In Billing
Dec 28th, 2017
In August 2017, UnitedHealthcare (UHC) indicated they would no longer reimburse inpatient and outpatient consultation codes, as of Oct. 1, 2017. When the implementation date came, UHC indicated they would delay the consultation services revision until 2018: We previously announced that certain revisions to the Consultation Services Reimbursement Policy would become effective for UnitedHealthcare Co...
Aug 1st, 2013
By G.J. Verhovshek, MA, CPC “Remember the ‘Three Rs’ for Payers Accepting Consults” (June 2013, pages 26-29) generated more than the usual number of reader responses, and a few readers took issue with my insistence that what matters most when coding for consultations are a documented request, reason, and report. Specifically, they suggested what mattered ...
Jun 1st, 2013
Proper documentation is a must for reimbursement of 99241–99245, 99251–99255. By G.J. Verhovshek, MA, CPC Medicare payers haven’t accepted claims for either outpatient (99241-99245) or inpatient (99251-99255) consultations since Jan. 1, 2010. Private payers, however, may still pay for consultation services as long as those services are supported by the “three Rs” of consult documentation: ...
Aug 1st, 2012
By Erin Andersen, CPC, CHC The age of electronic health records (EHRs) has begun. The days of deciphering illegible chicken scratches, cajoling busy physicians to write more than 10 words, and extensive searches for missing charts will one day be extinct. The EHR allows coders to work from home, promises a more complete record, timesaving ...
In Audit
Jun 1st, 2012
The Centers for Medicare & Medicaid Services (CMS) has posted on its website the MLN Quarterly Provider Compliance Newsletter for April. The top billing errors for this month, detected by Comprehensive Error Rate Testing (CERT) and recovery auditors, all pertain to inpatient hospitals. Three-day Rule At the top of the list is a CERT finding ...