Posted and filed under Coding, Medical Record Auditing.

2017 UDT Codes Refresher

As of January 1, 2017, providers who administer controlled substance testing should apply the proper and most current guidelines for L35724 – Controlled Substance Monitoring and Drugs of Abuse. Best Practices Ensure that services and procedures reported on submitted claims match the service(s) ordered by the physician. Remember that a maximum of one presumptive and…

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

Think Twice Before Appending Modifiers

Coding Modifiers In the English language, a modifier is used to describe the who, what, how, why, and/or where of a situation. Coding modifiers perform the same role for medical coders and billers. These types of modifiers further describe procedure codes without altering its original definition. Modifiers can be found in both the CPT and…

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Posted and filed under Coding, ICD-10.

ICD-11 Scheduled to be Finalized by 2018

Just when you thought it was safe, the World Health Organization has announced that the International Classification of Diseases is undergoing the 11th round of revisions. ICD-11 is scheduled to be finalized for presentation to the World Health Assembly by 2018, and is intended to be even more comprehensive than ICD-10. It’s understood than the…

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Posted and filed under Careers, Coding.

5 Things You Need to Know About Becoming a CPC

Strategy is Key Becoming a Certified Professional Coder is no easy feat, and the exam administered by the American Academy of Professional Coders (AAPC) is a long, grueling assessment. Of course, the exam will present CPCs-to-be questions on CPT codes, Evaluation and Management, the bodily systems, and the application of multiple code sets – but…

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Posted and filed under Coding, YouBeTheCoder.

You Be The Coder: Evaluation and Management (E/M)

Assess your knowledge of Evaluation and Management while taking our free E/M Calculator for a test drive! Review the below patient notes and plug the appropriate information into our audit tool. History of Present Illness (HPI) Patient is complaining of chest pain which he has been experiencing on and off for two days now. He…

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Posted and filed under Coding, Compliance, FWA, Healthcare.

Pre-Litigation Considerations

Law firms have been known to enlist the help of a third-party when dealing with healthcare fraud cases. This is because in addition to investigating the allegations against one party, there is a myriad of additional pre-litigation considerations. In multi-faceted cases in which health plan overpayments are being pursued within the judicial system an audit…

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Posted and filed under Coding, FWA.

Investigating Health Plan Overpayments

Picture yourself balancing on top of a fence with vast expanses of land, each with their own set of governance, visible to you from both sides. You’re straddling the fence, your legs occupying each of the divided spaces. Where do you stand? It depends on which way the wind blows. Such is the case with…

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Posted and filed under Coding, Cybersecurity, Events, Fraud, FWA.

From ECC to IASIU

Advize Health kicked off the month of April by diving headfirst into Conference Season, and attending the Eastern Claims Conference in Boston, MA. The Eastern Claims Conference, recently relocated from New York to Massachusetts was an impressive assembly of insurance professionals. Catering to life, disability, medical, legal, and insurance claims; the Eastern Claims Conference has…

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Posted and filed under Coding, Compliance, Cybersecurity, Fraud.

Safeguard Your EHR

If healthcare was a chemical solution, and relevant technologies were solutes – the mixture would quickly become a fragmented clump of, well…various technologies. The healthcare market is over-saturated with technology designed to “fix” the present problems plaguing the ecosystem. Of course, in a paradoxical twist of fate, these solutions come with a new set of…

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Posted and filed under Coding, Compliance, Fraud.

Upcoding vs. Downcoding

Physicians and their billing/coding staff have an established history with, and an acute awareness of upcoding and overpayments. In fact, unless they’re operating within a fraudulent billing scheme, they’re avoiding the practice of upcoding all together. Upcoding is arguably the most common red flag in both audit selections and audit results, making it a serious…

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