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Place of Service Coding

by John Verhovshek, MA, CPC Place of Service Codes (POS) are two-digit codes reported on health care professional claims to indicate the setting in which a service was provided. Each billable line item...

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Avoid Claim Denials for Incision and Drainage Services

Getting Medicare administrative contractors (MACs) to reimburse your Part B claims for incision and drainage services requires familiarity with national and local coverage determinations. Payer...

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Insufficient Documentation No. 1 Reason for Claims Denials

Insufficient documentation caused more than 94 percent of Comprehensive Error Rate Testing (CERT) review contractor-identified improper payments during the 2014 reporting period, according to the...

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CMS Puts ESRD Home Dialysis Policy in Writing

The Centers for Medicare & Medicaid Services (CMS) has added language to its billing guidelines for home dialysis (less than full month) to be consistent with its policy for partial-month,...

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The Benefits of Credit Card on File

by Mary Pat Whaley, FACMPE, CPC To ensure successful collections in a medical practice, front desk staff must be involved. As a first point of contact for patients, front desk staff should understand...

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Medicare Provides Incentive to Talk About Death

No one wants to be the bearer of bad news, especially when it involves the death of someone you’re caring for. After all, it’s ingrained in provider ethics to save lives and to “be dedicated to...

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Reporting Clotting Factor Units in 2016

The Centers for Medicare & Medicaid Services (CMS) recently announced the annual clotting factor furnishing fee for 2016. At approximately the same time, Palmetto GBA published an article reminding...

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New POS Code Adds Specificity to Outpatient Hospital Departments

Beginning January 1, 2016 the place of service (POS) code you report on Medicare/Medicaid claims for services provided to beneficiaries in outpatient hospitals might change. No longer will you report...

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Teen Substance Abuse Program in Long Beach Files Phony Claims

September 2, the U.S. Department of Justice (DOJ) published in Justice News an indictment of a fraud scheme in which more than $50 million in bogus bills were paid for alcohol and drug treatment...

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T Minus 22 and Counting (21, 20, 19…)

It looks like we are finally going to get to ICD-10. No more delays, no more waiting. So, now what? It is time to get your final checklist ready and make sure that your practice will be prepared...

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ICD-10: CMS Announces Another Successful End-to-End Testing Week

The Centers for Medicare & Medicaid Services (CMS) released information on the final end-to-end testing week held July 20-24, 2015. Approximately 1,200 Medicare Fee-For-Service health care...

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2015-2016 Seasonal Flu Vaccine Pricing Released

School is in session, and you know what that means: Flu and cold season is off and running! Patients will soon be coming to your physician office in droves to receive their influenza and, possibly,...

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Healthcare Claims Denial Management: Best Practice

by Linda Martien, CPC, CPC-H, CPMA Denial management can encompass any aspect of the revenue cycle that may result in no or low reimbursement. The reasons for the denials can include: incomplete or...

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CMS Delays Implementing Permanent Pacemakers NCD

The Centers for Medicare & Medicaid Services (CMS) announced in the Sept. 10 issue of MLN Connects® Provider eNews that it is temporarily delaying implementation of the National Coverage...

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The Answer to Getting Power Wheelchair Claims Paid Properly

According to the Centers for Medicare & Medicaid Services (CMS), the improper payment rate for power mobility devices (PMDs) in 2013 was 81.8 percent, which amounts to approximately $329 million in...

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UHG to Pay California ASCs $9.5M for ERISA Violations

UnitedHealth Group, Inc. has agreed to pay $9.5 million to settle a putative class action accusing the company of underpaying California out-of-network ambulatory surgical centers (ASCs) in violation...

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Communication Is Key to Code Lesion Excisions (and More)

Provider documentation does not always provide the information necessary to code with precision. For example, lesion excision codes 11400-11646 are size-based, with margins factored into the...

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Avoid EHR Shortcuts

by John Verhovshek, MA, CPC Electronic medical records have simplified documentation and record tracking. In some cases, the electronic record allows the physician to bring forward, or to “cut-and...

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Defining Anesthesia Time

by John Verhovshek, MA, CPC CMS defines surgical anesthesia time as the continuous, actual presence of the anesthesiologist or CRNA. Surgical anesthesia time begins when the physician or CRNA starts...

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Modifier 22: Difficult Isn’t Enough

by John Verhovshek, MA, CPC Difficulty alone doesn’t justify appending modifier 22 Increased procedural services. The procedure must be unusually difficult in relation to other procedures of the same...

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