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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Posted and filed under Coding, ICD-10.

Through the Smoke: Coding for Tobacco Cessation Counseling

Since the 2014 Patient Protection and Affordable Care Act (ACA), physicians can be reimbursed for the preventative services of tobacco use screening and cessation counseling. It is a well-known fact that smoking has negative effects on your healthy,but did you know that if you require surgery while maintaining your smoking habit, that the risk of…

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Posted and filed under Coding, Medical Record Auditing.

Keep M.E.A.T. on Your List for a Healthy Audit

If you’re reading this article, chances are you already know what HCC Coding is – but we’ll give you a refresher anyway. Hierarchical Condition Category (HCC) and Risk Adjustment Coding is a CMS-mandated payment model. This particular model works to identify those with chronic and other serious illnesses and prescribes a risk factor score to…

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Posted and filed under Coding, Compliance, Healthcare.

Listen Up, Doc. These MACRAnyms Can Make You Money in 2017.

If you’re in the healthcare industry – you’ve heard about MACRA. The Medicare Access and CHIP Authorization Act, Medicare’s two-track payment system for physicians and healthcare providers will be implemented on January 1st, 2017. Understanding the new system and rules that comes along with MACRA’s implementation is vital for the success of physicians and hospitals….

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Posted and filed under Coding, Medical Record Auditing.

Overview of Colonoscopy Coding

Diagnostic Colonoscopy A diagnostic colonoscopy is a test performed as a result of an abnormal finding, sign, or symptom (such as diarrhea, abdominal pain, etc.). Factors for Consideration: Symptoms before the procedure such as a change in bowel habits, rectal bleeding, etc. Findings during the procedure (polyp, cancer, diverticulosis, etc.) Personal history of cancer or…

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Posted and filed under Coding, Healthcare.

Teaching Physician Guidelines

Billing and documentation guidelines are not the same in all 50 states. A statement such as, “I saw and evaluated the patient. I agree with the resident’s documentation,” may be acceptable in some states, but in other states, the Medicare Administrative Contractor (MAC) would consider this to be a generic attestation, and require the teaching…

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Posted and filed under Coding.

‘Tis the Season…For Proper Coding

We’ve all seen cute memes on Facebook as we scroll through our timeline; “Bitten by A Vampire? There’s a code for that!” ICD-10 S10.87XA. “Overdose on turkey? There’s a code for that!” ICD-10 E70.5 or R63.2. “Grandma got run over by a reindeer? There’s a code for that, too!” ICD-10 V06.00XA. The list goes on…

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Posted and filed under Coding.

Ambulance and EMS Transport Coding

The need for ambulatory services has seen an increase in recent years, and as a result ambulance transport claims have also risen. Payers generally cover ambulance services for patients whose medical condition is such that air transport is medically necessary. EMS Transport Coding is a unique coding set of non-physician provider services, where medical necessity…

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Posted and filed under Coding, ICD-10.

ICD-10 Codes That Will Haunt You

For a long time, ICD-10 was regarded as a nightmare for healthcare providers and their billing teams. The healthcare industry “woke up” and eventually embraced the reality of ICD-10, only to be faced with another monster; MACRA. This Halloween, we’re taking it back to more simple times and exploring the spookiest ICD-10 codes you’ll ever…

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Posted and filed under Coding, Fraud.
pain-management

Chiropractic Billing Red Flags

All insurance payers are obligated to perform routine reviews of claims submitted by providers who operate under their plans. In recent years these claims examinations have gotten more rigorous, with antifraud initiatives being pushed by private health plans and those operating under the umbrella of CMS. The prevalence of insurance fraud has created a hypervigilant…

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