Code 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 More
New 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 More
Is the End Really Near?
What happens once the COVID-19 emergency declarations have ended?Read More
Relative Value Units (RVUs) the Easy Way, Really?
The Medicare Physician fee schedule was implemented in 1992 using a relative Value scale methodology called RVUs to base payment rates on the resources used to perform the service. This is currently how the Medicare Physician Fee Schedule (MPFS) is set. But beware, there may be an industry-wide change to a Value-Based Payment. We will save that for another time; this article will focus on how the RVUs are calculated and Medicare Fee schedules.Read More
E/M Transformations and Clarifications Eff January, 1 2023
Pay close attention to the new code description changes when coding E/M in 2023, the changes keep coming. Several codes have been consolidated, revised, or deleted. Learn what to look for in this article.Read More
Compliance Billing: Power Mobility Devices
In May of 2022, the OIG conducted a nationwide audit of Power Mobility Device (PMD) repairs for Medicare beneficiaries. The findings were not favorable; the audit revealed CMS paid 20% of durable medical suppliers incorrectly during the audit period of October 01, 2018- September 30, 2019. This was a total of $8 million in device repairs out of $40 million paid by CMS. We gathered information in this article to assist providers and suppliers in keeping the payments received, protecting beneficiaries, and assisting you in ensuring compliance.Read More
REMINDER: CMS Discontinuing the use of CMNs and DIFs- Eff Jan 2023 Claims will be DENIED!
Updated Article - REMINDER! This is important news for durable medical suppliers! Effective January 1, 2023, CMS is discontinuing the use of Certificates of Medical Necessity (CMNs) and DME information forms (DIFs). We knew this was coming as the MLN sent out an article on May 23, 2022, but it is time to make sure your staff knows about these changes.Read More
Billing for Incontinence and Urinary Products
We all understand anything covered under health insurance must be medically necessary. In other words, it must be essential in treating and managing a patient's condition or to evaluate, diagnose, or treat an illness, injury, disease, or its symptoms. In this article, we will address catheters, urological supplies, and disposable ...Read More
Emergency Department - APC Reimbursement Method
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 ...Read More
Medical Billing Errors Can Cost More Than Just a Few Dollars
When it comes to medical billing codes, we take seriously our responsibility to provide accurate data. Whether it is ICD-10 or CPT codes, our clients need to be able to trust that what they find in our databases is accurate. Otherwise, errors are waiting to happen. Those errors can sometimes cost more than just a few dollars.Read More