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Latest articles

Healthcare Common Procedure Coding System (HCPCS)
August 13th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
There are three main code sets and Healthcare Common Procedure Coding System (HCPCS), is the third most common code set used. They are often called Level II codes and are used to report non-physician products supplies and procedures not found in CPT, such as ambulance services, DME, drugs, orthotics, supplies, ...
Q/A: I Billed 2 Units of L3020 and Claim was Denied. Why?
August 13th, 2019 - Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA
Question: We billed 2 units of L3020 but were denied for not using the right modifiers. What should we do? Answer: Rather than submitting two units of the L3020 to indicate that the patient one orthotic for each foot, you would need to use modifiers identifying left foot and right foot. Appropriate coding ...
Will Medicare Change Their Rules Regarding Coverage of Services Provided by a Chiropractor?
August 13th, 2019 - Wyn Staheli, Director of Research
Two separate pieces of legislation introduced in the House of Representatives (H.R. 2883 and H.R. 3654) have the potential to change some of Medicare’s policies regarding doctors of chiropractic. Find out what these two bills are all about and how they could affect Medicare policies.
The OIG Work Plan: What Is It and Why Should I Care?
August 9th, 2019 - Namas
The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ...
CMS Proposes to Reverse E/M Stance to Align with AMA Revisions
August 6th, 2019 - Wyn Staheli, Director of Research
On July 29, 2019, CMS released their proposed rule for the Medicare Physician Fee Schedule for 2020. Last year’s final rule “finalized the assignment of a single payment rate for levels 2 through 4 office/outpatient E/M visits beginning in CY 2021.” It also changed some of the documentation requirements (e.g., ...

Editors choice articles

Tips to Preventing Audits
July 23rd, 2019 - Christine Taxin
There is an ever-increasing number of dental claims that have come under scrutiny for fraud. One such payer, Aetna, is actively pursuing dental fraud by employing their special investigative units (SIUs) to identify and investigate providers who demonstrate unusual coding and billing practices. When payers identify the activities they deem ...
Act Now on CMS Proposal to Cover Acupuncture for Chronic Low Back Pain
July 17th, 2019 - Wyn Staheli, Director of Research
Now is the time to comment on a proposal to cover acupuncture for chronic low back pain. This comment period is the part of the HHS response to the opioid crisis. You only have until August 14th to officially comment.
Denial Management is Key to Profitability
July 15th, 2019 - Wyn Staheli, Director of Research
A recent article by Modern Medicine cited a report by Becker’s Hospital Review which stated that it costs approximately $118 per claim to resolve a claim denial. Granted, these were hospital claims, but the process is essentially the same for outpatient services. In fact, you could say it is...
5 Ways to Minimize HIPAA Liabilities
July 12th, 2019 - BC Advantage
Last year was historic for HIPAA enforcement. The HHS Office of Civil Rights collected a record $23.5 million in settlements and judgments against providers guilty of HIPAA violations. To avoid becoming part of that unwanted statistic, it’s important to pay extra close attention to five key areas of HIPAA vulnerability. Take ...
Helping Others Understand How to Apply Incident to Guidelines
July 5th, 2019 - Namas
Over the past few months, I have worked with different organizations that have been misinterpreting the "incident to" guidelines and, in return, have been billing for services rendered by staff that are not qualified to perform the services per AMA and CPT. What I found within the variances is that ...

Latest questions/posts

Code for physical activity counseling
1st    Aug 9th, 2019 - Corley

CPT 29799
   Jul 30th, 2019 - RedKat  

Physician ESRD Capitation Billing
   Jul 11th, 2019 - anitac

CPT 99441
   Jul 9th, 2019 - abbyakinleye 9 

UNNA boot application
1st    Jul 3rd, 2019 - cmarsh

CPT Code for Repositioning of endothelial keratoplasty
   Jun 12th, 2019 - yml3768 31 

CPT for Long Term Acute Care Hospital
1st    Jun 11th, 2019 - nwettach

   Jun 10th, 2019 - AMat    2 

UnitedHealthcare to Discontinue Coverage of Consultations
   May 28th, 2019 - msimmons11   

MDM in Table B
   May 17th, 2019 - damills    3 

Level 3 & Level 4 Hospital Consults
   May 15th, 2019 - nate0922 7 

Bone Stimulator Billable Amount
1st    May 8th, 2019 - pattybth

Podiatry - CPT codes 99222 & 99223
   May 1st, 2019 - daystarjj 4 

Coding for respiratory tract infections and other conditions during pregnancy
1st    Apr 25th, 2019 - Paramesh

Medicare Annual Wellness Visit in the Nursing Home Setting
1st    Apr 22nd, 2019 - staracres

96372 Billing
   Apr 18th, 2019 - dlstoner512 1 

Appropriate Modifier for 83615 @ 2 Units for CMS?
1st    Apr 11th, 2019 - RNokes

43249 with 43236
   Apr 2nd, 2019 - AMat    2 

Synagis Injection
   Mar 28th, 2019 - Hgorby

nurse practitioner/hospital charges
   Mar 19th, 2019 - anitac


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