Basics of Medicare Payment for Ambulatory Surgical Services (ASCs)

Medicare covers surgical procedures provided in freestanding or hospital-operated ambulatory surgical services centers (ASCs). In January 2008, Medicare began paying for facility services provided in ASCs— such as nursing, recovery care, anesthetics, drugs, and other supplies—using a new payment system that is primarily linked to the hospital outpatient prospective payment system (OPPS). (Medicare pays for […]

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 […]

HIPAA Compliance for Optometry

Running a successful practice in today’s competitive eye care industry requires you to be up-to-date and aware of everything that happens under your roof. One of the key areas of practice management that cannot be compromised is HIPAA compliance within Optometry. Any missteps can create a headache for everyone involved and can lead to fines […]

Ground Ambulance Transports Coverage Requirements

All of these coverage requirements apply to ground ambulance transports: The Transport Is Medically Reasonable and Necessary A medically reasonable and necessary ground ambulance transport must meet these requirements: Medical necessity is established when the patient’s condition is such that the use of any other method of transportation is contraindicated. In any case in which […]

Documentation Guidelines for Cardiology

Specifying anatomical location and laterality required by ICD-10 is easier than you think. This detail reflects how physicians and clinicians communicate and to what they pay attention to – it is a matter of ensuring the information is captured in your documentation. In ICD-10-CM, there are three main categories of changes Definition Change; Terminology Differences; […]

Ambulatory Surgical Center Terminated Procedures

Ambulatory Surgical Center Terminated Procedures The following guidance determines the appropriate ambulatory surgical center (ASC) facility payment for a scheduled surgical procedure that is terminated due to medical complications, which increase the surgical risk to the patient. Payment is denied when an ASC submits a claim for a procedure that is terminated before the patient […]

Cardiology Billing and Coding Updates: 2021

Cardiology billing services are designed to help you maximize collections by meeting government regulations and private payer requirements. Since 2016 when ICD-10 became the official code set for the United States we saw several changes to cardiovascular diagnosis codes. No more hypertension table, we now have a new way to code hypertension (I10 – I15). […]

CPT Changes for OB-GYN in 2020

With the new 2020 ICD-10-CM code set now available, we know that there have been more than 740 different changes. More than 30 of the changes for 2020 actually apply to Obstetrics and Gynecology (OB-Gyn) correction, from changes and updates to coding multiple gestation pregnancies to coding for obstetric surgical wound infections. Here’s a closer […]

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