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Knock Out Medical Claim Denials With This 1-2-3 Prevention Plan

19. December 2019

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If denial prevention is one of your New Year’s resolutions, we’ve got some ideas to help you achieve your goal. Make 2020 your best year yet by watching the little details that matter for your medical claims, including changes for Appropriate Use Criteria, Medicare Beneficiary Identifiers, and global billing address requirements. 1. Remember That Code […]

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What Does the 2020 MPFS Say About Nasal/Sinus Endoscopy Payment?

16. December 2019

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The 2020 Medicare Physician Fee Schedule (MPFS) final rule states Medicare will apply the special rule for multiple endoscopic procedures to nasal/sinus endoscopy medical codes 31231-31298. In case you don’t have time to wade through the whole long rule, here are the major pointers on this change for otolaryngology coders. The change will be effective […]

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Meet the Latest Modifier-Related RAC Topics

21. November 2019

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You may know that medical coding modifiers can affect payment and bundling rules for your claims, but did you know modifiers are on the radar for Recovery Audit Contractors (RACs), too? Here are some of the recently added audit issues that have links to modifier use. Quick background: Medicare’s RAC program is used to identify […]

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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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Watch April MPFS Update for NGACO Code Changes With a January Twist

18. March 2019

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Ready for some retroactive MPFS changes? The next Medicare Physician Fee Schedule update may have an April 1, 2019, implementation date, but the effective date is Jan. 1, 2019. The theme for the HCPCS codes involved is Next Generation Accountable Care Organization (NGACO) Model Post Discharge Home Visits. Remember: “MACs will not search their files […]

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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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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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