In Billing
Jun 7th, 2018
The Centers for Medicare & Medicaid Services (CMS)  issued a MLN Matters article ( MM10412 Revised) on May 31 with a retroactive effective date of January 1, 2018 clarifying documentation requirements when performed by Medical Students in a teaching situation. Confusion About Provider Participation There was confusion when this rule was first issued because coders, auditors ...
In Coding
Jun 7th, 2018
Each time you meet with a patient, you should document a chief complaint (CC). CPT defines the CC as “A concise statement describing the symptom, problem, condition, diagnosis, or other factor that is the reason for the encounter, usually stated in the patient’s words.” Simply stated, the chief complaint is a description of why the ...
In Coding
Jun 6th, 2018
Part 1: Educated coders and providers are crucial to claim success. Delivering quality care, while ensuring effective clinical documentation and compliant medical coding, is an ongoing challenge in a fast-paced emergency department (ED). Over the next two months, we’ll review best practices to optimize coding compliance and reimbursement of ED claims. In part 1 of ...
But be sure you step up your game on meeting attestation and signature requirements. As an ongoing effort to help reduce administrative burden on practitioners, the Centers for Medicare & Medicaid Services (CMS) released an important update for physicians and other clinicians working in teaching institutions. According to CMS’ E/M Service Documentation Provided by Students ...
Correct bad habits before your E/M services claims are audited. by Tim Stelma, BA, CPC, CPMA, AAPC Professional Auto-fill and self-leveling functions in electronic healthcare records (EHRs) have led to higher utilization of upper-level evaluation and management (E/M) services. This has not gone unnoticed by insurance carriers. To dodge a large take-back resulting from a ...