Oct 1st, 2012
By Mary A. Inman, JD, and Timothy P. McCormack, JD As Medicare-managed care health plans (Medicare Advantage (MA) plans) expand—especially in the past five years—providers are more regularly affected by “risk adjustment.” When done properly, the risk adjustment model has great potential to enhance the quality of patient care. Unfortunately, risk adjustment is also susceptible ...
May 1st, 2012
With a trend moving toward hospital care, consider chargemaster basics. By Dorothy Steed, CPA, CPC-H, CPC-I, CEMC, CFPC, CPMA, CHCC, CPUM, CPUR, CPHM, CCS-P, ACS-OP, RCC, RMC As more physicians head under the hospital umbrella to furnish cost-effective care, opportunities are opening for coders in the facility environment. Your doctor may be considering a move ...
Jul 1st, 2010
By Nancy Reading, RN, BS, CPC, CPC-I Proper application of evaluation and management codes (E/M) codes and modifier 25 Significant, separately identifiable evaluation and management service by same physician on the same day of the procedure or other service has been a longtime challenge for physician coders. More recently, the appropriate assignment of E/M service ...
In CMS
Nov 4th, 2008
The Outpatient Prospective Payment System/Ambulatory Surgical Center Payment System (OPPS/ASC) 2009 final rule includes a 3.6 percent annual inflation update for hospital outpatient departments (HOPDs), but sets the ASC update at 0 percent. The Centers for Medicare & Medicaid Services (CMS) projects final 2009 payment rates under the OPPS will result in a 3.9 percent ...