Jan 1st, 2015
Navigate complex state rules and comply with payers’ coverage guidelines and bylaws. By Joette Derricks, MPA, CMPE, CPC, CHC, CSSGB In 2013, the American Medical Association (AMA) established a definition for a qualified healthcare professional (QHP), in terms of which providers may report medical services: “A ‘physician or other qualified health care professional’ is an ...
In Audit
May 19th, 2014
Medicare allows coverage for services provided by Non Physician Practitioners (NPP’s) such as Nurse Practitioners (NPs) and Physician Assistants (PAs), per the following key principles. Qualifications To furnish covered services to a Medicare program beneficiary, Medicare requires that NPs: Be a registered professional nurse authorized by the State in which services are furnished to practice ...
Feb 1st, 2013
Overlooking these modifiers can result in improper reimbursement. By Terri Brame, MBA, CHC, CPC, CGSC, CPC-H, CPC-I Any coder worth his or her wage knows about modifiers 25 Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service ...
Nov 1st, 2012
By Jaci Johnson CPC, CPMA, CEMC, CPC-H, CPC-I Whether performing an audit or providing education, when it comes to evaluation and management (E/M) coding, your first consideration should be accurate, compliant information and results. Choose Reliable Resources Our reliable resources are the Centers for Medicare & Medicaid Services (CMS) 1995 and 1997 Documentation Guidelines for ...
The basics of ambulatory surgery center (ASC) coding and billing aren’t hard to master, but they do differ from physician and facility requirements. The following overview will help you know what’s most important in the ASC setting. Definition of ASC To understand correct coding and billing for an ASC, you must first understand what an ...