MEDICAL BLOG

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RT and LT Modifier Usage Change (effective 2019-03-01)

Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
2019-05-21

According to Noridian Medicare, there are new changes required when reporting the RT and LT modifier(s). In the past, it was appropriate to bill the RT and LT modifier on the same line when it was required for certain HCPCS codes. Noridian released a publication stating claims reported with RT/LT on the same ...

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Biofeedback - Is it Medically Necessary?

Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
2019-04-24

Biofeedback is used for many reasons, and most commonly used for pain management. Each payer should be consulted with to verify coverage when treating with Biofeedback to verify if the treatment is considered experimental or investigational. The majority of payers will list Biofeedback on an exclusions list. Others such as BC ...

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OIG Announces New Review For Medicare Part B Payments for Podiatry and Ancillary Services

Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
2019-04-23

Due to prior OIG work identifying inappropriate payments for podiatrists and ancillary services, the OIG announced in Feb 2019 they will begin a new review starting in 2020.  The OIG stated they will review Medicare Part B payments to determine if medical necessity is supported in accordance with Medicare requirements.   Part of the ...

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Let's Talk High Risk E/M Services

Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
2019-04-23

Have you ever assigned a high-complexity E/M code (e.g., 99205, 99215, 99223, 99233, 99245, etc.) and wondered if it would stand up to further scrutiny? Well, let’s take a closer look at the requirements for reporting high-level E/M services.   Both the American Medical Association and Medicare-published E/M Guidelines agree that a ...

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CPT Announces 2021 E/M Changes

Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
2019-04-23

In 2018, Medicare announced their plans for revamping the Evaluation and Management coding structure and was met with a rapid response from the medical community, including the AMA and many other organizations. As a result, the Medicare changes implemented in 2019 were mostly documentation-related changes that generally benefited providers but were not ...

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Coverage for Hearing Aids and Auditory Implants

Brandon Dee Leavitt QCC, CMCS, CPC, EMT
2019-04-23

For hearing impairment, Medicare is firm in its stance on when it will and will not cover hearing correction. In the PUB 100-02 Medicare Benefit Policy Manual, Chapter 16, Medicare cites the Social Security Act by explaining:  "..."hearing aids or examination for the purpose of prescribing, fitting, or changing hearing aids" ...

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What is Medical Necessity and How Does Documentation Support It?

Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
2019-04-23

We recently fielded the question, “What is medical necessity and how do I know if it's been met?" The AMA defines medical necessity as: It is important to understand that while the AMA provides general guidance on what they consider medically necessary services, these particular coding guidelines are generic and may be ...

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Auditing Chiropractic Services

By Evan M. Gwilliam, DC MBA BS CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow Clinical Director, PayDC Chiropractic EHR Software President, Gwilliam Consulting LLC drgwil@gmail.com
2019-04-22

Chiropractic is unique from other types of health care and auditors need to be aware of the nuances of this field. Chiropractic has become the focus of more and more audits as doctors seem to struggle to create records that properly support the care provided to the patient throughout the entire episode.

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Auditing Ophthalmology and Optometry Exams

Namas
2019-04-19

Auditing Ophthalmology and Optometry Exams If you work in an ophthalmology group or audit ophthalmology then you are most likely aware of the caveats that exist in this specialty. Ophthalmology and Optometry practitioners can select from either the E/M code set or the Ophthalmologic exam code set. Having this knowledge in ...

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Prepayment Review Battle Plan

Wyn Staheli, Director of Research
2019-04-08

Any type of payer review can create some headaches for providers and cause problems for a healthcare office. Even for a practice that has taken administrative steps to try and prevent a prepayment review, it can still happen. A prepayment review means that you must include documentation WITH your claim. ...

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