Legally, when a physician, physician assistant (PA) or nurse practitioner (NP) enroll in a Medicare, Medicaid or commercial insurance, the practitioner signs an agreement attesting that accurate claims will be submitted. The practitioner is responsible for claims submitted under his/her NPI. CMS’s E/M guide says, “When billing for a patient’s visit, select codes that best represent the services furnished during the visit. A billing specialist … [Read more...]
HCC diagnosis coding: what medical practices need to know about risk adjusted diagnosis coding
Webinar - Recorded December 14, 2017 Risk coding is all the rage! Are you up-to-date? In fee-for-service medicine, physician services are paid based on the fee associated with that CPT code, HCPCS code and modifiers. The diagnosis coding establishes the medical necessity for this service. With new payment models, diagnosis coding for physician services takes on added importance and affects future payments. In this presentation from … [Read more...]
I Want to See that in Writing | Medical Coding Source Citations
Lunch and Learn - February 2017 Coders are often asked to prove a coding rule to physicians and managers. Coding rules change, reimbursement rules change and coders interpret rules differently. How many times have you been challenged to show proof? Not all citations are created equal. Coders need to rely on source citations, not opinions. Browse more coding resources: Everyday Coding E/M Services Cheat Sheet Boost Collections … [Read more...]
How to get paid for services in medical practices: three quick videos for new clinicians and staff
An Overview of CPT Codes, HCPCS, Diagnosis Codes & ICD-10-CM This three-part series from CodingIntel is a must see for new staff and physicians, and is a helpful review for everyone. Includes modules on How Physician Services are Paid, and the basics of CPT codes, HCPCS, diagnosis codes and ICD-10-CM. Part 1 - How Physician Services are Paid Have a new staff member or physician who needs a primer on “how physician services are paid?” This … [Read more...]
How Physician Services are Paid
Have a new staff member or physician who needs a primer on "how physician services are paid?" This short video is a must see! Learn how all the pieces come together, from CPT and HCPCS, to diagnosis coding and Medicare rules. All in about 15 minutes... … [Read more...]
Medical Billing: Avoiding the Three Deadly Sins of Compliance
What is the real risk of compliance audit from commercial payers or from Medicare? This short video addresses three specific areas of risk and offers practical steps you can take to reduce that risk and avoid being a target for audit... … [Read more...]
Not billing consult codes? You are losing $$$$
In 2010, Medicare stopped recognizing consultation codes. In their discussion, they stated that they still did pay for consultations, but they used other codes to pay for them such as office visits, emergency department visits, and initial hospital services. Practices adjusted to this change, and continued to bill Medicare for services. Some groups stopped billing all office consults, thinking that the private payers would follow Medicare’s … [Read more...]
Pecked by a parrot. Oh no, not again!
We’ve all had a lot of fun with the ICD-10-CM external cause codes. But, do we need to use them? The answer to that is no according to the official guidelines and yes if your payers require them. Here is what the official ICD-10-CM guidelines say, “There is no national requirement for mandatory ICD-10-CM external cause code reporting. Unless a provider is subject to a state-based external cause reporting mandate or these codes are required … [Read more...]
Prescription drug management and medical decision making (MDM)
The Documentation Guidelines identify three key components in E/M services: history, exam and medical decision making. When should you count prescription drug management in determing the level of MDM? It may be simpler than you think! Medical Decision Making (MDM) MDM itself is divided into three components: The number of diagnoses or management options, The amount and/or complexity of data to be reviewed and The risk of significant … [Read more...]
Skype ≠ Telemedicine
I got a call from a vendor trying to develop a video conferencing product for a physician to use to talk to a patient who is at home. He said “I’m having trouble finding codes for telemedicine that the doctor can use.” Aren’t we all. Talking to your patient using a secure video connection doesn’t meet the criteria for telehealth as developed by CMS. There are no current CPT codes that describe that situation. There is no way to report it to … [Read more...]
Risky business, or tempest in a teapot: Are you an audit target?
Some days, it appears we compliance and coding folks are like the boy who cried wolf. We see shadows around every corner. We emulate Captain Kirk, shouting, “Red Alert! Shields up!” (Done mixing my metaphors now, I promise.) The mainstream press doesn’t help with headlines of fraud accusations and sensational stories of government regulations. In the past three days, the New York Times had headline stories about a hospital chain encouraging … [Read more...]
Cloning: I Read the News Today, Oh Boy.
Certain medical stories are irresistible to the popular press: ICD-10 external cause codes that are ridiculous (W61.43XD, pecked by a turkey, subsequent encounter) or medical practices using their electronic health records in a way that increases their revenue. A recent headline was eye-catching, as headlines are meant to be, “Report finds more flaws in digitizing patient files.” The New York Times reported on January 8, 2014 that the Office of … [Read more...]