Managers should not assume that they can review every guideline, every item in Coding Clinic, or every coding-related issue targeted by the OIG or Recovery Auditors. However, those issues that have been identified as the result of denials, external coding audits, or quality initiatives should surface to the top of the audit list for the coding manager.
Device-dependent edits require reporting a device code with procedures CMS has designated to be device intensive, and they are meant to ensure that device costs are accounted for in Medicare rates for device-intensive procedures.
As Medicare Advantage makes strides to becoming the new norm, organizations need to establish new processes, educate staff, and advocate for patients. Learn how your organization can keep pace with change before it’s too late to catch up.
Endometriosis is a condition where the tissue that usually grows in the lining of the uterus grows outside of the uterus. This typically happens in the neighboring sites of the uterus such as the ovaries, the fallopian tubes, the pelvic peritoneum, or even the intestines.
Internal audits can reveal inconsistencies in provider documentation and coding, reporting errors, and fraudulent billing practices. Review internal auditing basics and advice from regulatory experts on how to effectively educate providers on audit findings. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Nancy M. Enos, FACMPE, CPC-I, CPMA, CEMC, CPC , reviews 2021 proposals to E/M codes for office visits and other outpatient services and draft guidelines for the implementation of these changes.
U.S. District Judge Rosemary M. Collyer recently ruled that CMS exceeded its authority when it expanded a site-neutral payment policy that cut reimbursement for certain E/M services provided in previously excepted off-campus hospital clinics.
The fiscal year 2020 ICD-10-CM Official Guidelines for Coding and Reporting provide instructions for healthcare professionals on how to appropriately report complex diagnoses. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about significant guideline updates that will impact facilities starting October 1.
