Category Archives: Coding & Billing
Documentation for Risk Adjusted Payment
The concept of medical documentation has usually focused on those elements supporting the evaluation and management (E/M) code selection in fee-for-service payment environments; electronic medical records (EMRs) have done a great deal to alleviate the charting burden for these clinicians. … Read Full Post
ICD-10-CM Changes for 2021
CMS unveiled the 2021 changes for ICD-10-CM, which include 490 new codes, 47 revised codes and 58 codes that were deleted or invalidated. With some notable exceptions in a handful of commonly used categories, we believe the modifications affect mostly … Read Full Post
Did You know….Medicare pays for High Intensity Behavioral Counseling?
High Intensity Behavioral Counseling (HIBC) is a program that promotes the reduction or avoidance of sexual risks. It is tailored to the unique issues and needs of the patient, and includes education, skills training, and, guidance on how to change … Read Full Post
Lessons from the Cigna/DOJ Lawsuit: Health Risk Appraisals (Part 1)
This blog is the first in a series of lessons, or reminders, gleaned from the Department of Justice’s (DOJ) lawsuit against health insurer Cigna. The suit alleges that Cigna essentially committed fraud by reporting false information to CMS in a … Read Full Post
Substance Dependence: Do Your Charts Support it?
Drug and alcohol addiction are under the umbrella term of substance dependence in the DSM-V. ICD-10 includes them all under the heading Mental and behavioral disorders due to psychoactive substance use, which is coded from F10 to F19. In the … Read Full Post
How does Transitional Care Management (TCM) Work?
Transitional Care Management (TCM) encompasses the 30 days of a Medicare beneficiary’s post-discharge period from an inpatient acute care or psychiatric hospital, long-term care hospital, skilled nursing facility or inpatient rehabilitation facility. It focuses on helping the patient make a … Read Full Post
CMS Makes Changes to Telehealth Billing
This is a follow-up to an earlier blog about the Centers for Medicare and Medicaid Services’ (CMS) expanded provisions for coverage of telehealth (TH) visits for Medicare beneficiaries. CMS recently added additional billing codes to its approved list, and clarified … Read Full Post
The DOJ Targets MA Plans
The Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) reported that a study conducted in 2019 revealed, “Unsupported risk adjusted payments are a major driver of improper payments in the Medicare Advantage (MA) … Read Full Post
MACs Resume Medical Review on a Post-Payment Basis
To protect the Medicare Trust Fund against inappropriate payments, Medicare Administrative Contractors (MACs) are resuming fee-for-service medical review activities. Beginning August 17, the MACs are resuming with post-payment reviews of items/services provided before March 1, 2020. The Targeted Probe and … Read Full Post
CMS Approves COVID-19 Counseling
When patients are tested for COVID and are awaiting results – or if they’ve tested positive – research shows virus transmission is reduced by 86% if these patients self-isolate early. For this reason, CMS recently clarified that counseling, which includes … Read Full Post