Tag Archives | Doctors

Why We Need To Stop Calling Physicians “Providers”

It’s a change in nomenclature that’s come a bit out of the blue over the last few years. The forces appear to be aligning to gradually push the word “doctor” out of the center and towards the periphery of health care. Whether we are talking about administrative communication or health care information technology order entry […]

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What Should Hospital Administrators Concentrate More On?

Hospital administrators have to juggle between various tasks like managing finances, projects and the usual daily hospital operations. To top it all, the priorities are constantly changing from one department to another. Consequently, it is very important to know which task takes precedence over the others. Here are a few points that can help you […]

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The ICD-10 Doctor Exodus: Fact or Fiction?

Anecdotal evidence suggests the coding shift might chase physicians into retirement.

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Good News: It’s Reimbursement Time Now

Filed a claim during the legal battle between the American Medical Association (AMA) and UHC? There’s good news for you.

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Does 99360 Merit Medicare Pay?

Question: My doctors stand by for the cardiologists during a pacemaker placement in case they need to place epicardial leads. They want to report their time, and I have found 99360 for this. Do they need to dictate something in order for me to charge f…

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Handle Your Hand, Wrist Diagnoses With Care by Pinpointing Anatomic Site

Here’s how to differentiate the tiquetrum from the trapezium.
Doctors dealing with hand procedures don’t only treat carpal tunnel syndrome, and it’s up to you to link the correct diagnosis to the upper-extremity repair codes.
Use this anatomic dr…

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Medical Coders: Accepting a PFFS Plan is Your Choice

auditorHere are the pros and cons to help guide your decision.

Question: Our practice is considering accepting patients with PFFS plans. We’re heard that some patients are starting to have them, but we’re not sure whether we’re going to accept them or not. Are PFFS plans beneficial for us?

Answer: PFFS are Private Fee-for-Service plans, which are non-network plans. These plans let members receive care from any doctor or hospital that accepts the plan’s payment terms and conditions.

If your practice decides to accept these terms, you would become a “deemed” provider. Plan members can receive covered services from any deemed provider in the U.S. However, member patients must confirm that the provider is deemed every time a service is provided.

PFFS plans are different from Medicare Advantage plans because they do not require a doctor or hospital to contract with a health plan to provide services. This means that doctors or hospitals that do not agree to the PFFS plans’ terms and conditions may choose not to provide health care services to a plan member, except in emergencies.

Coming soon: Starting in 2011, PFFS plans will have to measure and report on their providers’ quality of care. But the catch is that they’ll also have to form provider networks with contracts.

In counties where there are two or more non-PFFS plans, PFFS plans will no longer be able to simply “deem” providers into the plan without a contract. Under current law, PFFS plans don’t have to prove they can meet access standards if they allow any willing qualified Medicare provider to participate, and they pay as traditional Medicare would pay.

One argument is that the network requirement would provide better access to care because there would be contracts between the providers of services and the plan. On the…

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Burn Coding: Calculate Total Body Surface Area (TBSA)

Investigate your physician’s documentation to determine the body area percentage actually debrided.
Question: My anesthesiologist administered anesthesia for a burn excision on the leg of a middle-aged adult male, but he didn’t give clear notes on the patient’s affected body surface area. How do I code for this?
Kansas Subscriber
Answer: You will start by coding 01952 (Anesthesia […]

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