If ICD-10-CM/PCS is used to its full potential, it will provide greater detail and a more accurate depiction of patient severity. This level of detail is expected to provide more information about the relationship between a provider’s performance and the patient’s condition.
CMS' 340B FAQ reviews modifiers -JG (drug or biological acquired with 340B drug pricing program discount) and -TB (drug or biological acquired with 340B drug pricing program discount, reported for informational purposes) and requires 340B hospitals to report modifiers even on drugs that are not subject to the discount policy.
When faced with a claim denial, providers need to understand what is being denied and when an appeal is appropriate. This article outlines basic steps providers need to take before composing an appeal for a claim denial and helpful tips for successfully navigating through the appeals process.
The first week of December was National Influenza Vaccination Week, a week highlighting the importance of continuing flu vaccination, particularly through the holiday season. Peggy Blue, MPH, CCS, CCS-P, CPC, CEMC , writes about CPT coding for vaccinations and immunization administration.
The improper payment rate for hospital outpatient services was 5.4%, accounting for 7.5% of the Medicare Fee-For-Service improper payment rate, according to 2016 Medicare Fee-for-Service Improper Payments Report.
Updates to the 2018 CPT Manual , set to go into effect January 1, include several additions, revisions, and deletions to E/M and anesthesia procedural code sets. Familiarize yourself with these coding changes to aid in accurate reporting and prevent disruptions to the claims process. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Coding for respiratory conditions can be challenging, given the structural complexity of the upper and lower respiratory tracts. Refresh your knowledge of respiratory anatomy to aid in the accurate reporting of common respiratory diagnoses such as emphysema, asthma, and chronic bronchitis. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Each year, more than 2,000 Americans are diagnosed with mesothelioma— an aggressive and deadly type of cancer that develops in the lining of the lungs, abdomen, or heart. Debbie Jones CPC, CCA , writes about different types of mesothelioma and how they should be reported in ICD-10-CM.
HCCs aren’t new, but for many organizations, their impact hasn’t been apparent until recently. Organizations must educate staff on HCCs to ensure success under reimbursement methodologies such as the Quality Payment Program and Merit-based Incentive Payment System reimbursement.
CMS is moving forward with its plan to drastically cut payments for drugs acquired through the 340B drug discount program, according to the 2018 OPPS final rule, released in November.
CMS’ policy in the 2018 OPPS final rule to cut reimbursement for drugs purchased through the 340B drug discount program by nearly 30%, accounting for the decrease from average sales price plus 6% to minus 22.5%, is getting a lot of attention from the provider community—and with good reason.
A new private payer rate-based Clinical Laboratory Fee Schedule (CLFS) system is estimated to drastically reduce Medicare Part B lab payments in 2018. Valerie A. Rinkle, MPA, details how this revision will impact providers in outpatient settings and payers tied to the Medicare CLFS.
November, a month associated with the pleasure of eating, is also Stomach Cancer Awareness Month. In this article, Yvette M DeVay, MHA, CPC, CPMA, CIC, CPC-I, describes signs and symptoms of stomach cancer, and outlines best practices when assigning diagnostic and procedural codes for this disease.
Review vascular anatomy and terminology in order to aid in accurately assign codes for interventional radiology procedures such as angioplasties, atherectomies, and lower extremity revascularizations. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
More and more, hospitals are experiencing a shift of services from inpatient to outpatient settings. In this article, Laura Jacquin, RN, MBA , describes common challenges healthcare workers face when providing comprehensive documentation for services across the care continuum.
In order to accurately code for complex diseases and procedures of the brain, spinal cord, and sense organs, coders need a basic understanding of nervous system functionality. This article provides detailed information on nervous system anatomy and terminology, common brain and nervous system disorders, and recently introduced 2018 ICD-10-CM codes related to nervous system conditions.
Ovarian cysts may develop at any point in a woman's life and frequently occur with other medical diseases. In this article, Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, details best practices when assigning ICD-10-CM/CPT codes for ovarian cyst diagnoses and procedures.
Section 216(a) of the Protecting Access to Medicare Act of 2014 (PAMA) added a requirement that will dramatically revise the Medicare Clinical Laboratory Fee Schedule (CLFS) effective January 1, 2018.