Make a point to learn drug coverage and payer requirements for billing. It’s essential not to confuse vaccine injections with injectable medications. Injectable medications, for example, are reported with HCPCS Level II codes and vaccines are reported with CPT® codes. But that’s not all: In many instances, injectable medications require prior authorization — and the ...
New metrics and quality measures call for improved documentation to track this growing problem. Opioid dependence and overdose are at crisis levels. Healthcare professionals have a front row seat to this epidemic, and we have a responsibility to know coding and documentation requirements for such cases. Opioid Use Becomes a Quality Measure According to the ...
In Billing
Feb 19th, 2018
Effective Jan. 1, 2018, newly approved biosimilar biologicals with a common reference product are no longer grouped into the same billing code. This change was finalized in the 2018 Medicare Physician Fee Schedule final rule. Q5102 Replaced with Two New Codes The April 2018 update to the Medicare Physician Fee Schedule Database (MPFSD) includes three ...
Accurate coding and better documentation can help raise red flags when patient abuse is present. The U.S. Department of Health and Human Services (HHS) reports that drug overdose deaths are the leading cause of injury death in the United States; and each year, drug abuse causes millions of serious illnesses or injuries across America. Commonly ...
In CMS
Jul 13th, 2017
The Office of Inspector General’s (OIG) combat on healthcare fraud, waste, and abuse of taxpayer’s money recovers $5 for every $1 spent on investigating, which gives them incentive to target more areas of fraud. The OIG’s latest and largest fraud takedown happened this month when opioid fraud was exposed with the help of state and federal law ...