In Audit
Mar 5th, 2019
Separately billing routine evaluation and management (E/M) services provided on the same day as another medical procedure is typically denied by Medicare. Healthcare providers may sometimes separately bill E/M services if they meet certain criteria and append modifier 25 Significant, separately identifiable evaluation and management service by the same physician or other qualified health care ...
In Audit
Mar 4th, 2019
Follow this step-by-step guide to coding and documentation compliance. It’s always better for a facility to find compliance issues before a government agency or payer does (who may respond by levying penalties and fines). Pre- or post-bill audits help facilities uncover minor concerns before they become major compliance issues, thereby promoting revenue integrity. Here’s how ...
In CMS
Jan 15th, 2019
Every year, the Centers for Medicare & Medicaid Services (CMS) updates their Designated Health Services (DHS) Code List. What are designated health services, and why should you care? The Link to Designated Health Services and the Law By law, CMS categorizes the following as designated health services: Clinical laboratory services Physical therapy services Occupational therapy services ...
In Audit
Nov 29th, 2018
A 5-year demonstration to develop improved procedures for the identification and prosecution of potential Medicare fraud occurring in the Home Health Program will begin in Illinois no sooner than Dec. 10, pending Congressional approval. The Centers for Medicare & Medicaid Services (CMS) will conduct the Review Choice Demonstration for Home Health Services in Jurisdiction M, ...
In the absence of payer guidance, look to CMS and CPT® for guidance on reporting an E/M as a separate service from chiropractic manipulative treatment with modifier 25. Editor’s Note: Healthcare Business Monthly was recently asked about reporting evaluation and management (E/M) services separately from chiropractic manipulative treatment (CMT) of the spine. As with most ...