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MEDICAL BLOG

Emergency Department - APC Reimbursement Method

Christine Woolstenhulme, CPC, CMRS, QCC, QMCS
2022-09-15

CMS pays emergency department visits through a payment method using Ambulatory Payment Classifications (APCs). Most payers also use the APC reimbursement system; however, there may be some differences in payer policies (always review your specific payer policy). APCs are the primary type of payment made under the OPPS, comprising groupings ...

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Report - AMA's 2021 Coding Updates Problematic For Dermatology

Find-A-Code
2022-09-07

The American Medical Association (AMA) updated its coding guidelines in 2021 in an attempt to simplify medical coding for doctors. Ideally, simplified coding would allow clinicians to spend more time taking care of patients and less time trying to figure out codes. But according to a new report, all is not well. The new system is proving problematic in dermatology.

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The Secret to Billing Endoscopic Procedures

Christine Woolstenhulme, CPC, CMRS, QCC, QMCS
2022-09-06

Billing endoscopic procedures can be confusing, but coding rules will assist in this process. Most of the coding principles we will review are the same as any other type of coding; however, endoscopic procedures are paid differently.  This article will address the process of how to find the correct code ...

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CMS says Less Paperwork for DME Suppliers after Jan 2023!

Christine Woolstenhulme, CPC, CMRS, QCC, QMCS
2022-08-18

Attention providers, suppliers, billers, and vendors who bill Durable Medical Equipment (DME) to Medicare!  Currently, a supplier receives a signed Certificate of Medical Necessity (CMN) from the treating physician or creates and signs a DME Information Form (DIFs); these are required to be sent with the claim. However, this is about ...

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Before Requesting a Review on Modifiers, Read This!

Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
2022-08-08

Generally, there is uniformity in the use of modifiers between payers. However, this is not always the case; you may see a difference in payer policies and how modifiers are handled. One way to know if a modifier can be used according to CMS rules can be found when using ...

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Correct Place of Service Codes are Not that Big of a Deal!

Christine Woolstenhulme, CPC, CMRS, QCC, QMCS
2022-08-02

Have you heard the saying, "I am getting paid, so I must be doing something right!" Claims get processed and paid incorrectly all the time; the fact is you may be doing something wrong even if you are getting paid! If you don't understand how the physician fee schedule works, ...

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E/M Changes Coming Our Way in 2023!

Christine Woolstenhulme, CPC, CMRS, QCC, QMCS
2022-07-12

Changes are one thing we can count on being consistent; even though this is one we have been anticipating, it is time to prepare, and we will have some work to do. The AMA released the new 2023 E/M Guidelines early to help us prepare for the change effective January ...

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$636 Million in Overpayments Made by Medicare to Providers for Neurostimulators

Christine Woolstenhulme, CPC, CMRS, QCC, QMCS
2022-03-31

According to the OIG "MEDICARE OVERPAID MORE THAN $636 MILLION FOR NEUROSTIMULATOR IMPLANTATION SURGERIES." So often we think if we get paid, we must be doing it right, well this is not always the case. You may get paid and then have to return the funds if billed incorrectly or a step ...

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Dentists; Treating Patients with a Medical Condition

Christine Woolstenhulme, CPC, CMRS, QCC, QMCS
2022-01-25

Understanding a patient's medical condition can have an impact on healing, as well as other problems. Of course, a dentist is not required to diagnose a medical condition such as diabetes.  However, it is in the patient's best interest that the provider is aware of any conditions that may affect ...

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Treating the Genitofemoral Nerve?

Christine Woolstenhulme, CPC, CMRS, QCC, QMCS
2022-01-25

Finding which CPT code is appropriate for certain nerves can get complicated. Recently I was asked which CPT code would be used for radiofrequency ablation of the genitofemoral nerve and for a second procedure: release of psoas tendon under ultrasound guidance. Radiofrequency Ablation of the Genitofemoral Nerve I found is there is no code ...

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