In Audit
Jul 12th, 2019
The No. 1 claim error for June in 11 states plus the District of Columbia was for non-covered charges, according to Novitas Solutions, Medicare Administrative Contractor for Jurisdictions H (Arizona, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas) and L (Washington DC, Delaware, Maryland, New Jersey, and Pennsylvania). This error is identified by Explanation of ...
In Billing
Jul 11th, 2019
The professional service of preparation and provision of antigens for allergen immunotherapy — reported using CPT® 95165 Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens (specify number of doses) — is often misunderstood and incorrectly coded and billed to third-party payers. This misunderstanding causes a ...
In Coding
Jul 8th, 2019
When you have distinct, separate procedures, know which modifiers will get the claim paid in full. Modifier 59 Distinct procedural service acts as a “universal unbundling” modifier for procedures that are normally included as part of another procedure, or “bundled.” The modifier tells the payer that there are special circumstances that warrant separate reporting (and ...
In CMS
Jun 21st, 2019
The Centers for Medicare & Medicaid Services (CMS) released on June 20 the ICD-10-CM code descriptions, tables and index, and addendum for fiscal year 2020. There are 273 additions, 21 deletions, and 30 revisions, effective Oct. 1, 2019, which will increase the code set from 71,932 to 72,184 diagnoses. Chapter Review The majority of changes ...
CMS’ latest guidance reiteration will, hopefully, make coding these sometimes-confusing services easier. Determining the date of service (DOS) when reporting a medical claim seems straightforward, but the Centers for Medicare & Medicaid Services (CMS) recently-released “Guidance on Coding and Billing Date of Service on Professional Claims,” is a good indication this topic is more complex ...