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VA program enabling vets to use private providers hits road bump

09/19/2016

Providers who were looking to expand their patient bases by treating American service veterans should tread carefully. The program created to do that appears to have stumbled.

Watch time, threat to organ systems in documenting critical care in the office

09/19/2016

by: Roy Edroso

Critical care cases don’t happen often, but if you get one in your office, make sure you fulfill the requirements and document appropriately to justify the payment.

ICD-10 – How to ensure proper diagnosis coding as grace period ends

09/19/2016

by: Fran Wingerter

Have you heard the echoed sighs of relief throughout the health care community since last fall? Physicians, administrators and billing personnel commiserating with a resounding, “aw, that wasn’t SO bad”? They speak, of course, of the dreaded ICD-10 conversion that went into effect Oct. 1, 2015.

How to look up past fee schedule data

09/19/2016

by: Julia Kyles, CPC-A

Question: Where can I find the Colorado conversion factor for 2009, 2010, 2011?

CCI Version 22.3 scorecard

09/19/2016

by: Richard Scott

Find out which systems are impacted by the 42,000 new code bundles wrapped up in the Correct Coding Initiative (CCI) version 22.3 edits, effective Oct. 1.

Critical care office use plummets; urgent care picks up some slack

09/19/2016

by: Roy Edroso

Critical care codes used to be claimed twice as often in physician’s offices — but a steady drop and a recent denial surge for 99291 (Critical care, E/M of the critically ill or critically injured patient; first 30-74 minutes) has resulted in a 21st-century low of 4,982 claims utilization — and a high 56% denial rate.

Build in workflow, create a tagging system to succeed with CCM payments

09/12/2016

by: Richard Scott

Tip your cap to the many providers who found success in the first year of chronic care management (CCM) but also take a hard look at your CCM potential — you may be leaving money on the table for services you already provide.

New claims suggest 99214 becoming ‘new normal’ — but mind necessity when you code

09/12/2016

by: Roy Edroso

More practices are claiming level 4 established patient visits, and they seem to be going through — but make sure that in addition to all the elements you need to claim them, you have sufficient medical necessity to back them up.

Confirm a definitive diagnosis to select first-listed ICD-10 code

09/12/2016

by: Richard Scott

Get up to speed on ICD-10 coding guidelines to select the proper first-listed diagnosis – a nuanced calculation that contains a number of wrinkles in the outpatient setting.

ERISA challenge works on self-funded plans – but only if insurer broke the law

09/12/2016

by: Roy Edroso

Question: It is my understanding that the Employee Retirement Income Security Act of 1974 (ERISA) does not apply when the patient is employed by a company with a self-funded insurance plan. Is that true?

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