Patients over Paperwork – CMS’s Approach to improve Patient Care

On 26th Sept 2019, the Centers for Medicare & Medicaid Services (CMS) is taking action at President Trump’s direction to “cut the red tape,” bringing relief to America’s healthcare providers by reducing unnecessary burden, allowing them to focus on their top priority – patients. The Omnibus Burden Reduction (Conditions of Participation) Final Rule strengthens patient […]

AMA Announces 2021 E/M Changes

In 2018, Medicare announced its plans for revamping the Evaluation and Management coding structure and was met with a rapid response from the medical community, including the AMA and many other organizations. As a result, the Medicare changes implemented in 2019 were mostly documentation-related changes that generally benefited providers but were not necessarily accepted and […]

Basic Guidelines for Accurate Diagnosis Coding

Medical coding facilitates the billing process by bringing uniformity to the procedures through recognizable codes. Using standard diagnosis codes and procedure codes that are recognized by insurance companies, all medical practices, and relevant care related agencies, the medical coder will ensure that the insurance companies, commercial payer, or the Centers for Medicare and Medicaid (CMS) […]

ICD-10-CM Guidelines for Coding and Reporting FY 2020 – Respiratory System

The Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), two departments within the U.S. Federal Government’s Department of Health and Human Services (DHHS) provide the guidelines for coding and reporting using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). These guidelines should be used as a […]

New Medicare Beneficiary Identifiers (MBI)

MBIs are required for all claims and transactions starting Jan. 1, 2020 (with few exceptions). Out with the old Health Insurance Claim Numbers (HICNs) and in with the new Medicare Beneficiary Identifiers (MBIs) as beneficiaries receive updated cards in advance of a Jan. 1, 2020, transition. As of Aug. 19, the Centers for Medicare & […]

New Patient vs Established Patient E/M Codes

New patient visits used to be easy to distinguish from those with established patients. A new patient was someone you had not previously seen or perhaps someone for whom you did not have a current medical record. Today, like so many other aspects of health care delivery, differentiating between new and established patients, and coding […]

Medical Record Documentation for E/M Services

Medical record documentation is required to record pertinent facts, findings, and observations about an individual’s health history including past and present illnesses, examinations, tests, treatments, and outcomes. The medical record chronologically documents the care of the patient and is an important element contributing to high-quality care. The descriptors for the levels of E/M services recognize […]

Appropriate Use Criteria Program

Background The Protecting Access to Medicare Act (PAMA) of 2014, Section 218(b), established a new program to increase the rate of appropriate advanced diagnostic imaging services provided to Medicare beneficiaries. Examples of such advanced imaging services include: computed tomography (CT) positron emission tomography (PET) nuclear medicine, and magnetic resonance imaging (MRI) Under this program, at […]

Medical Coding for Group Visits

Many physicians are interested in providing group medical visits. Whether the drop-in group medical appointment (DIGMA), chronic care health clinic (CCHC), or other model is delivered, the coding and billing of these services raise questions about codes and payment policies. While past instruction on coding for group visits often indicated that physicians should report code […]

Understanding Medicare’s Outpatient Mental Health Treatment Limitation

By law, Medicare payment for outpatient mental health services is limited to 62.5 percent of covered expenses incurred in any calendar year in connection with the treatment of a mental, psychoneurotic, or personality disorder for an individual who is not an inpatient of a hospital at the time the expenses are incurred. Unfortunately, when you […]

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