In Coding
Jul 24th, 2019
Clinicians will soon be able to better identify and track deep pressure-induced tissue damage in their patients for surveillance and quality improvement purposes. Several new ICD-10-CM codes under category L89 Pressure ulcer clear up the confusion that was created between the diagnosis code set and promulgated clinical literature after the National Pressure Ulcer Advisory Panel ...
In Coding
Jun 6th, 2018
The answers to proper medical coding and reimbursement are not always transparent. From the referral to the claim submission, there are many opportunities for errors that result in a claim denial, improper payment, or even an audit. To secure proper payment, here is a checklist of five essential questions to ask yourself as you code ...
Regulatory reform has changed proof of litigation rules for guidance documents. Written by: Joette Derricks, MPA, FACMPE, CPC, CHC, CLSSGB On Jan. 25, the U.S. Department of Justice (DOJ) issued a memorandum (commonly referred to as the Brand memo) limiting the use of agency guidance documents in affirmative civil enforcement (ACE) cases. The memo stated, ...
In Audit
Mar 14th, 2018
Although most providers aim to stay under the radar of the Office of Inspector General (OIG) and private payers for fraudulent billing practices, others hide intentional wrong-doing and are fearful of being discovered. While still other providers choose to self-disclose once errors and fraudulent conduct is revealed. If your healthcare organization finds illegal billing activity, consider ...
Avoid fighting stacks of denials by adhering to documentation requirements in LCDs. The importance of diagnostic test orders to proper compliance and reimbursement is well illustrated by a personal story. Years ago, I received a frantic phone call from an imaging center going through a Medicare contractor prepayment review. Approximately three months before, the program ...