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Latest articles

Medicare Improper Payment Report (2016)
September 1st, 2017 - Wyn Staheli

The Medicare Improper Payment Report for 2016 has been released by the OIG. Please note that the improper payment rate does not measure fraud. Rather, it estimates the payments that did not meet Medicare coverage, coding, and billing rules. The estimated Medicare FFS payment accuracy rate (claims...

Quality Measures for Chiropractic - 2017
August 29th, 2017 - Wyn Staheli

Performance Measurement Codes for Chiropractic: Although there are hundreds of Performance Measurement (PM) services and events, only two may be reported for chiropractors for the 2017 reporting year. Pain Assessment and Follow-Up 131 ENCOUNTER: 90791, 90792, 92002, 92004, 92012, 92014, 92507, 92508, 92526, 96116, 96118, 96150, 96151, 97161, 97162, 97163, 97164, 97165, 97166, 97167, ...

VA Patient-Centered Community Care and Veterans Choice Program: Worth it for Providers?
August 23rd, 2017 - Jared Staheli

As the opportunities for providers outside the VA system expand in order to meet demand, you may be interested in offering services to veterans and the VA, if you are not already. With overwhelming bipartisan support, the opportunities are not likely to abate, but are those opportunities worth it for ...

Transparency and Fees
August 15th, 2017 - Christine Taxin

More than any other industry, healthcare is almost notorious for its lack of price transparency. While patients generally know how much their copay will be and certainly how much their final bill turns out to be, few hospitals and practices publish the actual costs of their services prior to those ...

United HealthCare Ending Consultation Reimbursements: Effective October 1st, 2017
August 15th, 2017 - NAMAS

While Medicare discontinued payment allowance for consultation services (ranges 99241-99245 and 99251-99255) in January 2010, many commercial carriers have continued to cover these services. United Healthcare is now joining Medicare's opinion on consultation services. In the June 2017 edition of the United HealthCare Bulletin, United Healthcare has announced that effective October ...

Editors choice articles

Health Care Fraud - Don’t Do It!
July 31st, 2017 - Chris Woolstenhulme, CPC, CMRS

If you wonder if what you are doing is fraud, DON’T DO IT! The government takes this extremely serious. I don't need to tell you this. I have often been apprehensive about making a mistake and I wonder, will it be fraud? Will I spend time in jail for accidentally sending in a duplicate ...

Pre-op visits: True or False?
December 29th, 2015 - Codapedia Editor

Are the following statements true or false? • The PCP cannot be paid to do a pre-op assessment of a Medicare patient prior to surgery because of the new consult rules. • The surgeon can never be paid to do a pre-op visit if s/he is going to take the patient to surgery. • The...

Billing Incident to Services-Whose Number Should Be Used?
December 29th, 2015 - Seth Canterbury, CPC, ACS-EM

Should You Bill Incident to Services for a Medicare Patient Under The Number of the “Supervising Physician” or the “Ordering Physician”? This issue was first clarified in the preamble of the 11/1/01 Federal Register (available here on p. 23 of the file, p. 55267 of the...

Cloned E/M notes
December 29th, 2015 - Codapedia Editor

Have you ever read a physician office note and thought it was strangely familiar? Or, not just familiar but identical to another note? Well, Medicare contractors have noticed the same thing, and the Office of Inspector General has included this on their 2011 Work Plan. Medicare contractors have...

Cardiology Coding Unmasked - Part 2 Therapeutic Cardiology Procedures, CPT Codes (92980-92982; 92984; 92995-92996), Medical Necessity Issues (ICD-9-CM)
December 29th, 2015 - Nancy Maguire

92980 Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel 92981 Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; each additional...