Category Archives: Coding & Billing

ICD-10 Implementation is not just Doom and Gloom

Doomsday predictions certainly abound – Heaven’s Gate, Y2K, the Mayan apocalypse – and they all came and went with a fizzle.  ICD-10 has its own group of “end of the healthcare world as we know it” zealots who predict catastrophe … Read Full Post

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What’s the difference between Type 1 and Type 2 Diabetes Mellitus?

According to the American Diabetes Association, diabetes mellitus (DM) is a “group of diseases characterized by high blood glucose levels that result from defects in the body’s ability to produce and/or use insulin.”  Insulin is a hormone that helps the … Read Full Post

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Palmetto RAP Suppression:

Palmetto GBA plans to suppress RAP payment to home health agencies with a large number of auto-cancelled RAPs.  Here is an excerpt from their most recent communique: “Providers are given the greater of 120 days after the start of the … Read Full Post

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Temporary Delay in Implementing Ordering and Referring Denial Edits

Due to technical issues, the implementation of the Phase 2 ordering and referring denial edits is being delayed.  These edits would have checked claims for an approved or validly opted-out physician or non-physician.  If either of these were missing or … Read Full Post

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CMS is holding some provider payments

The Centers for Medicare & Medicaid Services (CMS) has identified technical issues with certain parts of the April 2013 quarterly systems release.  For claims with dates of service or “through dates” on or after April 1, 2013, the issues affect … Read Full Post

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What We’re Reading – Four things doctors actually like about ICD-10

As you may already know, the largest complaint about the ICD-10 is that it is “complex and highly specific” with almost three times the number of codes than ICD-9.  Although the 10th edition was introduced in 1992 and most developed … Read Full Post

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Tips on Ordering and/or Referring Providers

UPDATE ON 4/25/13:  CMS announced the delay of PECOS edits that would result in denial of home health claims & Medicare part B claims when the ordering/referring physician is not enrolled in PECOS.  CMS will advise the new implementation date … Read Full Post

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What We’re Reading – Getting prepared for ordering and referring denial edits

Are you aware that, effective May 1, 2013, CMS will deny claims if the ordering and/or referring providers are not enrolled in the Medicare system?  This will affect all Medicare Part B covered services, durable medical equipment, orthotics, and supplies … Read Full Post

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Do EHRs Contribute to Coding and Payment Inaccuracies?

Many providers have touted the electronic health record (EHR) as the magic bullet to improve billing accuracy.  However, according to the Center for Public Integrity, “Medicare regulators also acknowledge they are struggling to rein in a surge of aggressive — … Read Full Post

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Minimize Claims Issues with One Simple Step

Most physician practices experience claims challenges, from denials and rejections to payment inaccuracies.  As frustrating (and costly) as those issues are, they are almost avoidable with one simple step:  verifying patient insurance eligibility. For patients covered by Medicare, it may … Read Full Post

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