Category Archives: Coding & Billing

What We’re Reading – How to get your behavioral health codes right

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5, in medical parlance) is a handbook, if you will, to assist in making diagnostic judgments in cases of mental disorders.  The manual classifies conditions and provides diagnostic criteria in … Read Full Post

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What We’re Reading – Improve Clinical Documentation for ICD-10

Your administrative staff has probably hounded you for years to improve your documentation.  With the ICD-10 transition around the corner on October 1, 2014, clinician documentation will be more important than ever.  The code sets from have expanded from 14, … Read Full Post

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How is the ICD-10-CM Code Set Different from ICD-9-CM?

ICD-9 codes have between three and five characters, and with the exception of “V” and “E” codes, are exclusively numeric.  The fourth or fifth character is utilized for greater specificity and combinations of diagnoses are coded separately.  One example is … Read Full Post

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What We’re Reading – Medicare E/M claims for new patients

Beginning on October 1, 2013, CMS will use a new claim edit to determine if more than one initial visit code was billed for a Medicare beneficiary within a three year period.   This edit will also identify claims where established … Read Full Post

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2014 Holds Big Changes for the CMS-HCC Model

The purpose of the CMS-HCC model is to improve the accuracy in predicting the costliness of Medicare Advantage (MA) enrollees’ healthcare costs and to properly fund MA plans for those expenses. It isn’t a perfect model but it surpasses the … Read Full Post

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Is your practice utilizing the Advanced Beneficiary Notice of Noncoverage (ABN) correctly?

The Advanced Beneficiary Notice of Noncoverage, or ABN for short, is a waiver of liability that is provided to all Medicare patients if the provider believes an item/service may not be covered by Medicare or considered medically necessary.  Now that … Read Full Post

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What We’re Reading – Bilateral procedures and MUEs

Are you stumped on when to use modifier 50 instead of modifiers LT and/or RT for Medicare? Modifier 50 is defined as a bilateral procedure which is performed on both sides of the body in the same operative session or … Read Full Post

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What We’re Reading – Manual update regarding the repayment of overpayments

If your business has ever received a demand letter from Medicare regarding overpayments, your first thought has probably been, “How am I going to pay this back while keeping my business afloat?”  There is good news!  Effective September 3, 2013, … Read Full Post

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What We’re Reading – Preventing duplicate claim denials

Are you experiencing more claims denials as duplicates recently?  Make sure that your billing staff and/or billing company are aware that effective July 1, 2013, The Centers for Medicare & Medicaid Services (CMS) instituted new claim edits.  All claims received … Read Full Post

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What We’re Reading – Boost Reimbursement through Improved Documentation: 5 Tips

Physicians and coders/billers need to be on the same page when it comes to getting claims processed and reimbursed correctly.  The key to this – and you’re probably sick of hearing it – is documentation.  Especially with ICD-10 coming around … Read Full Post

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