Coding Category
Many evaluation and management (E/M) service codes distinguish between “new” and “established” patients. To help distinguish between the two and to clarify several common scenarios, AAPC’s Managing Editor G. John Verhovshek, MA, CPC, recently published an article through the California Medical Association.
“A patient is new if he or she has not received a face-to-face, professional service from the provider, or a provider of the same specialty/subspecialty in a group practice, within the previous 36 months,” he says.
Read the full article.
April 3rd, 2013
In small to midsized practices, failing to educate staff about correct coding may contribute to the practice’s downfall. Medical coding errors can be a huge source of lost revenue. A recent article in Physicians Practice reviews common billing and coding mistakes and offers suggestions on avoiding them. Several AAPC members were interviewed and quoted in the article as experts in the field, including Lynn Anderanin, CPC, CPC-I, COSC; Nancy Enos, CPC, CPMA, CPC-I, CEMC; Raemarie Jimenez, CPC, CPMA, CPPM, CPC-I, CANPC, CRHC; Debra Seyfried, CPC; and Cynthia Stewart, CPC, CPC-H, CPMA, CPC-I.
The solutions offered include:
- Internal auditing
- Dedicating staff to following up on denials
- Verifying patients’ personal and insurance information
- Reviewing how to correctly use modifiers
- Teaching physicians what documentation is needed
- Learning the most recent code changes
Read the full article.
Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services (CMS), announced there will be no delay to implementation for ICD-10-CM and PCS, which is scheduled October 1, 2014. She then encouraged everyone in the industry to work diligently toward a successful transition.
Tavenner made the statement at the annual Health Information Management Systems Society (HIMSS) conference, a year after she announced a 90-day comment period to determine if and how long a delay would be. The comments at that time ranged from killing ICD-10 completely to making no change from the originally planned date of 2013. Ultimately, the implementation was postponed by a year. Many providers and payers are using the extra year to better prepare.
Several organizations hoped Tavenner might announce another postponement at the HIMSS gathering, and some still advocated shelving the code set, but it looks like implementation is a done deal.
March 21st, 2013
When submitting medical claims, not only do you need to get the codes right but you have to apply the right rules. AAPC’s Director of Product Development Raemarie Jimenez, CPC, CPMA, CPPM, CPC-I, CANPC, CRHC, recently published an article in Physicians Practice that reviewed how the rules vary between code book guidelines, payer preferences, and Medicare limitations.
“One of the biggest mistakes a practice can make is applying Medicare rules to all payers. This can cause improper reimbursement,” she says. “There are some procedures Medicare does not cover that private payers will and vice versa.”
Read the full article.
The Centers for Medicare & Medicaid Services (CMS) and many insurance payers are analyzing medical necessity of a one-day length of stay for inpatient admissions to hospitals versus observation. AAPC’s National Advisory Board Member Relations Officer Melody S. Irvine, CPC, CPMA , CEMC, CFPC, CPC-I, CCS-P, CMRS, recently published an article in Physicians Practice that explained the two sets of observation codes and how to make sure everyone is on the same page for billing to avoid revenue consequences for hospitals and physicians.
“I highly recommend auditing observation visits on a regular basis to prevent revenue consequences,” she says. “If the medical record documentation or the patient condition appears to fail to meet standardized admission criteria you could be a target for a RAC audit and could risk repayments to Medicare.”
Read the full article.
March 6th, 2013
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