Newsletters & Industry Updates

We are committed to keeping your office current on policies of the rapidly evolving medical financial world. With video broadcasts and informational articles, we are your trusted source for the most up-to-date information.

 

Charting Tips:

When you don’t follow a practice guideline when treating a patient, write reasons why in your medical records. It is not sufficient to write “patient doing better”. In what ways is he/she doing better? Be as specific as possible in your charting. Remember that the...

Unspecified Code Use

Payers look for claims to contain highly specific codes to support any medical necessity of a procedure or service performed in healthcare. Getting paid for “unspecified” diagnoses may be as difficult as getting paid for “unlisted” procedure CPT codes; and overuse of...

New Codes and Billing Instructions Effective July 1

The July 2016 update to the Outpatient Prospective Payment System (OPPS) includes key changes to, and billing instructions for, various payment policies, as indicated in the 2016 OPPS final rule. The Centers for Medicare & Medicaid Services (CMS) revised Intensity...

CMS to Reject More Unspecified Diagnosis Codes

The CMS outlines additional unspecified diagnosis codes that are excluded from both ICD-9 and ICD-10 reporting beginning January 2, 2017. CMS missive states the codes, “will not be accepted in the Alleged Cause of Injury, Incident or Illness (Field 15) or in any ICD...

Medical Billing: 4 Key Areas to Risk Adjustment Documentation

Health care has quickly transformed from a fee-for-service payment model where providers are paid based on volume of services to various value-based payment methodologies. These new payment systems are focused on promoting quality of care and creating better outcomes....

PQRS

Although 2016 may be the final year of the PQRS program, as Medicare implements a new payment system under the Medicare Access and CHIP Reauthorization Act of 2015, it is a critical one.  Providers and group practices that do not satisfy PQRS requirements in 2016 face...

Charting Tip

When not following any widely accepted practice guideline when treating your patient, write the reasons why you are not following the accepted recommendation in your medical record. It is not sufficient to state “patient doing better”.  In what ways is the patient...

Confusion Regarding Co-Pays & Courtesy

Many managers realize that there are “compliance” issues with professional courtesy and waiver of co-pays, leading to confusion on how to handle them. Professional courtesy needs to be distinguished from waivers of co-pay.  Professional courtesy is the waiver or...

Frequently Asked HIPAA Questions

Does the HIPAA Privacy Rule limit an individual’s ability to gather and share family medical history information? NO. The HIPAA Privacy Rule may limit how a covered entity (for example, a health plan or most heath care providers) uses or discloses individually...