations. By drawing the attention of our provider community to these topics, we anticipate reducing the claim payment error rate and reimbursing for medically necessary services correctly and expeditiously. This is not an all-inclusive list, but it does represent frequent observations from our Medical Review and Medical Policy departments.

HIPAA - Expert outlines how to respond to a security breach:You have just been told an employee's laptop containing your patients' claims information was stolen. Should you make a public announcement, publish a warning on the website, or hope the problem goes away?

ICD-9 Coding for Beginners - MARCH 2006 EDITION:This course provides an introduction to the International Classification of Diseases, (Ninth Revision), Clinical Modification (ICD-9-CM) manual. Volumes 1 and 2 are discussed at length including discussion of the coding tables in Volume 2. Participants will learn the importance of coding to the "highest level of specificity" using practical examples and gain an understanding of the ICD-9 footnotes, symbols, instructional notes and conventions. Volume 3 is briefly discussed for Part A providers

Complete transcript of the HIPAA roundtable discussion:Since it became law in 2003, the Health Insurance Portability and Accountability Act (HIPAA) has been invoked many times when relatives, neighbors and other interested individuals have sought information about a medical patient and were denied that information. The word "HIPAA" has also been invoked when journalists have sought and been denied what they perceive to be vital public information. During the early years of its implementation, how has HIPAA affected the quality of health care, the quality of public safety and access to public information?

Practice Management

New tax change allows startup costs deduction:There's a new tax break for small-business owners you may not have heard of. Simply known as the Section 195 deduction, this new provision allows businesses to deduct $5,000 of their startup costs. This article from MSNBC.com gives you the skinny on the new deduction, including a catch to claiming it (hint: you start losing the $5,000 when your startup costs go over $50,000) and a brief comparison to similar deductions small businesses can claim.

Practice Management

Get down to business in 2006:JAY BERKOWITZ gives a simple outline of how to go about developing a 2006 business marketing plan

Practice Management

Pathway to success:DOES your office experience a rejection rate in insurance denials that's higher than you'd like it to be? Does your front-desk and billing staff know the type of information that's important to obtain when registering a patient? Do they know WHY the information they're collecting is important?

Ways to deal with :How many times have you received reduced payment on claims for charges that are "above usual and customary"? Many insurance companies get their payment data from Ingenix and use the 80th percentile to determine how much they will pay for a specific CPT code. Anything billed over that amount is denied as above usual and customary. Our company always fights these denials.

Healthcare users struggle with HIPAA:Increased regulation, according to healthcare users, has hit their industry hard. Harder, most estimate, than regulations in other industries where businesses are more used to staying on top of trends in IT. In fact, most of the healthcare users SearchStorage.com spoke with had only made the move from DAS systems last year, and then only grudgingly in response to the Health Information Portability and Accountability Act (HIPAA).

Medicare Appeals Process:CMS contracts with private insurance organizations to process Medicare claims. These entities process Parts A and B claims for hospitals, skilled nursing homes, home health agencies, and hospices, as well as Part B claims for physicians and other outpatient suppliers

Medical Review Matching of Electronic Claims and Additional Documentation in the Medical Review Process:SUMMARY OF CHANGES: Clarifies that for medical review contractors require the submission of paper claims except as expressly permitted section 90, of the Medicare Claims Processing Manual. Clarifies how paper documentation for medical review purposes. Indicates when additional documentation shall be matched or considered for medical review.
NEW/REVISED MATERIAL
EFFECTIVE DATE: February 10, 2006
IMPLEMENTATION DATE: February 10, 2006

Practice Management

Do you have the contract you need?:EVERY medical billing company should have a comprehensive contract and review it often. The contents of a good contract will spell out exactly what you will provide to a client and should include clauses such as: term, renewal, services to be provided, covenants of client, compliance with insurance programs, programming modifications, ownership of software, fee payment, confidentiality, liability, termination, waiver or breach, litigation, modifications, agreements outside contract and more.

Legally Speaking: Does HIPAA cover our four-legged friends?:A few years ago the health care industry changed dramatically when lawmakers added a strict privacy act into the Health Insurance Portability and Accountability Act, otherwise known as HIPAA. That move has caused confusion all around, even at veterinarian clinics.

Practice Management

Need help? don't call us:ONLINE forums are now saving medical companies thousands of dollars a year, are you one of them?
Many billing and coding companies still will not allow their staff internet access to ensure that employees don't waist time sending personal emails, surfing the web and more.

