Posted and filed under Coding, Medical Record Auditing.
claims data

Auditing Claims Data: What Can The Data Tell You?

There are many techniques to extracting data that can range from reviewing claim line billing data to actual medical record reviews. Relying exclusively on the claims data to analyze and identify atypical billing patterns or potential red flags is always challenging. As auditors we all know that the value of the audit process is only…

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Posted and filed under Coding.

How to Use Taxonomy Code Correctly

Providers with a Primary and Secondary Specialty National Government Services Every healthcare provider has at least one taxonomy code that reflects his or her specialty. Esure that your provider’s specialty is accurately represented by this. Medicare Part B providers are not required to report taxonomy codes on claims, however, National Government Services is urging providers…

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Posted and filed under Coding.

The Top 3 Things to Remember When Coding for Wound Repairs

Wound repairs require determining three separate components before selecting the appropriate CPT code: Layer – What is the depth/complexity of the wound repair? Location – Where on the body is the wound? Length – How long in centimeters is the wound repair? Layer Simple repairs are for superficial wounds that are uncomplicated and primarily involve…

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Posted and filed under Coding.

Top 5 Reasons Practicing Yoga Helps Coders to be More Successful

As we all know, medical coding can be a fast-paced, high-intensity job, and with that comes high stress. A typical coder has a bulky workload and is responsible for ensuring that they are up-to-date with industry changes. Furthermore, the majority of coders wear several different hats in their practice, some including being the biller, manager,…

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Posted and filed under Coding.

CMS Proposed Rule: New Reporting Requirements for Labs

The Centers for Medicare & Medicaid Services (CMS) released, Sept. 25, a proposed rule that will significantly revise the Medicare payment system for clinical diagnostic laboratory tests (CDLTs) and advanced diagnostic laboratory tests (ADLTs) paid under the Clinical Laboratory Fee Schedule (CLFS) beginning in 2017. The new payment system will base payments on a weighted…

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Posted and filed under Coding.

New Patient or Not?

Your group just merged with another practice, are these considered patient’s new or established? With mergers and acquisitions so frequent in the healthcare industry, it’s important to be aware when faced with these issues and knowing what to do with your patients when going through this transition. A few key questions to help determine this…

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Posted and filed under Coding.

Enlight-10-ment: November

Reasons (other than disease) for Services Chapter 18 Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99) Patients often present with signs or symptoms that may point to several “working” diagnoses. These conditions are the reasons patients present for evaluation, testing and sometimes treatment without definitive diagnosis assignment or where one is…

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Posted and filed under Coding, Healthcare.

Importance and Usage of Modifier 25

Modifier 25 Appropriate Use Modifier 25 indicates a “significant, separately identifiable evaluation & management (E&M) service by the same physician on the same day of the procedure or other therapeutic service.” Both services rendered must be significant, separate and distinct Medicare will not make separate payment unless the documentation supports significantly, separately identifiable service that…

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Posted and filed under Coding, Compliance.

ER Upcoding Rules & Regulations To Be Aware Of

Does documentation of more than 50% of time spent counseling or coordinating care suffice for time documentation, and therefore E/M code level selection? Many will answer: YES Let’s take a peek at an often forgotten CMS rule “In general, to bill an E/M code, the physician must complete at least 2 out of 3 criteria…

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Posted and filed under Coding, ICD-10.

Top 10 ICD-10 Codes

Although the transition to ICD-10 has been difficult, due to the large amount of codes that have been added with the implementation, coders are beginning to see how beneficial this transition will be in the future. Now that ICD-10 has officially been implemented for 10 business days, our Advize Health coders and friends of Advize…

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