Category Archives: Coding & Billing

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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What We’re Reading – Sometimes physician query is imperative

A staff member’s role is one of supporting the clinician.  However, in the area of coding and billing, the perspective is more of collaboration as the employee must appropriately transfer the practitioner’s documentation into correct codes, advise him/her on the … Read Full Post

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Electronic Prescribing: the Double-Edged Sword

In these days of information overload, it’s easy to overlook things that affect a provider’s bottom line.  One such item is the Electronic Prescribing (eRx) Incentive Program.  Established in 2009, eRx encourages eligible professionals (EPs) who render services to Medicare … Read Full Post

What We’re Reading – Top Five Rejections Related to HIPAA Version 5010

The conversion to 5010 on January 1st has been relatively smooth one, but there has been some hiccups along the way that have caused denials and associated cash flow disruptions.  Ken Bradley researched the reasons that claims were being denied … Read Full Post

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CMS Provides Guidance on 5010 Discretionary Enforcement Period for Medicare Fee for Service

Medicare Fee-for-Service (FFS) issued an announcement on December 14th regarding its plan for the 90 Day Discretionary Enforcement Period for non-compliant HIPAA covered entities.  According to that announcement, CMS provided a 90 day discretionary period for compliance with planned January … Read Full Post

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5010 – Much Ado about Nothing?

It seems like not a day goes by in healthcare without some gloomy prediction about the changes lurking on the horizon. The one causing the most stir at the moment is 5010. To understand “5010,” we first need to take … Read Full Post

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