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 […]
Primary Care First (PCF) Model Options is a set of voluntary five-year payment options that reward value and quality by offering an innovative payment structure to support the delivery of advanced primary care. It will help in prioritizing the doctor-patient relationship; enhancing care for patients with complex chronic needs and high need, seriously ill patients, […]
A patient over Paperwork (POP) Initiative Through ‘Patients over Paperwork,’ CMS established an internal process to evaluate and streamline regulations with a goal to reduce unnecessary burden, increase efficiencies, and to improve the beneficiary experience. As part of the Patients over Paperwork Initiative, Medicare is simplifying documentation requirements so that providers spend less time on […]
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 […]
Assistant surgeon billing can seem overwhelming, so it’s crucial to take it one step at a time. But there are several key points to remember that will make it much easier to understand. Assistant at Surgery: An assistant at surgery is a physician or non-physician practitioner who actively assists the surgeon and goes beyond providing […]
The medical audit is the systematic, critical analysis of the quality of medical care, including the procedures used for diagnosis and treatment, the use of resources, and the resulting outcome and quality of life for the patient’. The audit is a continuous cycle involving observing practice, setting standards, comparing practice with standards, implementing change, and […]
The global surgical package, also called global surgery, includes all the necessary services normally furnished by a surgeon before, during, and after a procedure. Medicare payment for a surgical procedure includes the preoperative, intra-operative, and post-operative services routinely performed by the surgeon or by members of the same group with the same specialty. Physicians in the […]
The Durable Medical Equipment Medicare Administrative Contractors (DME MAC) are changing the requirement that medical coders to use the RT and LT modifier for certain HCPCS codes, and that the modifiers be used when billing two of the same item or accessory on the same date of service and the items are being used bilaterally. […]
There are many services and products that may be billed when a patient presents with chronic asthma or other serious respiratory conditions or acute exacerbation of related symptoms. Physicians must capture all pertinent information in their documentation and, in turn, coders (or those who validate pre-coded electronic health record charges) must account for all related […]
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