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Medicare Helper: Don’t Let DOS Be the Downfall for Your Claims

2. May 2019

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Determining date of service (DOS) can be harder than it seems. Once you dive into the world of professional/technical components, monitoring services, and other non-obvious DOS possibilities, things get complicated fast. You can use the Medicare rules below as a starting point. Apply Different Dates for Radiology Components For many radiology codes, the Medicare Physician […]

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$325 Million in Office Visit Underpayments! How Much Is Yours?

8. April 2019

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Audit discussions often focus on the fear of upcoding and having to hope that repaying the extra amount is the worst of the consequences. But downcoding is another problem area affecting your payments and more. Here’s why you should never purposely downcode your services. Start With a CERT Story Wondering about the $325 million in […]

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No More 99201? What’s Coming in 2021 for E/M

4. April 2019

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There’s been a lot of buzz about what Medicare has planned for E/M in 2021. One question all that raises is how it will mesh with AMA CPT® coding rules. Here are some hints from the February 2019 CPT® Editorial Summary of Panel Actions about what is in store for the code descriptors and guidelines. […]

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Keep Your Finger on the OIG Pulse by Knowing Where to Find Audit Targets

12. March 2019

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OIG audit targets can feel like moving targets with the website updated each month. Find out where you can go to keep tabs on the Office of Inspector General’s Work Plan items, and see an example of a recently added area to watch. (Tip: For more OIG information, you also can check out this free […]

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Look Ahead to These 3 Trends for April 2019 CCI Updates

4. March 2019

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Think Medicare’s April CCI updates are small potatoes? You may reevaluate that stance when you learn there are more than 11,000 additions planned for April 1, 2019. To help make it manageable, watch the three areas below. Our focus: The topic here is Medicare practitioner procedure-to-procedure (PTP) Correct Coding Initiative (CCI) edits that will be […]

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ICD-10-CM OGs: Get Team In Sync on Coding Based on Provider’s Statement

21. February 2019

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ICD-10-CM Official Guidelines state that your choice of diagnosis code is based on the provider’s diagnostic statement, but that’s not always as clear-cut as it sounds. Let’s dig in to this guideline. Work From the Official Guideline Wording The 2019 ICD-10-CM Official Guideline (OG) we’re discussing here is I.A.19: Code assignment and Clinical Criteria The […]

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Update Your Knowledge of MIPS Promoting Interoperability for 2019

4. February 2019

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In 2019, there are some changes to the Promoting Interoperability performance category of MIPS. Here’s what you need to know about CEHRT and scoring news for this performance year. Background: MACRA requires the Quality Payment Program (QPP) to include a MIPS performance category on meaningful use of certified EHR technology, the QPP 2019 rule states. […]

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Here’s How Medical Documentation Can Help or Hurt for Reimbursement

24. January 2019

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The 2018 CERT report estimates 58 percent of Medicare improper payments were caused by insufficient documentation (and this is an ongoing trend). More than half is nothing to sneeze at, especially when you consider that those documentation problems could lead to having to repay Medicare or having to spend time working on underpayments. Here’s a […]

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Say Cheese! Medicare Is Paying for Photo and Video Evals in 2019

17. January 2019

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If a picture is worth 1,000 words, how much is evaluating a picture worth? Medicare has taken a stance on that. As of Jan. 1, 2019, Medicare is paying for remote evaluation of pre-recorded patient videos and images reported using G2010. Here’s what we know from the Medicare Physician Fee Schedule Final Rule. Compare Our […]

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Modifier 59 Misuse Cost 1 Health System Millions — Know Where to Go for the Rules

7. January 2019

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Exploiting modifier 59 was a major factor in a recent $12.5 million settlement for False Claims Act allegations. How’s that for motivation to shore up your modifier 59 know-how? Here are some resources to get you on your way. Read the Write-Up on the Recent False Claims Act Settlement Find out some of the details […]

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