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What Does ICD-10 Have to Do With Prescriptions to Treat Acute Pain?

27. September 2017

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We’re just days away from ICD-10 2018 implementation. One group with ICD-10-CM on the brain may be Ohio pharmacists. Here’s why: Effective Dec. 29, 2017, there will be new rules in Ohio for prescribing opioids. One of the requirements is for the prescription to include “The ICD-10-CM medical diagnosis code of the primary disease or […]

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Straight From the Source: Use Modifier 25 the Right Way With CCI Manual Tips

22. September 2017

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It can be tricky knowing when to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service). More specifically it can be tough to determine whether work performed by a provider amounts to a separate […]

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Are These ASCQR Resources on Your List?

5. September 2017

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The Ambulatory Surgical Center Quality Reporting (ASCQR) Program affects Medicare reimbursement for ASCs. In short, ASCs have to meet administrative, data collection, and data submission requirements to avoid a payment reduction. Here’s a look at some ASCQR resources recently listed in Outpatient Facility Coding Alert. 1. CMS ASCQR Page The CMS ASCQR page links to […]

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Pair These ICD-10 2018 Official Guideline Updates With Their Code Set Counterparts

18. August 2017

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The ICD-10-CM 2018 Official Guidelines are out and ready for review. When you check through the new OGs for changes, take special note of these updates that line up with 2018 code set revisions. Look at Level to Choose ‘In Remission’ Code When you start to apply new codes for substance abuse in remission (you’ll […]

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Transition and Flexibility Are the Buzzwords for QPP 2018 Proposed Rule

18. July 2017

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CMS released the proposed 2018 Quality Payment Program (QPP) rule on June 20. To sum up the 1,000+ pages, 2018 will be something of a transition year like 2017 was for QPP, which was established under MACRA. If you read through the various summaries available, you’ll see the term “flexibility” used quite often, with specialty […]

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Don’t Let EHR Tempt You to Upcode E/M Services

27. June 2017

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EHRs can assist with many aspects of E/M coding (like tracking for coding based on time), but the problem of reporting higher-level E/M codes without medical necessity is still around. A recent article in Ophthalmology Coding Alert discussed the example of a doctor who billed almost all level-four and level-five E/M codes for established patients. […]

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Don’t Get Too Comfortable With That Meaningful Use Payment – Here’s Why

20. June 2017

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When the title of an OIG report is about Medicare paying out hundreds of millions it shouldn’t have, that’s not great news for Medicare or the providers who got those funds. But that’s exactly what a report released June 12, 2017, says: “Medicare Paid Hundreds of Millions in Electronic Health Record Incentive Payments That Did […]

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3 Things You Can Do Today to Prepare for a RAC Audit

7. June 2017

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What’s the first think you think of when you hear Recovery Audit Contractor? RACs have been around for a while (and not without controversy) as part of a Medicare program to find and correct past improper payments. Even folks who don’t get nervous at the thought of an audit probably don’t look forward to the […]

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Step-by-Step Guide to Checking National Correct Coding Initiative Edits on SuperCoder

6. June 2017

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CCI Edits Checker is one of the tools SuperCoder subscribers use the most, so here’s a quick instructional guide to help users make the most of this resource, including the color-coded results and RVU options.   Note: This guide is specific to the CCI Edits Checker for Medicare PTP practitioner edits, but Outpatient Facility Coder […]

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Here’s What’s in Store for Medicare Advantage and Part D in 2018

23. May 2017

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Check out these bullet points for highlights from the 2018 Medicare Advantage and Part D payment and policy updates posted by CMS. Medicare Advantage Medicare Advantage (MA) plans, sometimes called Medicare Part C, are private plans approved by Medicare for people enrolled in Medicare. Medicare pays a fixed amount to the MA plan company, and […]

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