Trey La Charité, MD, FACP, SFHM, CCS, CCDS , analyzes the challenges that both inpatient and outpatient CDI specialists encounter and offers advice to lessen provider opposition to participating in outpatient CDI.
Katie Patterson, CPC , summarizes the Medicare Quality Payment Program, provider qualifications, clinician participation, and how they work to achieve the program’s main objectives.
Julia Kyles, CPC , summarizes the advice CMS provided during a January event about reporting HCPCS add-on code G2211 for increased complexity with E/M codes.
Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, and Karla VonEschen, MS, CPC, CPMA, CCDS-O, take a look back at the progression of diagnosis and mortality coding before looking ahead to ICD-11 and how coding departments can prepare for it.
Heart failure affects more than 6 million adults in the U.S. and costs the nation more than $30 billion. Review ICD-10-CM guidance and documentation details required for accurately reporting the condition. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Artificial intelligence (AI) has burst on the scene with numerous clinical and coding applications for providers. This article looks at how the technology can be used and where human oversight is still required.
Most fracture cases originate in the ED, so orthopedic coders must understand the various scenarios that may arise based on the patient’s condition and the intent of the performing clinician. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The behavioral health coverage that CMS calls among the most important in Medicare history were finalized and expanded in the 2024 Medicare Physician Fee Schedule final rule.
Michael Malohifo’ou, RN, MBA, PhD , explains how excessive use of emergency departments can result in unfavorable outcomes . He also assesses the complicated relationships between EDs, social determinants of health ICD-10-CM coding, and mental and behavioral health CPT services.
Julia Kyles, CPC , reviews the 2024 First Quarter National Correct Coding Initiative (NCCI) code update, which included 929 new procedure-to-procedure edit pairs.
The 2024 OPPS final rule details changes to price transparency compliance, reimbursement changes and, updates to numerous other hospital programs. Additionally, CMS is moving forward with its proposals to address unlawful payment reductions to 340B drug reimbursement.
Part B providers will have to prepare for a net 3.4% payment decrease across services in 2024, according to the 2024 Medicare Physician Fee Schedule final rule. The rule covers numerous operational areas for medical groups, including new coverage opportunities and billing revisions to coding and compliance updates.
The decision for an emergency clinician to report fracture or dislocation care CPT codes with an E/M code can have significant reimbursement ramifications. Hamilton Lempert, MD, FACEP, CEDC, explains the complexities of reporting this care and covers details coders should watch out for in documentation.
Coding staff and treating providers can increase E/M code reporting accuracy to ensure their claims hit the mark by reviewing these six Q&As. The material, created by Julia Kyles, CPC , covers medical decision making and time-based coding.
The 2024 Medicare Physician Fee Schedule proposed rule received more than 17,000 stakeholder comments. Julie Kyles, CPC , highlights some of the major concerns that commenters expressed, such as requests for more telehealth policy flexibility and community health integration services.
CMS recently proposed to pay for certain currently bundled caregiver training service CPT codes and three new CPT codes that, if finalized, will be established January 1. Review the criteria of defining a caregiver and which caregiver training services apply.
In this article, the author takes a closer look at CMS’ 2024 Medicare Physician Fee Schedule (MPFS) proposed rule—specifically a proposal to allow new providers to perform and bill behavioral health codes, offer providers new service categories, and give a code-valuation adjustment.
CMS published the 2024 Medicare Physician Fee Schedule (MPFS) proposed rule on July 13 with new potential policies and codes affecting physician reporting, including new HCPCS codes for E/M services and behavioral health.
Julie Kyles, CPC, explains that CMS issued a modest set of hospital and practitioner procedure-to-procedure and medically unlikely edits in the latest quarterly update to the National Correct Coding Initiative (NCCI) edits, effective July 1