Considering Wound Care Compliance for Getting Paid on Time

All hospital staff members working in the wound center provide services under the direct supervision of an advanced practitioner (AP) (I.e. physician, podiatrist, or nurse practitioner). The practitioner can be employed by the hospital or in private practice. There have been cases in which providers’ alleged failures to satisfy provider-based criteria have given rise to […]

Medicare Covered Vision Services

Medicare Fee-For-Service/ original Medicare does not normally cover routine vision services, such as eyeglasses and eye exams. Medicare may cover some vision costs associated with eye problems resulting from an illness or injury. This article covers Medicare-covered vision services for certain beneficiaries, including Intraocular lenses (IOLs); Glaucoma screenings, and other Medicare-covered services. Generally, Medicare covers […]

How to Use the Medicare National Correct Coding Initiative (NCCI) Tools?

(This article talks only about the Medicare Fee-For-Service Program / Original Medicare) What is NCCI? The Medicare National Correct Coding Initiative (NCCI) (also known as CCI) was implemented to promote national correct coding methodologies and to control improper coding leading to inappropriate payment. NCCI Procedure-to-Procedure (PTP) code pair edits are automated prepayment edits that prevent […]

Medicare Proposed Changes for 2020 Physician Fee Schedule

The Centers for Medicare and Medicaid Services (CMS) is seeking to change its approach to paying clinicians for many office visits, incorporating recommendations and ideas from research done by the American Medical Association. Medicare also is pressing for greater disclosure to consumers about hospital prices and for the creation of incentives for dialysis centers to […]

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

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 […]

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