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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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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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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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Prep Time! July 2018 MPFS Updates Bring More Than RVU Changes

1. June 2018

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We’re a month away from the July 2018 Medicare Physician Fee Schedule (MPFS) update. These quarterly changes are easy to overlook, but checking any fee schedule update is important. Even if, for some reason, you’re not interested in RVU changes, there may be changes to indicators (like PC/TC) that affect proper reporting. Here are some […]

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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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Will ICD-11 Have a Code for ‘Struck by Turtle’?

3. May 2018

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Subcategory W59.22- (Struck by turtle) is an ICD-10-CM code that’s been in the blog a few times. So when I started playing with the WHO ICD-11 Coding Tool, I had to try “turtle” as a search term. No luck, but I did find PA71 (Unintentionally struck, kicked, or bumped by animal) after I changed my […]

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Podiatry Alert: Here’s What Caused $330 Million in Improper Payments for Part B and DMEPOS

16. April 2018

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We’ve talked about CERT 2017 report results before in this blog, but that’s mostly been Part B. Podiatry coders need to be thinking about DMEPOS, too. And based on the 70.5 percent error rate estimated for podiatry under DMEPOS, practices need to put that on their priority lists. Review the CERT Report Stats The “2017 […]

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