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Listen Up for These Tips for Reporting Cerumen Disimpaction

23. March 2016

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After almost three months, some practices still report confusion about when to report the new cerumen removal code for CPT® 2016, 69209 (Removal impacted cerumen using irrigation/lavage, unilateral). Who could blame them, given years of being told not to report a cerumen removal procedure unless your provider uses instrumentation to disimpact the wax. Also, given the […]

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Bundle Up With CCI Edits Updates

21. March 2016

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Bundling of payments — this is a trend you can expect to see continue to grow, with effects on a wider array of services. Many physicians have experience with bundling in the form of “global surgery periods” or global payments for obstetrical care. In a newer wrinkle of bundling, called a bundled payment methodology, a […]

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Minimize Costs, Maximize Pediatric Practice Revenue With These Tips

9. March 2016

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Are you looking closely at the costs of running your pediatric practice, hoping to find  ways to increase revenue for your practice? Check out these tips for improving your billing and coding to make sure you’re getting the reimbursement your practice deserves for its hard work. Make Sure You’re Paid Contracted Amounts Got managed care […]

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CMS Payment Models Move From Volume to Value

8. March 2016

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Moving from volume to value — this phrase sums up the new Medicare payment model being advanced by the Centers for Medicare and Medicaid Services (CMS). In fact, by 2018, experts say you can expect CMS to move at least half of all Medicare payments from fee-for-service (FFS) to alternative-based systems with payments based on […]

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Nurse Practitioner Care Costs Less Than Physician Care, Study Says

7. March 2016

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A recent study by researchers at Brandeis University’s Heller School for Social Policy and Management, Mathematica Policy Research, and Montana State University reports that the cost to Medicare is actually less for patients whose primary care provider is a nurse practitioner. In the past, you may have heard the opposite, that nurse practitioner care doesn’t […]

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Australia Cuts Diagnostic Scan Payment, While U.S. Expands Some Coverage

4. March 2016

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Australian cancer patients are up in arms following a January announcement from Australian Medicare warning that it would be cutting payments to practitioners for bulk billing for diagnostic services. According to the Australian Diagnostic Imaging Association (ADIA), patients with cancers would fare the worst under these cuts, as they often require multiple diagnostic imaging studies like […]

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Take the Initiative to Keep Your ENT Coding Correct with CCI Edits

25. February 2016

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More than 57,000 National Correct Coding Initiative (NCCI) edits went into effect on January 1—that’s a lot to keep up with! The National Correct Coding Initiative — CMS’s Way of Promoting Coding Accuracy As you know, HHS implemented the Medicare National Correct Coding Initiative (NCCI, also known as CCI) to control improper coding that can […]

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Self-Audit Your E/M Coding to Avoid Overpayments

23. February 2016

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Don’t let the payer find your E/M errors before you do — perform self-audits of your E/M codes at least annually! That’s the lesson providers should take away from a recent report from the Medicare administrative contractor (MAC) NGS Medicare. NGS Reports Error Rate of More Than 70 Percent NGS reported that in an audit […]

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Slice Into Better Reimbursement for Corn and Callus Treatment

19. February 2016

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What’s the secret to ensuring your providers get paid for corn and callus debridement procedures? Documentation, of course! But documentation can also trip you up as you try to code and file a claim. One problem is that Medicare doesn’t cover routine foot care, which is where it classes the procedures of corn and callus […]

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CMS’s 2015 CERT Report Reveals Dangers of Upcoding and Downcoding

12. February 2016

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Yes, upcoding, or assigning an inaccurate code to a medical claim to increase reimbursement, equals fraud. But when you think about it, downcoding is just as bad as upcoding. Many practices think that if they downcode, or intentionally bill charges at a lower level than their documentation supports, they’ll stay off auditors’ radar. But the […]

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