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Latest articles

Finalized Confidentiality of Alcohol and Drug Abuse Patient Records Regulations
August 31st, 2018 - Wyn Staheli, Director of Research
In January, the U.S. Department of Health and Human Services (HHS) issued updates to the privacy regulations regarding the confidentiality of patient information of substance use disorder patients (42 CFR Part 2).  This notice included references to better alignment with HIPAA regulations, but did state that Part 2 is more protective ...
Pricing for ASC’s and APC’s
August 27th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
For Medicare purposes, an Ambulatory Surgical Center Resources (ASC) is a distinct entity that operates exclusively to furnish surgical services to patients who do not require hospitalization and in which the expected duration of services does not exceed 24 hours following admission. ASC payment groups determine the amount that...
PSAVE Pilot Program - What Does it Mean to You?
August 20th, 2018 - Wyn Staheli, Director of Research
Noridian's pilot program Provider Self-Audit with Validation and Extrapolation (PSAVE) has been extended which means that it has been successful for the payer, which means that they are saving money. Historically, when a pilot program is proven to be successful, it isn’t too long before other MACs follow. Before signing up to participate, providers need to carefully evaluate the program. Are the benefits worth the costs?
Importance of Depression Screenings
August 16th, 2018 - Wyn Staheli, Director of Research
Why would a chiropractor be concerned about depression screenings when you aren’t trained to be a mental health provider? The answer lies in patient outcomes. Many quality care organizations recommend depression screenings for patients with a chronic condition. According to The National Institute of Mental Health, “People with other chronic ...
Using Modifiers 96 and 97
August 16th, 2018 - Wyn Staheli, Director of Research
The Affordable Care Act (ACA) requires coverage of certain essential health benefits (EHBs), two of which are rehabilitative and habilitative services and devices. Since the ACA did not define these terms or specify coverage requirements, it is left up to individual states to create benchmark plans to determine coverage requirements. ...

Editors choice articles

Pricing for ASC’s and APC’s
August 27th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
For Medicare purposes, an Ambulatory Surgical Center Resources (ASC) is a distinct entity that operates exclusively to furnish surgical services to patients who do not require hospitalization and in which the expected duration of services does not exceed 24 hours following admission. ASC payment groups determine the amount that...
PSAVE Pilot Program - What Does it Mean to You?
August 20th, 2018 - Wyn Staheli, Director of Research
Noridian's pilot program Provider Self-Audit with Validation and Extrapolation (PSAVE) has been extended which means that it has been successful for the payer, which means that they are saving money. Historically, when a pilot program is proven to be successful, it isn’t too long before other MACs follow. Before signing up to participate, providers need to carefully evaluate the program. Are the benefits worth the costs?
Patients Over Paperwork?! We have Great News!
July 18th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Spend more time with patients and less time documenting? Great Concept! Document meaningful information? Sound good? CMS is proposing just that! CMS released a new proposal July 12, 2018, focused on streamlining clinician billing and expanding access to high-quality care. The goal is to improve and restore the doctor-patient relationship, modernize Medicare ...
Attention Providers - Please Make Time to Read this Letter
July 17th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
In an effort to show CMS is committed to changing the rules to accommodate their providers CMS released a letter to Doctors of Medicare Beneficiaries. The letter offers encouragement and a promise to reduce the burden of unnecessary rules and requirements. The letter states “President Trump has made it clear that ...
Dual Medicare-Medicaid Billing Problems
July 12th, 2018 - Wyn Staheli, Director of Research
It is important to keep in mind that Medicaid is run at a state level so there can be some differences when it comes to coverage. However, the rules regarding balance billing of covered services is set at the federal level. The law states (emphasis added): A state plan must provide ...

Latest questions/posts

Outcome Assessment Tools
1st    Sep 14th, 2018 - DrEd

NHP-RI CPT 64450-XS denied as non coverd
   Sep 11th, 2018 - austin

Diabetic Foot Care
   Aug 28th, 2018 - alleegator13

Hiv - 2
1st    Aug 21st, 2018 - Jstew

MDM credit in Table B
   Aug 17th, 2018 - damills 1 

Grouping of mutually exclusive CPt4 in IR DRG
1st    Aug 17th, 2018 - Hhiba

Denial in question
   Aug 15th, 2018 - alleegator13

Incident To Billing
   Aug 14th, 2018 - dlstoner512 1 

Reimbursement Question for J2785 - Injection, regadenoson, 0.1 mg
1st    Aug 13th, 2018 - Jaywalkz

CPT 61510 and 61518- multiple tumors
   Aug 12th, 2018 - LBAROGIANIS 250 

ICD-10 - Help
   Aug 7th, 2018 - precod 10 

Repair Code vs Flap Code
   Aug 2nd, 2018 - sharris

Dexcom G5 CPT
   Jul 13th, 2018 - precod 10 

I need codes for private lab tests to report to Medicare and AARP
1st    Jun 28th, 2018 - maryaloftus

Rewording prior question on CPT 93000
   Jun 27th, 2018 - sschwartz 3 

Aetna denial on E/M codes
   Jun 27th, 2018 - gowri.tina

Pouchoscopy with dilation of anus with biopsy?
1st    Jun 25th, 2018 - mlh2000ku

VP tie off
   Jun 22nd, 2018 - lizzg

Axillary artery cutdown
1st    Jun 20th, 2018 - dll

Mesh removal in office
1st    Jun 13th, 2018 - Nikkibear


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