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 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 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 […]
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 […]
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 […]
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 […]
For the 2018 reporting period, insufficient documentation accounted for 81.6 percent of improper payments for ostomy supplies. Additional types of errors for ostomy supply claims in the 2018 reporting period were no documentation (2.3 percent) and medical necessity (1.9 percent). Medical records must contain adequate, clear documentation that supports the medical necessity of the amount […]
Critical care services must be medically necessary and reasonable. Services provided that do not meet critical care services or services provided for a patient who is not critically ill or injured in accordance with the above definitions and criteria but who happens to be in critical care, intensive care, or other specialized care units should […]
Modifier 50 applies to bilateral procedures performed on both sides of the body during the same operative session. When a procedure is identified by the terminology as bilateral or unilateral, the 50 modifiers are not reported. If a procedure is authorized for the 150 percent payment adjustment for bilateral procedures (payment policy indicator 1), […]
Moderate Sedation Coding Guidelines To ensure accurate billing, it’s essential to follow Sedation Coding Guidelines, which specify the proper codes for different sedation levels and procedures. By adhering to these challenges, medical practices can avoid coding errors and ensure appropriate reimbursement. Moderate sedation is a service provided by the physician or other qualified healthcare professional […]
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