Tag Archive | "Medicare"

Modifier 25 Scavenger Hunt! Can You Find These Answers?

Tuesday, May 21, 2019

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Keeping up with modifier 25 rules can be intimidating, so let’s add a little fun by seeing if you can unearth the answers to these questions at the locations provided. Ready, set, go! 1. Is This a Separate E/M? You may have the descriptor memorized for modifier 25 (Significant, separately identifiable evaluation and management service […]

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Clear Up Coverage Questions for Medicare’s Hepatitis B Screening

Friday, May 17, 2019

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The percentage of people who have hepatitis B but don’t know it could be as high as 67 percent, and the opioid epidemic is fueling an increase in infections, according to the Department of Health and Human Services (HHS). That’s one reason screening is so important. Medicare’s coverage rules for hepatitis B screening are specific, […]

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Bulk Up Your Global Surgical Package Knowledge for Cleaner Claims

Monday, May 6, 2019

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Let’s take Medicare’s list of services included in global surgery payment up a notch. If you remember each added tip below, you’ll be more likely to avoid reporting both too many and too few codes. Read This Booklet to Dive Deeper The source of the straight-from-Medicare bullet points quoted below is Medicare’s Global Surgery Booklet. […]

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Make the CCI Manual Your Go-To Guide for Shoulder Arthroscopy With Debridement

Thursday, March 21, 2019

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Before you code debridement with shoulder arthroscopy, make sure you know what the Medicare Correct Coding Initiative (CCI) manual has to say. You’ll find the highlights here to help you get started. Where to look: You’ll find these instructions in chapter IV, section E, of the Medicare CCI manual. Same Shoulder? Stick to the Basic […]

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

Tuesday, March 12, 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

Monday, March 4, 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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Here’s Why the MPFS Should Be at the Top of Your Modifier Checklist

Monday, February 25, 2019

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When you think of the Medicare Physician Fee Schedule (MPFS), fees might be the first word that comes to mind. But modifiers should be a close second. Here’s how you can use the MPFS to improve your modifier accuracy for Medicare claims. Start here: To read about the MPFS bilateral indicator and modifier 50, read […]

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Do You Know About Medicare Add-On Code Edits? You Should!

Monday, February 11, 2019

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Pairing an add-on code with an appropriate primary code is a key factor in bringing in that extra add-on reimbursement. The CPT® manual often provides a listing of appropriate primary codes for an add-on code, but not always. In those cases, you may find answers in Medicare’s Add-On Code Edits, our topic for today. Know […]

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Primary Care and Specialists Need to Know These Twin Add-On Codes by 2021

Monday, January 28, 2019

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The 2019 MPFS proposed rule discussed potential add-on G codes to represent E/M visit complexity. Here’s a quick look at the intent of the proposed codes and what the final rule had to say about their implementation in 2021. See What Happens to This Code for Specialists In the 2019 Medicare Physician Fee Schedule (MPFS) […]

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

Thursday, January 24, 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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