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Inappropriate Use of Units Costs Practice Over $800,000
June 11th, 2018 - Wyn Staheli, Director of Research & Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT
A recent OIG enforcement action emphasizes the need to understand the proper use of units. A healthcare provider in Connecticut improperly submitted multiple units for drug screening urine tests. The proper billing of units has proven to be problematic for more than just lab tests. Is your billing of drugs & biologicals, injections and timed codes appropriate?
Dental and Medical- Controlled Substance Awareness
January 29th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
As an effort to cut down on opioid abuse and related crimes, in August of 2017 the Attorney General Sessions established a new Department of Justice (DOJ) section called “Opioid Fraud and Abuse Detection Unit”. Due to the serious public health issue and drug overdose deaths, this unit was established and ...
$4.6 million in Claims Paid Incorrectly by CMS when Using KX Modifier
January 16th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
$4.6 Million was paid by CMS for claims that did not comply with Medicare requirements.  The claims were paid in 2017 and reported by the Office of Inspector General (OIG) stating, "A 2017 Office of the Inspector General (OIG) report noted that, in some cases, pharmacies incorrectly billed Medicare Part B ...
Medicare Reimburses for Discarded/Wasted Drugs
January 5th, 2018 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT
Your organization may be leaking revenue without realizing the leak can be stopped. If your organization purchases single-use packets or single dose vials for individual patient use and ends up discarding some of the drug, Medicare has now authorized payment for the discarded or wasted portion. Stop leaking revenue today by reading this article and implementing the guidance provided here.
Average Wholesale Price (AWP)
November 17th, 2017 - David Berky
Clinical Drug Information, LLC Average Wholesale Price (AWP) is intended only to be used by Clinical Drug Information, LLC customers. While many use this information as a price index, the Clinical Drug Information, LLC AWP does not represent an average of wholesale prices from any group of transactions in the ...
List of Common Unclassified Injectable drugs (this list in not all-inclusive)
August 4th, 2017 - Chris Woolstenhulme, CPC, CMRS
This is a list of some of the most common Injectable unclassified drugs used with J3490 Antilirium – 1 mg/ml Ascorbic Acid – 500 mg/ml Ascorbic Acid – 250 mg/ml Bacitracin, Intramuscular – 50,000 unit vials Bacitracin, Intramuscular – 10,000 unit vials Brevital Sodium – 500 mg/5 ml Caffeine and Sodium Benzoate – 250 mg/ml Capastat Sulfate – 1 ...
Prescription Drug Management: Is it a Level 3 or a Level 4?
June 29th, 2017 - J. Paul Spencer, CPC, COC
If you place four auditors around a table and place a typical established patient visit in front of them, what tends to follow is a scene that resembles less about building consensus and more along the lines of a National Geographic special regarding the hunting habits of hyenas. Perhaps no ...
Modifier JW With Drug Codes
June 27th, 2017 - Find-A-Code
Modifier JW In the past, some Medicare Administrative Contractors have required providers to report wasted drugs with modifier JW (Drug amount discarded/not administered to any patient). Use of the modifier was at the contractor’s discretion, and some contractors told providers not to report it. But effective January 1, 2017, all providers ...
April 28th, 2017 - Christine Taxin
Prescribers, including dentists, who write prescriptions for Part D drugs are to be enrolled in an approved status or validly opted out with Medicare, in order for their patients’ prescriptions to be covered under Medicare Part D. Full enforcement of Part D prescriber enrollment requirement will begin on January 1, 2019. ...
New and Deleted Drug Screen codes for 2017
January 23rd, 2017 - Chris Woolstenhulme, CPC, CMRS
Deleted Codes for Drug Screening, the following codes are no longer valid for services performed on or after January 01, 2017. Deleted Codes for 2017 80300   Drug screen, any number of drug classes from Drug Class List A; any number of non-TLC devices or procedures, (eg, immunoassay) capable of being read by direct optical ...
Which Drugs Require Intensive Monitoring for Toxicity?
March 22nd, 2013 - Seth Canterbury, CPC, ACS-E/M
Question: When coding E/M services, what drugs qualify as those requiring “intensive monitoring for toxicity” on the MDM Risk table? Answer: Therapeutic drug monitoring is required for a variety of reasons, one of which is a drug’s high potential for toxicity. Intensive monitoring for...

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