Medicare

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    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..
    Posted on 10 Aug, 2018
    Conquer Common Documentation Errors Identified by CERT & RAC
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    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..
    Posted on 27 Jul, 2018
    Conquer Inpatient Telemedicine Consultations
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    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..
    Posted on 20 Jul, 2018
    Nip Errors in the Bud with the NCCI and MUEs
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    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..
    Posted on 10 Jul, 2018
    How to Overcome Challenges in Medicine Auditing
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    National healthcare fraud is on the upswing, with a 400% increase in annual takedowns since 2013—and this, despite sequestration of mandatory funding for the Department of Justice (DOJ), the Department of Health & Human Services (HHS), the Office of Inspector General (OIG), and the FBI. Take   Read more..
    Posted on 29 Jun, 2018
    400% Rise in Healthcare Fraud Takedowns
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    Recoup lost revenue by following up on denials.   After a claim has been properly documented, coded, and submitted for payment, a few things could happen. Hopefully, the insurer pays the claim and the office receives the appropriate reimbursement. But there are other scenarios that could   Read more..
    Posted on 25 Jun, 2018
    Don’t Take Rejections Lying Down
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    After an extensive outreach with clinicians, patients, and other stakeholders, CMS tweaked their original strategic objectives to drive progress and improvements. These minor enhancements to the strategic objectives will help guide their final policies and future rule-making in order to design, implement, and advance a Quality   Read more..
    Posted on 18 Jun, 2018
    What You Need to Know About the QPP’s Strategic Objectives
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    In the 2018 Medicare Fee Schedule rule, CMS reviews MACRA patient relationship categories and codes, their development and timelines, and provides details for the initial claims-based reporting of the relationship categories and codes to CMS. These patient relationship categories and codes define and distinguish the   Read more..
    Posted on 13 Jun, 2018
    Conquer Patient Relationship Categories and Codes
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    Telemedicine now allows providers to virtually interact with patients in a way that improves the quality and delivery of care, especially for those patients who are unable to come to the office. The convenience and instant feedback patients receive are among the driving factors behind   Read more..
    Posted on 8 Jun, 2018
    Learn the Criteria Necessary for Medicare’s Telemedicine Services—Part II
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    Medicare pays telehealth services under the Medicare fee-for-service program, with a larger payment made to the consulting physician or practitioner (at the distant site) than the payment made to the facility at the site where the patient is located. According to a MedPAC report, from 2014-2016   Read more..
    Posted on 5 Jun, 2018
    Ace Medicare Telehealth Reimbursement Basics—Part I

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