PECOS is the short form for Provider, Enrollment, Chain, and Ownership System. It is a database where doctors register with the Centers for Medicare and Medicaid Services (CMS). It is a national electronic database for recording and retaining data on Medicare-enrolled providers and suppliers. CMS developed PECOS as a mechanism to combat fraud and abuse. PECOS […]
As medical credentialing enables the patients to confidently trust their chosen healthcare providers, it has become very crucial. A medical practitioner cannot work at a hospital legally or partner with insurers, without proper medical credentialing. Only a new physician or practitioner who is credentialed is allowed to see patients, treat hospital inpatients, and receive insurance […]
Loss of Protective Sensation (LOPS) Basics Diabetic sensory neuropathy, or peripheral neuropathy, is the most common factor leading to amputation in people with diabetes. In diabetes, sensory neuropathy is an anatomically diffuse process primarily affecting autonomic and sensory fibers; however, distal motor findings may be present in advanced cases. Long nerves are affected first, with […]
Replacing Code 0249T CPT Category III code 0249T, ligation, hemorrhoidal vascular bundle(s), including ultrasound guidance, has been deleted and converted to CPT Category I code 46948, hemorrhoidectomy, internal, by Code for Transanal Hemorrhoidal Dearterialization (THD), 2 or more hemorrhoid columns/groups, including ultrasound guidance, with mucopexy, when performed. The new code, CPT 46948, more accurately describes […]
On 19th Jan 2020, the American Medical Association (AMA) added new CPT codes (91302 and 0031A) for Janssen COVID-19 Vaccine, a division of Johnson & Johnson. Janssen is a single-dose COVID-19 vaccine which is 4th vaccine to get unique CPT codes for documentation and billing. The new CPT codes will be effective for use on […]
As healthcare regulations change, so do healthcare provider reimbursement models. Understanding different forms of reimbursement and their advantages and disadvantages can help you better figure out your healthcare organization’s revenue cycle management. The two main models between which the American healthcare network has been fluctuating are fee-for-service (FFS) and value-based care (VBC). Fee-For-Service In the […]
The Centers for Medicare & Medicaid Services (CMS) on 2nd October 2020, finalized policies that allow certain new and innovative equipment and supplies used for dialysis treatment of patients with End-Stage Renal Disease (ESRD) in the home to qualify for an additional Medicare payment. This final rule encourages the development of new and innovative home […]
Medicare won’t provide coverage for items and services that are not reasonable and necessary for the diagnosis or treatment of an illness or injury. National coverage determinations (NCDs) are made through an evidence-based process, with opportunities for public participation. In the absence of NCDs, an item or service may be covered at the discretion of […]
Medical documentation and coding are bricks and mortar of the medical billing process. In the past 25-30 years, we seen the increased importance of documentation and coding. Compliant clinical documentation and coding are essential to every healthcare setting, no matter the individual responsible for and/or performing the tasks. We need to ensure medical necessity is […]
CMS’s Proposed Rule on Automating Prior Authorization On 10th December 2020, The Centers for Medicare & Medicaid Services (CMS) proposed a new regulation aimed at improving the sharing of healthcare data between payers and providers and streamlining, a major administrative hassle for providers. This new rule will boost patient data exchange and streamline which will […]
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