In Billing
Oct 11th, 2018
Valid claims submitted by physical therapists (PTs) in private practice are being denied by some Part B Medicare Administrative Contractors (MACs), according to the Centers for Medicare & Medicaid Services (CMS). These claims are for the professional component (PC) or global code for certain diagnostic services involving electromyography (EMG), nerve conduction velocity (NCV), and sensory-evok...
In Billing
Oct 3rd, 2018
Prior authorization for healthcare services is required for certain services. If authorization is not obtained prior to performing the service, the insurer may not reimburse for the procedure. Most services requiring prior authorizations are surgical procedures or high-cost ancillary services or may be determined as not necessary in some circumstances. The requirement for prior authorizations ...
In Audit
Oct 2nd, 2018
If you are a particularly observant medical coder, you’ve probably noticed that many codes identified as deleted were actually promoted to new roles. Nearly 50 codes were revamped to become parent codes of more specific codes,and it’s causing some confusion because some electronic coding systems mark them as deleted AND new. Same Codes Marked as Deleted/New Take ...
In Billing
Oct 1st, 2018
If you’re one of the medical coders who has been looking forward to perusing the 2019 GEMs files, you’re going to be pretty disappointed. The GEMs files have seen their day. GEMs Sunset Planned The GEMs file was developed as a crosswalk between ICD-9-CM and ICD-10-CM during preparation for ICD-10-CM’s implementation. Used by many as ...
In Billing
Sep 28th, 2018
Health Management Associates, LLC (HMA), a hospital chain that has its headquarters in Naples, Florida will be paying over $260 million to avoid criminal and civil claims associated with a scheme to defraud the government of the United States. In this case, the government alleged that HMA was billing inpatient services when they should have ...