Practice Management

Spiraling Out of Control: 5 ways to Reduce Workers' Compensation Claims:One of the biggest expenses affecting small businesses is workers' compensation insurance, which covers expenses associated with injuries to employees while on the job. In fact, 33 percent of small business owners identified workers' compensation as a critical problem in 2004, according to the National Federation of Independent Businesses (NFIB).

Practice Management

Outsource the Outsourcing:By now, nearly everyone understands the logic of offshoring. Why keep noncore functions in-house when you can contract them out to lower-cost providers overseas? Less obvious is how to put that understanding into practice--that is, how do you actually create a global organization able to operate across multiple time zones and tricky cultural and linguistic divides?

Practice Management

Huge growth for tech in health sector:Medicine is an increasingly hi-tech business, but doctors and hospitals around the world remain bogged down in paperwork.

Medical Records Create Problems For Evacuees:HOUSTON -- Nearly two months ago Hurricane Katrina lit the fuse on a chain reaction that has changed the city of New Orleans and the face of Houston. Thousands of new residents in the Bayou City have added all sorts of challenges. But the biggest is medical issues -- from chronic to life threatening illnesses, the KPRC Local 2 Troubleshooters reported Tuesday.

Feds Explain Provider ID Plans:The Centers for Medicare and Medicaid Services has published a six-page tutorial on the national provider identifier.

Practice Management

Synergy Forms Alliance with the SBA - Begin Your Medical Billing Business in 1 Month!:Finding the right financing is too often the most significant and frustrating challenge facing small and home based medical billing center owner. Whether you are creating, expanding, or buying a company, knowing and understanding the commercial lending process is the most essential element of creating a successful loan application.

Web-Based Electronic Medical Records Offer Portability, Disaster Protection:In areas of Louisiana and Mississippi affected by Hurricane Katrinarelated flooding, nearly 6,000 physicians directly involved in patient care were displaced, and numerous others suffered disruptions to their practice. As offices flooded and charts became waterlogged or computer discs were damaged, loss of medical records directly threatened patient care. Even worse, patient records containing identifying data and other sensitive information may have floated downstream into the wrong hands, leaving patients susceptible to loss of privacy and even identity theft.

Billing

Getting Hired - Volunteer work can it help?:Q. I am a recent graduate of medical billing and have been unsuccessful, so far, in my job search. I am considering doing volunteer work in a local hospital to get a head start on my career, and am scheduled for volunteer orientation in a few days.

Billing

Ever get a nasty letter from a ticked-off patient? Here's how to defuse the situation:Every doctor is bound to receive a poison-pen letter from a patient from time to time. Billing disputes, misunderstandings, and complaints about medical care or treatment by staff can all spark irate correspondence. Tempted as you may be, you can't afford to simply ignore such letters. Many's the malpractice suit that was preceded by a complaint that went unanswered.

Practice Management

Managing the financial aspects of your practice is a challenge!:Managing a medical practice can be incredibly challenging. With billing issues, changing insurance plans, and keeping equipment up to date, it can seem like dealing with finances gets in the way of what you really want to do take care of your patients

Is It Finally Time to Put Patients' Medical Records Online?:Although it has been a long time coming, physicians are beginning to consider the Internet an integral part of their practice.

Practice Management

PDA App Speeds Care for Katrina Victims - Can it help your business?:Hospital Medicine Service clinicians say using hand-held charge capture software helped them speed care for patients they treated as a result of Hurricane Katrina. The caregivers worked double shifts at Our Lady of the Lake Regional Medical Center, Baton Rouge, La., to care for an influx of patients in the 10 days following the hurricane.

Coding

Volunteer work is an excellent door-opener:I am a recent graduate of medical billing and have been unsuccessful, so far, in my job search. I am considering doing volunteer work in a local hospital in order to get a head start on my career, and am scheduled for volunteer orientation in a few days.

Billing

Medical Billing Scams - How to Protect Yourself:If you're looking for a home-based business that can help you pull in $20,000 to $45,000 a year using your computer, a work-at-home opportunity doing medical billing may sound like the perfect choice. But before you part with your money, consider this: The Federal Trade Commission (FTC) has brought charges against promoters of medical billing opportunities for misrepresenting the earnings potential of their businesses and for failing to provide key pre-investment information required by law.

Practice Management

Quality Still the MIPS Heavyweight in 2019:One final note regarding the basics of the Quality category

Billing

Key Performance Indicators to Judge the Effectiveness of a Medical Billing Company:The intricacies of medical billing appear to have no end in today's complex and difficult reimbursement situations. Regardless of the challenges, you must be ready to guarantee that collections are optimized and streamlined.

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