Category Archives: Coding & Billing

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

Tagged bilateral procedure, center for medicare and medicaid services, coding and billing, cpt codes, first coast service options, medicare billing, medicare guidelines, medicare physician fee schedule, modifier 50, modifier lt, modifier rt |

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

Tagged center for medicare and medicaid services, cms manual, coding & billing, extended repayment plan, extended repayment schedule, first coast service options, medicare overpayments, overpayment for medicare claims, recovery audit contractors |

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

Tagged center for medicare and medicaid services, claim denials, claim edits, duplicate claim denials, duplicate claims, medicare claims, modifiers, preventing duplicate claim denials |

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

Tagged current procedural terminology, documentation, e&m, e&m level, ehr, electronic health record, evaluation and management, highest level of specificity, improving documentation, medical necessity, physician documentation, reimbursement |

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

Tagged basics of icd-10 coding, center for medicare and medicaid services, coding and billing, coversion to ICD-10, documentation, documentation guidelines, home health agencies, icd-10 assessment process, icd-10 conversion, icd-10 implementation, physician offices, poor documentation, practice management, practicing icd-10, transition to ICD-10 |

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

Tagged american diabetes association, controlled diabetes, diabetes mellitus, diabetes mellitus type 1, diabetes mellitus type 2, diabetes with complications, diagnosis of diabetes, high blood glucose levels, iddm, insulin dependent, juvenile type diabetes, niddm, type 1 dm, type 2 dm, uncontrolled diabetes |

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

Tagged auto-cancelled raps, corrective action plan, home health agencies, home health billing, homecare billing, Imark consulting, palmetto gba, palmetto rap suppression, payment suppression, rap payment, rap payment to home health agencies, rap suppression, tips on home health billing |

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

Tagged center for medicare and medicaid services, delay in ordering and referring edits, home health billing, Imark consulting, phase 2 ordering and referring denail edits, tips on home health billing |

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

Tagged ambulatory surgical center claims, center for medicare and medicaid services, home health billing, home health claims, homecare billing, Imark consulting, indirect medical education, inpatient prospective payment system, medicare advantage, medicare advantage inpatient prospective payment system, outpatient critical access hospital, rural health clinic |

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

Tagged icd-10, icd-10 conversion, icd-10 implementation, icd-10-cm, icd-9, icd-9-cm, International Classification of Diseases 10th Edition Clinical Modification, International Classification of Diseases 9th Edition Clinical Modification, transition to ICD-10 |