Differentiating Between Medical Necessity and Medical Decision Making

Medical Decision Making specifically refers to the complexity of establishing a diagnosis and/or selecting a management option. Medical necessity refers to the appropriateness of the service provided for a certain condition. Medical necessity determines whether the service will get reimbursed. Problems arise when MDM and medical necessity are used interchangeably, or when practices and payers […]

Alternative Payment Models (APMs)

An Alternative Payment Model (APM) is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population. Types of APMs APMs: Meet the statutory definition of an APM. MIPS eligible clinicians participating in an APM are also subject […]

Preventing Diabetic Complications

Over time, diabetes can affect any part of your body. The good news is that you can prevent or delay many health complications by taking good care of yourself. Keeping your blood sugar within the target range acceptable to you and your doctor will help you to fight complications. Some common Preventing Diabetic Complications problems […]

Controlling Gestational Diabetes

Gestational diabetes is diabetes that a woman can develop during pregnancy. When you have diabetes, your body cannot use the sugars and starches (carbohydrates) it takes in as food to make energy. As a result, your body collects extra sugar in your blood. We don’t know all the causes of gestational diabetes. Some—but not all—women […]

ICD-10 Codes – Type 2 Diabetes Mellitus

Type 2 diabetes, the more common type, occurs when your body does not make or use insulin well. Insulin is a hormone that helps glucose get into your cells to give them energy, and without it, too much glucose stays in your blood. Over time, high blood glucose can lead to serious problems with your […]

Diabetes, Pre-Diabetes and DSMES Program

More than 30 million Americans have diabetes. Another 84 million US adults have prediabetes, a serious health condition in which blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. A person with prediabetes is at high risk of type 2 diabetes, heart disease, and stroke. […]

Diabetes and Chronic Kidney Disease (CKD)

If you have diabetes, get your urine tested every year to look for kidney disease. Your doctor should do a creatinine blood test to check how these organs are working. He’ll also check your blood pressure regularly. It’s key to slowing this disease. Your reading should be less than 130/80. Approximately 1 in 3 adults […]

ICD-10 Codes – Type 1 Diabetes Mellitus

Diabetes means your blood glucose or blood sugar is too high. With type 1 diabetes, your pancreas does not make insulin. Insulin is a hormone that helps glucose get into your cells to give them energy. Without insulin, too much glucose stays in your blood. Over time, high blood glucose can lead to serious problems […]

Medicare Coverage for Diabetics Shoes

Diabetes is a common disease that occurs when your blood sugar is too high. Type one diabetes is when the pancreas doesn’t make enough insulin, causing blood glucose levels to rise. Type two diabetes is when the body produces enough insulin, it just doesn’t use it properly. One in 5 Americans over the age of […]

Medicare Reimbursement for Pre-Diabetes Screening

Pre-Diabetes Screening involves the testing of asymptomatic, high-risk individuals to assess whether they meet the criteria for either prediabetes or type 2 diabetes. Screening for prediabetes and diabetes is more frequently done in health care settings than in community settings. The process used to target and test patients may include a team approach, employing various […]

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