A coding audit may be conducted by internal staff or external entities, typically representing the insurers paying for the care. When planning to implement a coding auditing program, the type of reviews, focus areas, and review frequency must all be taken into consideration.
Provider documentation must meet required standards to support the level of care provided. Rose Dunn, MBA, RHIA, CPA/CGMA, FACHE, FHFMA, CHPS , reviews payer guidelines and medical necessity requirements under Medicare for services performed in the outpatient setting.
Cornelia de Lange syndrome is a genetic disease that could be misdiagnosed due to its rarity. Yvette DeVay, MHA, CPC, CPMA, CIC, CPC-I , reviews symptoms, procedural treatments, and ICD-10-CM coding for the condition.
Understanding when and how to report hospital modifiers is critical to ensuring compliant billing. Review CPT guidelines for modifiers -25, -50, and -59, as well as case studies and denial numbers by specialty, to reduce your risk from audits. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Hospital systems need to be watchful for CMS proposals that will impact payment for drugs and drug therapies in 2019 and beyond. Jugna Shah, MPH, reviews the potential implications of recent CMS actions, such as the publication of the 2019 IPPS proposed rule and the overhaul of 340B drug payment program.
Cognitive impairment ranges from mild to severe and can impact a person’s ability to perform everyday functions such as talking, remembering, and comprehending information. Debbie Jones, CPC, CCA , reviews CPT and ICD-10-CM coding, and care planning for patients living with cognitive impairment.
Cancer is the second most common form of death in the U.S., according to the Centers for Disease Control. To accurately report CPT and ICD-10-CM codes for skin and breast cancer, coders need a thorough understanding of symptoms of malignancies and treatments used to prevent them from spreading. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A recent report from the Office of Inspector General focuses on improper payments for specimen validity tests billed in combination with urine drug tests. Yvette DeVay, MHA, CPC, CPMA, CIC, CPC-I, reviews Medicare instructions and coding guidance for presumptive and definitive drug testing.
Coders are on the front lines of claim submission and in a good position to foster compliance. Learn strategies to prevent fraud and abuse and encourage accurate documentation and billing within your outpatient facility. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
When planning to implement a coding auditing program, the type of reviews, focus areas, and review frequency must all be taken into consideration. Rose T. Dunn, MBA, RHIA, CPA/CGMA, FACHE, FHFMA, CHPS , details how to conduct an effective coding audit and ensure compliance with documentation requirements.
