Tag Archives: reimbursement

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 |

Maximizing the first patient visit of a period

Risk adjusted reimbursement hinges on proper management and reporting of a patient’s chronic conditions. We always advise clients to assess all chronic conditions at least twice per year: once in the period between January 1st and June 30th and again … Read Full Post

Tagged chronic conditions, cms-hcc model, documentation, health risk assessment, hospital admissions, medicare risk adjustment, mra, patient visit, pcp assessment, reimbursement, risk adjusted reimbursement |

Medicare ACOs: Healthcare providers and the ACO (Part 4)

The ACO contemplates a paradigm where the entire continuum of care (from physicians to hospitals to rehab centers and everything in between) is coordinated on the beneficiary’s behalf to deliver quality and cost-effective care. In the fourth installment of our … Read Full Post

Tagged center for medicare and medicaid services, fee-for-service methodology, healthcare providers and the aco, medicare acos, medicare beneficiaries and the aco, primary care physicians, quality and cost-effective care, reimbursement |

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

Tagged appendicitis, coding and billing, coding guidelines, medical documentation, medical necessity, pericarditis, query the physician, reimbursement |

What We’re Reading – Medical identity theft is a growing problem

Nothing seems to be off limits these days. Not only are people stealing identities for financial gain, but also for medical purposes. In this article, Jim Koenig, director & leader of PwC’s identity theft practice said, “Medical identity theft is … Read Full Post

Tagged fraud, healthcare fraud, insurance company, medical identity theft, patients, providers, reimbursement |

Documenting Manifestations: “Connect” with an Accurate Payment

Over the years, we’ve seen it all when it comes to physician documentation. One physician in a group insisted that if she wrote all the conditions on one line, they were connected. Her partner’s charting habit was using slash marks … Read Full Post

Tagged diabetes, documentation, electronic health record, manifestations, physician documentation, reimbursement, risk adjustment |

How does provider reimbursement work?

There are two common methods of reimbursing physicians: Fee-for- service (FFS) and capitation. There are also two major code categories in use by most primary care physicians: ICD-9-CM codes and CPT-4 & HCPCS codes. ICD-9-CM codes (soon to be replaced … Read Full Post

Tagged capitation, cpt codes, diagnosis, fee-for-service, icd-10, icd-9, procedure, provider, reimbursement |