Bundled Payments for Care Improvement Advanced, a new voluntary bundled payment model launched by CMS in January, includes 32 clinical episodes encompassing both inpatient admissions and outpatient procedures. Yvette DeVay, MHA, CPC, CPMA, CIC, CPC-I , writes about participation criteria, payment calculations, and quality measures for this program.
In recent years, numerous pieces of legislation have been passed to limit healthcare spending, combat losses due to fraud, and ensure that dollars are being spent on quality care. Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP , describes different watchdog programs created to promote billing compliance and quality of care.
In this article, Valerie A. Rinkle, MPA, offers guidance regarding the 340B drug discount program. She provides tips for accurate documentation of drug purchases and reviews frequently asked questions about billing for 340B-acquired drugs in 2018.
Complying with healthcare regulations within a coding department or physician practice involves promoting a positive attitude toward activities such as self-monitoring and staying up-to-date with healthcare regulations. Follow these steps to adhere to sound business ethics and set expectations for behavior across an organization. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
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.
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.
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.
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.
In July, Utah pain doctor Jahan Imani, MD, and Intermountain Medical Management, P.C., entered into a nearly $400,000 settlement with the OIG to resolve allegations that Imani’s practice submitted false or fraudulent claims due to improper modifier use for payment by improperly using modifier -59 with HCPCS code G0431.
Documentation is crucial for the development of data reflecting the healthcare needs of domestic violence victims. Yvette DeVay, MHA, CPMA, CPC, CIC, CPC-I , explains how to properly screen for and code incidents of domestic violence.
E/M services are some of the most frequently used CPT codes, and they are also some of the most frequent examples of incorrect coding. One of the problem areas in selecting the proper E/M code is distinguishing between new and established patients. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
The Quality Payment Program proposed rule seems to bring relief to providers anticipating escalation of Medicare Access and CHIP Reauthorization Act (MACRA) requirements, but there are a plethora of reasons for coding professionals to start adapting their workflow for MACRA now. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
As CMS and third-party payers have looked for ways to treat patients in the outpatient setting and reduce inpatient volumes, CMS has used the 2-midnight rule, in addition to other methods, to treat patients as outpatients or in observation whenever possible.
CMS Special Edition article 1609 was released in April to clarify CMS’ policy on prolonged drug and biological infusions using an external pump. Valerie A. Rinkle, MPA , breaks down that article and discusses its billing and reimbursement implications in the first of this two-part series.
In the second part of a two-part series on SE1609, Valerie A. Rinkle, MPA , distinguishes between CPT code 96416 and HCPCS code G0498 for billing and reimbursement purposes while outlining how practices can achieve compliance with CMS’ current external pump policy.
CMS released the fiscal year 2018 IPPS proposed rule in April, and with it came a bevy of new potential ICD-10-CM codes. The update includes a total of 406 proposed new, revised, and deleted codes to be implemented October 1, 2017.