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 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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Posted and filed under Coding, Healthcare.

Enlight-10-ment: July

An Overview of the Genitourinary System The genitourinary system includes the reproductive and the urinary excretion organs. These are grouped together because of their proximity to each other. The structure of the urinary tract includes the kidneys; two ureters, which are the tubes leading from the kidney to the bladder and the urethra, which is…

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Posted and filed under Healthcare.

The Realities of Snoring and its Long-Term Effects

Snoring is often laughed about, but it is no joking matter. Chronic loud snoring, waking up choking or gasping for air, and cessation of breathing while sleeping for short periods of time are common symptoms of a condition called obstructive sleep apnea.  Sleep apnea affects nearly 22 million Americans, and according to the Cleveland Clinic,…

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Posted and filed under Coding, Compliance, Healthcare.

How to Code Transitional Care Management

Transitional Care Management (TCM) codes are used to report patients who are transitioning from inpatient hospital, observation, skilled nursing/nursing facility, or rehabilitation to the patients’ normal community settings such as their home, domiciliary, rest home or assisted living settings. The patient’s transition to a normal community setting is not the only requirement of the TCM…

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Posted and filed under Coding, Healthcare.
health revenue

Mining for Revenue: Turning 15 Cents into an HMO Dollar

Like most clinics, your office has probably decided to accept Medicare Advantage plans by now. So what is your plan of attack? Most providers are going to say that it is time to get each patient enrolled in these plans into the office for the all-important health assessment. Most office managers are going to prepare…

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Posted and filed under Coding, Healthcare.
stethoscope

History of Present Illness: Severity

Severity is a statement or a rating of intensity (0-10) from the patient that indicates the degree or measurement of how bad the chief complaint is. This rating not only is documented based on 0-10 scale, but it can be captured using phrases such as: worsening, improving, and increasing. An auditor performing a medical necessity…

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Posted and filed under Healthcare.
health costs

Template to Fulfill Home Health Requirements

Open door forums are being held to discuss the use of a template to aid in fulfilling the face-to-face requirement for Medicare beneficiaries receiving home health care. “In fiscal year (FY) 2014, the Comprehensive Error Rate Testing (CERT) program found that more than half (51.4 percent) of the home health claims were paid improperly. Of…

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Posted and filed under Coding, Healthcare.
pain management

Pain Management Specialty

The pain management specialty has seen more than its share of coding and reimbursement changes throughout the past few years. 2015 brought another round of changes for this specialty: a major revision to a commonly used coding set, reimbursement rate changes, and bundling of needle placement guidance with joint injections, to name a few.  …

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Posted and filed under FWA, Healthcare.
Gavel and Stethescope

12 Healthcare Fraud, Waste, & Abuse Facts

Fraud accounts for 19% of the $600 to $800B in waste in the U.S. healthcare system annually, including everything from bogus Medicare claims to kickbacks for worthless treatments and other services. 57% of insurers expect to see an increase in fraud losses this year on personal insurance lines (mainly auto and home insurance), while only 5% of…

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