Five areas of concern are noted by the author. In the first part of this series, we examined audit risks associated with observation claims. We should review what other risk…
Concerns are related to observation claims. By now just about everyone has surely heard about Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma’s blog post on May 2,…
The American Medical Association is giving high marks to a proposal by the Centers for Medicare and Medicaid Services to reduce the burden of Evaluation and Management codes on physicians.…
The rising cost of health care in this country puts millions of Americans at risk. One of the many issues that Congress can and should address to help improve this…
What’s the news: New proposals that prioritize patients over paperwork and let doctors be doctors by reducing administrative burdens—including simplifying coding for evaluation-and-management (E/M) office visit services—were released this week…
The ICD-10 codes associated with head CT examinations do not accurately reflect patient complexity, according to a new study published in Current Problems in Diagnostic Radiology. This discrepancy, the authors…
Advance-care planning (ACP) is the keystone of goal-concordant care, enabling patients to state their treatment preferences while they still have the mental capacity to do so. The Centers for Medicare…
Many readers may remember the Centers for Medicare & Medicaid Services (CMS) Transmittal 534. This was released in early August 2014, and it would have given Medicare contractors the ability…
A new collaboration between the AMA and UnitedHealthcare will work to address the social and environmental factors that affect patients’ health by standardizing data collection on their social determinants of…
Modifiers are the key to overriding Correct Coding Initiative (CCI) edits, so let’s give them the attention they deserve. We’ll start with a recent rule update and move on to…
Although International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) took effect on Oct. 1, 2015, there still are many gaps in the understanding and use of the code set.…
CMS has provided ICD-10-CM coding updates for fiscal year 2020 that include 273 additions 21 deletions and 30 revisions, according to the American Health Information Management Association. The 21 deletions for the fiscal year…
Just like our patients, proper coding and billing for obstetric patients can be…complicated. As a coding instructor and compliance auditor, I field a lot of questions from new students and…
In an era of value-based reimbursements, rising overheads, changing codes, and increased scrutiny of claims by health insurance companies, dermatology medical billing and coding has become quite complex. Dermatology practices…
You might think that you could rely on the accuracy of a Medicare Administrative Contractor (MAC) policy, but apparently, you can’t. First, I’d like to extend thanks to my colleague…
After the tumultuous transition to the 10th International Classification of Diseases, simply saying the phrase “ICD-11″ is liable to strike fear in the hearts of medical providers across the country.…