Are you on top of CMS documentation guidelines? The following points identify CMS guidelines for correct documentation that supports and validates the claim submitted for services/procedures: The record of the encounter/episode of care should be complete and legible Documentation should include: Reason for the encounter Assessment,   Read more..

KNOW THE BASICS Use modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the day of the procedure or other service) to identify when a patient has a separate E/M service along with a procedure   Read more..

If you teach medical coding, you know that keeping students motivated and interested is an ongoing challenge, especially for billing or medical assisting students who don’t choose coding as a career but must learn coding as part of their future jobs. Add the complexity of   Read more..

Inpatient consultations via telemedicine is improving lives. These encounters facilitate the delivery of certain services that might otherwise be unavailable to a patient located at an originating site. While you can’t use telemedicine to provide E/M inpatient encounters, you can use them to substitute for a   Read more..

Whether you’re provider, medical coder, practice, practice manager, or auditor, you need to be knowledgeable of federal regulations that relate to fraud, abuse, and compliance. Stay in the know: The five most important Federal fraud and abuse laws that apply to physicians are the False Claims   Read more..

Backstory: Why NCCI was Started The Centers for Medicare and Medicaid Services (CMS) is the agency responsible for the implementation of the National Correct Coding Initiative (NCCI), which was developed to encourage correct coding procedures on the national level and to reduce inappropriate coding that   Read more..

The Office of Inspector General (OIG) plays an important role in negotiating, developing, and enforcing corporate integrity agreements (CIAs). As a condition of settlement in a variety of civil and false claim cases, OIG will require an organization to incorporate a CIA in exchange for   Read more..

What is a compliance plan? A compliance plan is a collection of steps that a provider, organization, or practice establishes to ensure adherence to federal and state regulations. OIG developed voluntary compliance program guidance in an effort to help organizations with their compliance programs. Resources   Read more..

Medicine codes for both therapeutic and diagnostic services include injections, physical medicine, and rehabilitation services. These are some of the most difficult services to audit and, as a result, some of the most frequently audited in the medicine section of CPT®. Injections and infusions Injections and   Read more..

Doctors deal with interruptions every day. They need to call a patient back. The coding department asks them for clarification on a patient charge. Clinicians and staff come in to talk to them. Although the intention is there, the physician may not document the information   Read more..