MEDICAL BLOG
OIG Audit Reveals Diagnosis Reporting Problems Affecting Risk Adjustment Scoring
The Office of the Inspector General (OIG) recently published their Spring 2023 Semiannual Report to Congress. This report contained some diagnoses reporting issues that all providers need to be aware of. They focused on several groups of diagnoses that they considered “High-Risk” for being miscoded. Several states were included in the report and the types of errors for all can be generally grouped into several categories.
Read MoreIdentifying the Components of a High-Risk Evaluation and Management Service
How comfortable are you with selecting a high-level Evaluation and Management service and how often do you see high-risk E/M codes reported? In 2023, the CPT coding guidelines for E/M coding changed drastically, moving from a 3-key component scoring system to determining the final code using either time or medical decision making (MDM), but accurately scoring and having confidence in the selection of a high-level E/M service remains challenging.
Read MoreThe Perils of E&M Codes and Insurance
- ... Continue reading the article at RACmonitor → This article originally published on May 31, 2023, by RACmonitor....
Read MoreAre you Properly Reporting Radiology Services?
It’s probably not surprising that the most commonly billed imaging services are radiologic examinations of the humerus, spine, fingers, and abdomen (codes 72070, 73140, 73060, 74019). However, there are currently 653 CPT codes in the main imaging section (70000-79999). Therefore, it’s worth it to take a few moments to review some important information about these services to ensure that proper coding (including the correct use of modifiers) takes place. This can help your organization ensure correct coding and reimbursement and thus minimize the chances for claim denials and payer take-backs (post-payment denials).
Read MoreImminent Telehealth Changes After the COVID-19 Public Health Emergency (PHE) Ends
Between 2020 and 2023, an incredible amount of 1135 waivers were implemented due to the COVID-19 public health emergency (PHE). Now, with the announcement of the end of the PHE this year, how careful must we be to ensure we understand the which of the waivers will return to pre-PHE status and which will remain permanently changed? Let's take a look at some of the telehealth waivers we enjoyed during this time and how they will change either this year, or at the end of 2024.
Read MorePost PHE Changes to Coverage of Continuous Glucose Monitoring (CGM) Devices
With the announcement of the end of the COVID-19 public health emergency, many of the waivers and flexibilities will begin to go back to a pre-PHE status, one of which will affect tens of millions of patients in the United States. Continuous glucose monitors are an essential tool in successfully monitoring and reducing the complications associated with diabetes. However, this year, the process for accessing coverage through Medicare to obtain a CGM will soon require jumping through a few more regulatory hoops.
Read MoreMUEs and Bilateral Indicators
MUEs are used by Medicare to help reduce improper payments for Part B claims. This article will address the use of the National Correct Coding Initiative (NCCI) and Medically Unlikely Edits (MUEs) and how they are used by CMS.
Read MoreCode Sequencing Chapter 15 OB Visits
Sometimes payer guidelines differ from the official guidelines, this can be confusing, let’s look at a sequencing priority for example in Chapter 15: Pregnancy, childbirth, and the Puerperium (o00-o9A). the guidelines tell us how to code based on the provider's documentation, in addition, it is important to know Chapter 15 codes are never to be used on newborn records, only on the maternal record. Find-A-Code will sequence codes according to the ICD-10-CM guidelines first.
Read MoreNew Modifier Required on all Single-Use Drugs
Attention providers and suppliers, there is a new modifier in town! Starting July 1, 2023, Modifier JZ - Zero Drug wasted will be required on all claims to attest there is no drug leftover, If applicable.
Read MoreIs the End Really Near?
What happens once the COVID-19 emergency declarations have ended?
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