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Provider Change Practice? Understand 2019 Payments for MIPS 2017 Performance Year

4. September 2018

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With 2018 being in its last half, questions are coming up about MIPS payment adjustments in 2019 based on the 2017 performance year. One topic of interest is what happens if a clinician moved from one practice to another. Here is an answer, straight from the CMS Fact Sheet on 2019 MIPS payment adjustments based […]

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Modifier 58 or 78? Master These Confusing Modifiers

13. August 2018

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Knowing when to use modifiers 58 and 78 isn’t easy. Base your choices on this straight-from-Medicare guidance to help ensure cleaner claims. Make Modifier 58 Your Choice for Anticipated Procedures Modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period) is the focus […]

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Crash Course: Compare ICD-10-CM 2019 Official Guidelines for Post-Op Sepsis to 2018 Rules

9. August 2018

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The ICD-10-CM 2019 Official Guidelines are out and offer more details on how to use new codes for sepsis following a procedure. Take a look at what’s new and get a handle on how to sequence these codes. Remember These New Codes to Improve Sepsis Coding ICD-10-CM 2019 includes these two new codes with instructional […]

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Top Nuances to Know for the Medicare Card MBI Roll-Out

6. August 2018

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Medicare began mailing out new cards in April 2018 to meet the deadline of replacing Social Security numbers/Health Insurance Claim Numbers (HICNs) with Medicare Beneficiary Identifiers (MBIs) by April 2019. Here are some tips you may have missed to help you with the transition. Don’t Use the Dashes! On the new Medicare cards and in […]

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Hot Topic: Get the Scoop on Proposed MPFS 2019 Changes to E/M Coding and Payment

3. August 2018

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The 2019 proposed Medicare Physician Fee Schedule (MPFS) includes some major potential changes to E/M coding and payment in its 665 pages. Major. Here are the highlights. Just remember that what’s below is proposed and may change before the final rule is implemented. Here’s the Big Payment News About Levels 2-5 Let’s get right to […]

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Did You Know? AHA Says Nonphysician Documentation Supports Z55-Z65

26. July 2018

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Reporting ICD-10-CM social information codes (Z55-Z65) based on documentation from nonphysicians is OK, according to official guidelines from the AHA. Before you change your approach to coding, here are the facts. Locate the Original Coding Clinic® Q&A In early 2018, AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS (vol. 5, no. 1) published an answer to […]

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3 Things to Know About Advanced Practice Providers in Your Practice

20. July 2018

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Advanced practice providers (APPs), sometimes known as non-physician practitioners (NPPs), are essential members of the healthcare team and serve a lot of roles. But, of course, “essential” doesn’t mean they’re always easy to code for. Make sure you keep these top pointers in mind when you’re completing claims for APPs, such as physician assistants, certified […]

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Cataract Claims Double Dipped? These RACs Are Checking

8. June 2018

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If you perform cataract removal services in RAC regions 1, 2, or 3, be on alert. Coding and unit errors are under the spotlight. Here’s the scoop. What & Where: Learn the RACs and Regions Involved RACs Cotiviti Healthcare and Performant have both posted the following as approved audit issues: 0083 – Cataract Removal Excessive […]

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3 ICD-10-CM Cardiology Coding Tips That Line Up With the Risk-Adjustment Trend

25. May 2018

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All the discussions of risk adjustment have put a spotlight on diagnosis coding, and one big way cardiology coders can help is by ensuring they follow the official rules for coding and learn about coding comorbidities, too. Here are some good, old-fashioned rules that will also help ensure your pro-fee cardiology coding follows best practices […]

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Find Out Which 4 Codes Are Off the DMEPOS 2018 Prior Authorization Master List

18. May 2018

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DMEPOS had a 44 percent improper payment rate according to CERT’s 2017 Medicare FFS report. That’s high. Really high. So anyone submitting claims that fall under DMEPOS needs to be up on all the rules. One important area to watch is Medicare’s Master List of which codes require prior authorization. The recent annual update posted […]

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