Category Archives: Coding & Billing
“Removals” is not a bad word!
“You are leaving money on the table” is a common phrase Medicare Advantage providers hear from some auditors and even health plans regarding members’ risk scores. And that might be true. Some risk adjusted diagnoses may have fallen through the … Read Full Post
You Might Be Owed Money for Telehealth Visits
Depending on when you accessed CMS’s telehealth billing guidelines, you may have submitted claims using a Place of Service (POS) of “02” regardless of where you rendered the service instead of POS 11 if in the office. CMS recently announced … Read Full Post
ADA Changed Diagnostic Guidelines
From time to time, it’s important to revisit established diagnostic criteria for frequently encountered conditions because medicine evolves. One such change occurred in the diagnostic guidelines for diabetes. The standard was primarily one A1c of 6.5% or two fasting blood … Read Full Post
Did You Know… Medicare Pays for Counseling for Smoking Cessation
A staggering amount of research shows the detrimental effects smoking can have on a person’s health, and public service announcements abound on this topic. Some providers may not know that Medicare is also on this bandwagon and pays for PCPs … Read Full Post
Did You Know… Medicare Pays for Counseling for Obesity & CVD?
Intensive Behavioral Therapy (IBT) is a series of counseling sessions aimed at reducing the risk of cardiovascular disease (CVD), which can lead to heart attack or stroke. It is also used for helping patients make behavioral changes that facilitate weight … Read Full Post
Why Is July Relevant for MRA?
Risk adjusted reimbursement is based on the health status of the patient as summarized by certain ICD-10-CM codes reported by the provider. The reporting timeframe is twice per year in order to maintain stable funding; PCPs should assess, document and … Read Full Post
Wanna Bet Not All Your MDDs Are Valid?
Major Depressive Disorder (MDD) is fast becoming one of the most poorly supported conditions we find during audits, and it may stem from the fuzzily documented distinction between depression and major depression. After all, not all depression fits in the … Read Full Post
Reminders for Proper Documentation
We all know providers are stressed for time and want to provide the best medical care to each and every one of their patients even in a short window of time. Unfortunately, the first thing to suffer is the documentation … Read Full Post
Coding E/M Services – Part 2
Welcome back to our two-part series on Coding E/M Services. As we covered in part one of this series, the level of E/M service determines the payment for the visit an there are seven components that factor into the E/M … Read Full Post
The Joys & Perils of Templates
Most of us will jump at the chance to find an easier way to accomplish the same result. I mean, who doesn’t love shortcuts?! Electronic medical records (EMRs) are probably one of the biggest time-savers for a medical practice. The … Read Full Post