HCPro’s 2019 coding productivity survey showed that coding productivity held steady for 2019, but facilities continue to struggle with miscommunications between coding and CDI staff and unanswered physician queries.
James S. Kennedy, MD, CCS, CDIP, CCDS , reviews updated policies in the 2020 Medicare Physician Fee Schedule final rule that will affect ICD-10-CM risk-adjustment reporting and documentation for facilities.
Although the dollar figures aren’t big, the Office of Inspector General’s (OIG) report on faulty chronic care management (CCM) billing should be concerning for physician practices billing these codes.
JustCoding’s sister publication, HIM Briefings, conducted a benchmarking survey to shed light on edit and denial management processes across the industry. Review findings from the survey to see how your organization compares to those across the industry.
Review finalized changes to relative value units for office visits, new HCPCS codes for chronic care management and opioid treatment services, and future updates to the E/M reporting guidelines.
Perhaps the most momentous Quality Payment Program (QPP) news in the 2020 Medicare Physician Fee Schedule proposed rule is the Pathways version of the Merit-based Incentive Payment System (MIPS)—but that’s not happening until 2021.
Internal audits can reveal inconsistencies in provider documentation and coding, reporting errors, and fraudulent billing practices. Review internal auditing basics and advice from regulatory experts on how to effectively educate providers on audit findings. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS proposed a new framework for the Merit-based Incentive Payment System (MIPS) intended to make the transition to value-based care easier for physicians. Read up on the proposed framework, MIPS Value Pathways (MVP), and its potential impact on patients and providers beginning in 2021.
The 2020 Medicare Physician Fee Schedule proposed rule includes significant documentation and payment changes for outpatient office visits reporting using E/M codes 99202-99215. Beginning in 2021, these proposed updates could add billions of dollars to the national E/M revenue stream.
Before starting an ambulatory or outpatient clinical documentation improvement (CDI) program, those tasked with the project must first create some universal definitions, so everyone is on the same page and speaking the same language.
Medicare appropriate use criteria (AUC) requirements, currently in a voluntary testing period, will become mandatory starting January 1, 2020. Denise Williams, COC, CHRI , shares insight and analysis on AUC reporting requirements to help facilities prepare for what’s to come.
CMS recently released quarterly updates to the OPPS and Integrated Outpatient Code Editor (I/OCE), effective July 1. Judith Kares, JD , summarizes key coding and billing policy updates, including changes to APCs, status indicators, revenue code changes, and more.
Learn how ICD-10-CM coding accuracy, specificity, and compliance impacts provider performance in each of the four performance categories under the Merit-based Incentive Payment System (MIPS). Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A May report from the Office of Inspector General (OIG) found that some physician practices were at the root of basic coding errors that caused federal overpayments. Although the Essence audit was small, the findings have significant implications for physician coders.
The role of the coder has transitioned over the past few years to one that is more auditing-heavy. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , describes how to effectively perform internal audits and educate providers on coding best practices.
Anthem announced that it may reject claims that contain a subsequent E/M service that’s linked to the same diagnosis as an earlier E/M encounter. Learn what Anthem’s modifier -25 policy means for providers and physician coders.
Providers will find significant leeway in how they can report advance care planning (ACP) services for physicians given CMS’ open-ended coding requirements. Review potentially confusing CPT time rules and other obstacles that may be holding back providers from engaging in ACP services.
Even on a small scale, the implementation of an outpatient clinical documentation improvement (CDI) program can be overwhelming. Review advice from CDI specialists on developing successful outpatient CDI programs that facilitate accurate coding and billing.
It's been more than three years since CMS introduced a subset of modifiers it wants providers to report instead of modifier -59 (distinct procedural service), but they're still optional as barely any new guidance has been released.
The CMS risk adjustment model uses Hierarchical Condition Categories (HCC) to calculate risk scores based on ICD-10 diagnoses. Review HCC coding do’s and don’ts to help your facility manage risk effectively, enhance shared savings, and provide patient-centered care.
