Don’t let the financial stress of billing for a non-participating provider surpass the stress of an emergency visit. A trip to the emergency department (ED) is stressful, enough. Don’t rub salt on a wound by sending a surprise bill for services rendered by an “out-of-network” provider. Take steps to collect payments due and keep patients, ...
Apr 24th, 2019
The Centers for Medicare & Medicaid Services (CMS) released on April 23 proposed policy changes and rates for the 2020 Inpatient Prospective Payment System (IPPS) and Long-term Care Hospital Prospective Payment System (LTCH PPS). The proposed payment updates for 2020 are: 2.7% for hospitals that submit quality data and are meaningful EHR users 0.3% for ...
In CMS
Feb 8th, 2019
Under the “primary care exception,” a medical resident may perform (and bill for) limited, specific evaluation and management services without the presence of a teaching physician. Here’s what you need to know when reporting these resident services. When the Primary Care Exception Applies Ordinarily, services furnished by medical residents are excluded from Medicare payment because ...
In Coding
Feb 5th, 2019
Compare coding and billing for FQHCs to that of provider- and facility-based organizations. Federally qualified health centers (FQHCs) account for less than 10 percent of designated organizations, but as coding professionals we should understand the differences between FQHCs and physician- or facility-based organizations. Note: Medicare, Medicaid, and commercial carriers do not all process FQHC cla...
In Coding
Feb 5th, 2019
Don’t forget to review guideline changes while you familiarize yourself with 2019 code updates. For fiscal year 2019, we have 78,881 ICD-10-PCS codes to work with. Thankfully, there aren’t quite as many updates as last year: 392 new codes, eight revised codes, and 216 deleted codes. As usual, most of the code changes are in ...