In Billing
Oct 1st, 2018
If you’re one of the medical coders who has been looking forward to perusing the 2019 GEMs files, you’re going to be pretty disappointed. The GEMs files have seen their day. GEMs Sunset Planned The GEMs file was developed as a crosswalk between ICD-9-CM and ICD-10-CM during preparation for ICD-10-CM’s implementation. Used by many as ...
Jun 9th, 2015
By Nancy Clark, CPC, CPC-H, CPB, CPMA, CPC-I Almost every medical coder has seen denied claims. Becoming familiar with the reasons for these denials will increase the ability to prevent them, in the future. Sometimes, it is difficult to identify the specific reason for the denial based on the explanation of benefits (EOB) alone. We ...
May 20th, 2015
Physicians and non-physician practitioners: You are potentially submitting claims for cardiovascular nuclear medicine procedure codes with ICD-9-CM codes that do not support medical necessity for these services. Says who? A recovery auditor for the Centers for Medicare & Medicaid Services (CMS) that recently conducted automated reviews of such claims. CMS encourages physicians to review the dia...
Look beyond coding guidelines for complete and accurate reporting. By Chandra Stephenson, CPC, COC, CPB, CPCO, CPMA, CPC-I, CIC, CCS, CANPC, CEMC, CFPC, CGSC, CIMC, COSC In 2011, more than 1.2 million people in the United Sates were living with the human immunodeficiency virus (HIV), and only four in 10 of those individuals were in ...
In Billing
Dec 8th, 2014
Duplicate claim submitted — Claims are often denied as duplicates for the following reasons: The claim was previously processed (i.e., no payment made, allowed amount applied to deductible on the initial claim). The provider re-files the claim to “correct” it. The second claim submitted is considered a duplicate because the initial claim was processed correctly. ...