CPT® code and guideline changes show a shift towards collaborative care and behavioral health management. With the release of CPT® 2018, we see major changes in coding throughout the Evaluation and Management (E/M) section. New codes and chapters were added for collaborative care management (CoCM) and behavioral health management. Let’s review these complex changes, which ...
In Audit
Oct 28th, 2014
Physical therapy has made it in the Office of Inspector General’s (OIG’s) work plan for several years running. With medical reviewers on the lookout for high utilization of outpatient physical therapy services, coders and billers need to be vigilant about how their physical therapists are documenting services. Per Chapter 15, Section 220.1.1 of the Medicare ...
Dec 10th, 2013
The 2014 Medicare Physician Fee Schedule (MPFS) final rule, published in the Nov. 27 Federal Register, establishes preliminary guidelines for how physicians and other qualified healthcare professionals can receive separate payment for chronic care management (CCM) services furnished to Medicare patients beginning in 2015. The Centers for Medicare & Medicaid Services (CMS) first introduced CCM ...
Apr 1st, 2013
By Melody S. Irvine, CPC, CPMA, CEMC, CFPC, CPC-I, CCS-P, CMRS As a physician auditor, I spend much of my time educating clinicians on proper documentation. This involves explaining and interpreting coding and compliance guidelines. When providing such guidance, the most common reply I hear from providers is, “I want it in writing.” An auditing ...
In Audit
Jun 18th, 2012
CareFirst Blue Cross and Blue Shield reported recently that about 60 percent of the small teams of primary care physicians and nurse practitioners participating in its patient-centered medical home program met quality and cost goals and will start receiving increased fees for certain services starting July 1. As reported in Modern Healthcare, nearly 1 million ...