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 – Obstetrics

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 […]

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 […]

Diagnostic Medical Coding and Reporting Guidelines for Outpatient Services

These coding guidelines for outpatient diagnoses have been approved for use by hospitals/ providers in coding and reporting hospital-based Outpatient Services and provider-based office visits. The terms encounter and visit are often used interchangeably in describing Outpatient Services contacts and, therefore, appear together in these guidelines without distinguishing one from the other. Though the conventions […]

Quantifying Your Medical Decision-Making

Quantifying Cognitive Labor This is the most important of the three key components because the Medical Decision-Making (MDM) reflects the intensity of the cognitive labor performed by the physician. There are four levels of MDM of incrementally increasing complexity Straightforward; Low Complexity; Moderate Complexity; and High Complexity. Physicians must stratify the MDM into one of […]

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 & […]

Radiology Part B Billing for Hospital and SNF Patients

Acceptable HCPCS codes for radiology and other diagnostic services are taken primarily from the CPT-4 portion of HCPCS. Payment is the lower of the charge or the Medicare physician fee schedule amount. Deductible and coinsurance apply, and coinsurance is based on the allowed amount. For claims to A/B MACs (A) or (HHH), revenue codes, HCPCS […]

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 […]

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