Category Archives: Coding & Billing
The “Welcome to Medicare” Visit
When your patients reach the age of 65, they have a decision to make: sign up for Medicare Part B, enroll in an HMO, PPO, EPO or pick another type of insurance. At age 65, patients may be automatically enrolled … Read Full Post
CMS Urges Providers to Consider CPT 99483
In an recent blog, we explained a relatively new CMS service: the Cognitive Assessment and Care Plan Services (CPT 99483). As explained, this code can be reported for a specific visit where the provider conducts a cognitive assessment to more … Read Full Post
The Annual Wellness Visit
The American Academy of Family Physicians defines the Annual Wellness Visit (AWV) as an opportunity to gain information about a patient, including medical and family history, health risks, and specific vitals. Its purpose is to review the patient’s wellness and … Read Full Post
Did you know…. Medicare Pays for Cognitive Assessment & Care Plan Services?
Experts predict that the number of men and women with Alzheimer’s disease will triple in the next 30 years, with about one new case every 68 seconds. Dementia and Alzheimer’s disease affect the individual – and his/her entire family – … Read Full Post
Anthem OIG Audit Reveals Coding Issues
Last month, the Office of Inspector General published the report of a compliance audit conducted on one of Anthem Community Insurance Company, Inc.’s Medicare Advantage (MA) contracts. The OIG concluded that Anthem was overpaid by $3.4 million. MA plans’ payments … Read Full Post
A Fundamental Disconnect of Risk Adjustment Documentation
When CMS launched the risk adjustment model for Medicare Advantage payments beginning in 2003, the reason for the change – in many minds – was shortened to, essentially, being paid more for sicker members. While this is one part of … Read Full Post
What We’re Reading – Collecting Past-Due Patient Balances
Whether it’s a virtual or in-person visit, if a patient’s plan has a co-pay, the doctor’s office has to collect it and the patient has to pay it. Since the pandemic and with a lot of Americans struggling with layoffs, … Read Full Post
Billing No-Nos: Having the Billing Dept. Transact MA Encounters
Medicare Advantage (MA) plans are paid by the Centers for Medicare and Medicaid Services (CMS) based on the member’s severity of illness as conveyed by codes from the International Classification of Diseases, 10th Revision or ICD-10-CM that map to the … Read Full Post
Billing No-Nos: The Outdated or Exorbitant Fee Schedule
Every practice has a fee schedule, which is simply a list of the fees to be charged for each service provided, and it is widely used in the billing process. Most fee schedules are (or should be) based on a … Read Full Post
Billing No-Nos: Diagnostic Testing Global Fees
Many providers offer diagnostic services in-house. The billing of diagnostic services has two components: the technical and the professional. The technical component (TC) is for all non-physician work and includes the administrative, personnel and capital costs of the test. The … Read Full Post