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JustCoding.com provides coders, coding supervisors, and health information management (HIM) directors with educational resources to test their coding knowledge, employ correct coding guidelines, and stay abreast of CMS transmittals. To learn about the different levels of access to this site, click here.
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The IPPS PC Pricer: Make the most of this helpful software
Do you work in the finance department or business office at your facility? Are you part of a clinical documentation improvement team looking to implement a successful program? Are you a coding manager trying to improve how your staff reports complications and comorbidities (CC) and major CCs? If so, The IPPS PC Pricer software is just what you need. Kimberly Anderwood Hoy, Esq., sings the praises of this little known resource.
Free Download
Stephanie Ellis, RN, CPC, describes the compliance ramifications of coding and billing mistakes. She discusses common errors, such as upcoding and undercoding, as well as the risks and penalties for fraudulent behavior. Stay on the straight and narrow with quick tips from this industry expert.
Glenn Krauss, RHIA, CCS, CCS-P, CPUR, PCS, FCS, C-CDIS, examines the new, ultra-specific carcinoid tumor codes. Krauss defines malignant and benign carcinoid tumors, explains methods of classification, and delves into the clinical aspects of carcinoid syndrome. Familiarize yourself with diagnosis work-ups and treatment options to help prepare you for the October 1 implementation.
James S. Kennedy, MD, CCS, and Gloryanne Bryant, BS, RHIA, RHIT, CCS, address the importance of correct discharge disposition assignment. They discuss how inpatient payment for certain CMS-designated conditions (those with a present-on-admission [POA] U [insufficient documentation] indicator) may depend on it.
Fewer interactions with patients doesn’t mean fewer interactions with PHI
Chris Simons, RHIA, Elisa Gorton, RHIA, and Nancy Davis discuss the importance of HIPAA training for coding and billing staff. Although these staff members may not have much face-to-face interaction with patients, their constant access to medical records and protected health information still makes them susceptible to potential violations. Our experts give advice on how to provide education.
Earlier this year, CMS advised during an Open Door Forum that the medically unlikely edit (MUE) value for units with CPT infusion codes 90766 or 90761, which providers bill to fiscal intermediaries, would increase on April 1, retroactive to the original date of January 1. However, it wasn’t until the end of April that providers begin to notice that CMS was accepting infusion and injection claims for values that it had previously rejected. Andrea Clark, RHIA, CCS, CPC-H, and Jugna Shah, MPH, explain recent MUE changes.
The 2008 OPPS final rule challenges outpatient facilities to be more exact than ever regarding documentation and coding. This is nowhere more true than in the evaluation and management (E/M) guidelines. William L. Malm, ND, RN, and Shelia Gunn, CPC, CCS-P, PCS, CMBS-I, provide tips for adhering to the E/M 2008 OPPS final rule.
Healthcare happenings: MPFS rate increases from -10.6% to 0.5% due to Congress override of Medicare Improvements for Patients and Providers Act
July 23, 2008
The mid-year 2008 Medicare Physician Fee Schedule rate of -10.6% has been replaced with a 0.5% update, retroactive to July 1, 2008, according to a July 16 CMS fact sheet.
Healthcare Happenings: CMS doles out more than $36 million in bonus payments for its 2007 PQRI
July 23, 2008
In a July 15press release, CMS announced that it paid more than $36 million to health professionals who satisfactorily reported quality information to Medicare under the 2007 Physician Quality Reporting Initiative. More than 109,000 professionals participated in the 2007 program. Of those, more than 56,700 physicians and other eligible professionals met statutory requirements for satisfactory reporting and therefore received an incentive payment.
CMS issues instructions regarding exceptions to therapy cap expirations
July 16, 2008
Exceptions to outpatient therapy caps expired on June 30. This means that outpatient therapy service providers should not submit claims with the modifier -KX for services furnished after July 1. CMS is working with Congress, healthcare providers, and the beneficiary community to avoid disruption of the following:
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Delivery of healthcare services
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Payment of outpatient physical therapy
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Occupational therapy and speech-language pathology claims for services that physicians, nonphysician practitioners, and therapists furnish and that are paid under the physician fee schedule
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Check out what you're missing on JustCoding Platinum!
A copy of HCPro's Present on Admission Training Handbook in the Special Reports and News section.
The pressure is on for hospitals to accurately report present on admission (POA) data to avoid Medicare denials. Take a proactive approach to POA indicators by educating coders and physicians about POA reporting and documentation requirements.
Editor's note: To receive continuing education credits, take the quiz after reading the following articles:
- Identify common coding/billing errors to maintain compliance in your ASC
- Don’t forget to provide HIPAA training for billing and coding staff
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August 28, 2008
The Impact of the New and Revised 2009 ICD-9-CM Codes
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