Posted and filed under Medical Record Auditing.

The Benefits of DRG Validation

DRG validation is a tool that can be used to reduce risk, defend claims, and ensure the accuracy of the coded items. The purpose of DRG validation is to confirm that diagnostic, procedural information, and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending…

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Posted and filed under FWA.

Fraud Waste and Abuse Fact: August

DOJ and HHS Annual Report Highlights $3.3 Billion in Settlements and Judgments in FY 2014 “On March 19, 2015, the Department of Justice (DOJ) and Department of Health and Human Services (HHS) issued their annual Health Care Fraud and Abuse Control (HCFAC) Program report highlighting that the HCFAC Program obtained $3.3 billion in health care…

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Posted and filed under Coding, Compliance.

Medicare Guidance for Mid-Level Providers

Taking the Guesswork out of Correct Billing More and more health organizations are hiring midlevel providers to perform services that were formerly thought to be appropriate exclusively for medical physicians. While it is less costly to hire Physician Assistants, Nurse Practioners, and Certified Nurse Midwives, it’s imperative that institutions familiarize themselves with the rules regarding…

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Posted and filed under Coding, Healthcare.

Chiropractic Coding

Many years ago when I first began my career in the health field I worked for a chiropractic office as I was becoming familiar with their computer system, codes, and billing forms I had a lot of questions! Over 15 years, work on a bachelors degree and multiple coding and billing certifications later, I realize…

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Posted and filed under YouBeTheCoder.

You Be The Coder: August

What would the correct CPT code assignment be for this scenario? A male patient, 54 years of age, comes in on May 3, 2014 for a scheduled transurethral resection of the prostate (TURP). The patient had an initial TURP back in August 2012 but is still experiencing difficulty voiding. A. 52601 B. 52648 C. 52630…

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Posted and filed under Coding, Compliance, Medical Record Auditing.

Vaccine Administration Counseling

Vaccine administration coding and documentation is often confused by many providers, billers, coders, and even auditors.  One misunderstanding is what exactly is a toxoid component? And what documentation is necessary to support billing vaccine administration with counseling?  Here’s a quick look at the codes we are talking about. A toxoid component according to CPT refers…

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Posted and filed under Compliance.

Compliance Corner: August

Define the principle of “minimum necessary”? Answer: a covered entity must make reasonable efforts to use, disclose and request only the minimum amount of PHI needed to accomplish the intended purpose of it’s use

Posted and filed under Coding, Healthcare.

Enlight-10-ment: August

Digestion of Digestive Codes The digestive system is made up of the gastrointestinal tract. Digestion begins in the mouth with chewing the food, and ends in the small intestine; its unique function is to breakdown and process the food we eat, while removing unused products for waste disposal. The body then absorbs these smaller particles…

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Posted and filed under Careers, Coding, Medical Record Auditing.

Why you Should Consider a Career as an Auditor

As Advize Health continues to hire part-time and full-time remote Auditors, we felt it necessary to inform you of the reasons why you should consider a career in auditing and its benefits. Some of the perks you can enjoy as an auditor at Advize Health include: Free education with CEU’s provided through monthly auditor calls…

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Posted and filed under Coding, Compliance, Healthcare.

How ICD-10 is Like Trying to Eat an Elephant in One Bite

This past week, one of our auditors, Robert Blizzard, presented to the Central Florida Physician’s Alliance in Lakeland.  There were 7 practices represented at this particular presentation.  He was asked “ICD-10 is like trying to eat an elephant in one bite.  If you were to make 3 recommendations for practices to enact right now, what…

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