Know the 5 Levels of the Medicare Appeals Process
By Douglas J. Jorgensen, DO, CPC, FACOFP If you disagree with a Medicare payer’s audit findings, you may appeal (see Exclusions on Medicare and Limitations on Payment, 42 C. F. R. Part 405, Subpart I)....
View ArticleGrasp and Follow Basics of Incident-to Requirements
By Suzan Berman, CPC, CEMC, CEDC Mid-level providers (MLPs), such as physician assistants (PAs), nurse practitioners (NPs), and nurse specialists (NSs) are used to fill in gaps in practices, helping...
View ArticleUse E/M Benchmarking to Assess Your Audit Risk
By Stacy Harper, JD, MHSA, CPC In the current regulatory environment, physicians are searching for ways to minimize audit exposure. One way to do this is by understanding your use of CPT® codes prone...
View ArticleTop 10 Medicare Risk Adjustment Coding Errors
By Carol Olson, CPC, CPC-H, CPC-I, CEMC, CCS, CCS-P, CCDS Medicare Advantage (MA) reimbursement can trip you up in ways you didn’t expect. If you are seeing MA patients, be mindful of opportunities and...
View ArticleCMS Proposes Inpatient Admissions Policy Change
In a proposed rule published in the Federal Register May 10, the Centers for Medicare & Medicaid Services (CMS) clarifies the rules governing physician orders of hospital inpatient admissions for...
View ArticlePayers Targeting 80101 Abuse for Drug Testing
Per AMA instructions, when coding for drug testing by any method other than chromatography for multiple drugs or drug classes, you should report 80104 Drug screen, qualitative; multiple drug classes...
View ArticleStay Focused on Stark and Anti-kickback Regulations
Since the expansion of new Health Insurance Portability and Accountability Act (HIPAA) regulations, which redefines who is considered a business associate by covered entities under the Health...
View ArticleOIG Work Plan Release Is Pushed to January
If you want to get a jump start on your practice or hospital’s auditing and monitoring program as part of your compliance plan for 2014, you’ll have to wait. The U.S. Department of Health & Human...
View ArticleRAC Activity on the Rise All Around
Providers aren’t the only ones spending more time digging up material for recovery audit contractors (RACs). Hospitals report rising rejections of claims connected to RAC audits. Some of those...
View ArticleTake a Medicaid Moment: Use Proper Consent Forms
Know federal and state Medicaid policies for entitlement and their use. You shouldn’t expect your state Medicaid fund to pay or behave the same as other third-party payers, or even Medicare. Medicaid...
View ArticleDo Coders Seriously Stink at E/M Coding?
By: Stephanie Cecchini, CPC, CEMC, CHISP, Approved ICD-10 Trainer, VP Coding at Aviacode.com If you believe CMS…we get coding SERIOUSLY wrong. How wrong? In Evaluation and Management alone,...
View ArticleKnow the 5 Levels of the Medicare Appeals Process
By Douglas J. Jorgensen, DO, CPC, FACOFP If you disagree with a Medicare payer’s audit findings, you may appeal (see Exclusions on Medicare and Limitations on Payment, 42 C. F. R. Part 405, Subpart I)....
View ArticleGrasp and Follow Basics of Incident-to Requirements
By Suzan Berman, CPC, CEMC, CEDC Mid-level providers (MLPs), such as physician assistants (PAs), nurse practitioners (NPs), and nurse specialists (NSs) are used to fill in gaps in practices, helping...
View ArticleUse E/M Benchmarking to Assess Your Audit Risk
By Stacy Harper, JD, MHSA, CPC In the current regulatory environment, physicians are searching for ways to minimize audit exposure. One way to do this is by understanding your use of CPT® codes prone...
View ArticleTop 10 Medicare Risk Adjustment Coding Errors
By Carol Olson, CPC, CPC-H, CPC-I, CEMC, CCS, CCS-P, CCDS Medicare Advantage (MA) reimbursement can trip you up in ways you didn’t expect. If you are seeing MA patients, be mindful of opportunities and...
View ArticleCMS Proposes Inpatient Admissions Policy Change
In a proposed rule published in the Federal Register May 10, the Centers for Medicare & Medicaid Services (CMS) clarifies the rules governing physician orders of hospital inpatient admissions for...
View ArticlePayers Targeting 80101 Abuse for Drug Testing
Per AMA instructions, when coding for drug testing by any method other than chromatography for multiple drugs or drug classes, you should report 80104 Drug screen, qualitative; multiple drug classes...
View ArticleStay Focused on Stark and Anti-kickback Regulations
Since the expansion of new Health Insurance Portability and Accountability Act (HIPAA) regulations, which redefines who is considered a business associate by covered entities under the Health...
View ArticleOIG Work Plan Release Is Pushed to January
If you want to get a jump start on your practice or hospital’s auditing and monitoring program as part of your compliance plan for 2014, you’ll have to wait. The U.S. Department of Health & Human...
View ArticleRAC Activity on the Rise All Around
Providers aren’t the only ones spending more time digging up material for recovery audit contractors (RACs). Hospitals report rising rejections of claims connected to RAC audits. Some of those...
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