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Catch Radiation and Home Visit Changes Coming Soon to Medicare Manual

15. August 2019

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Medicare has announced two updates to the Medicare Claims Processing Manual (MCPM). The implementation date is set for Aug. 27, 2019, but they’re effective all the way back to Jan. 1, 2019. If your physician performs home visits or superficial radiation treatment, you’ll want to be sure your knowledge is up to date. 1. Eliminate […]

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Add These AUC-Related Modifiers to Your Imaging Claims in 2020

12. August 2019

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At the end of July, Medicare released a set of modifiers that you need to know if you’re involved in ordering or coding for imaging. The modifiers, effective Jan. 1, 2020, are part of Medicare’s changes related to Appropriate Use Criteria (AUC) for advanced diagnostic imaging services. Check out the AUC-related modifiers below and then […]

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MPFS 2020 Proposed Rule: E/M Blended Payment for 2021 Is Dead

5. August 2019

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Another day, another change to E/M plans for 2021! Medicare has released the 2020 proposed rule for the Medicare Physician Fee Schedule (MPFS), bringing in the recent AMA plan to revise E/M coding in 2021. But what does the MPFS say about Medicare payment for office/outpatient visits in 2021? Here’s the scoop. Know What to […]

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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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