Failing to thoroughly document signs and symptoms, assessments, and treatments of chronic diseases creates a ripple effect of misfortune. First, all relevant codes are not captured; this leads to improper payment (not to mention, an injustice to the patient). The next thing you know, the claim fails a Risk Adjustment Data Validation (RADV) or Office ...
May 1st, 2012
Understand your use of CPT® codes prone to audit review. By Stacy Harper, JD, MHSA, CPC In the current regulatory environment, physicians are searching for ways to minimize audit exposure. Medicare administrative contractors (MACs) frequently review high-level evaluation and management (E/M) services. Review may be based on a random sample, or targeted based on provider ...
Jan 2nd, 2010
Physician office and hospital coding are sometimes two different worlds. By Dorothy Steed, CPC-H, CHCC, CPC-I, CPUM, CPUR, CPHM, CCS-P, CEMC, CFPC, ACS-OP, RCC, RMC, PCS, FCS, CPAR When physician coders/billers transition to a hospital environment, they frequently encounter difficulty without a clear understanding as to why. Hospital managers have positions to fill, but the ...
In Billing
Oct 19th, 2009
According to the Centers for Medicare & Medicaid Services (CMS), billing staff often do not know where their physicians performed certain services, such as diagnostic test interpretations. Either that or they simply do not understand place of service (POS) codes enough to make informed decisions. “The use of office or POS code 11 in certain situations ...
In CMS
Oct 19th, 2009
Physicians, non-physician practioners (NPPs), and other Part B providers and suppliers submitting claims to carriers or Part B Medicare Administrative Contractors (B/MACs) for ordered or referred items or services can expect further scrutiny during the claims editing process. Beginning Oct. 5, carriers and B/MACs expanded claims editing to include validation of the ordering/referring provider’s nat...