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Exert extra attention on your diagnosis coding, particularly under Medicare Advantage (MA) models, or you may be at risk of running afoul of CMS regulations — and your payers’ good will. A May 2 report from the OIG found that some physician practices were at the root of basic coding errors that were causing federal overpayments.
A big boss-from-hell lawsuit at a major health system shows that workplace discrimination can be hard to address when the perpetrator has power over victims. To keep things from getting out of hand, practices should give their staff a chance to be heard safely in such instances.
A recent DOJ settlement over misuse of chronic care management (CCM) services acts as a reminder that, even if you’re using a CCM vendor to help, the care of the patient and the documentation of the service to CMS remains your responsibility.
Overcome the bad reactions that may afflict you when a wind of high denials hits for core allergy testing code 95004 (Percutaneous tests [scratch, puncture, prick] with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests).
You may be surprised to learn that the place of service (POS) with the most-claimed code under Medicare would be 12 (home) rather than 11 (office) or 21 (inpatient hospital). But that’s where the lion’s share of Medicare’s biggest code is billed. And the number of services claimed for home overall stretches into 10 figures.


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