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CMS says Codes are on the Move!
December 9th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS

Have you noticed your LCDs are missing something? CMS is moving codes out of LCDs and into Billing and Coding Articles. MACs began moving ICD-10-CM, CPT/HCPCS, Bill Type, and Revenue codes in January 2019, and will continue through January 2020. Therefore, if there is an LCD with its codes removed, you will find ...

Preview the PDGM Calculator for Home Health Today
December 4th, 2019 - Wyn Staheli, Director of Research

Until February 1, 2020, you can preview Find-A-Code's Patient-Driven Groupings Model (PDGM) home health payment calculator by going to https://www.findacode.com/tools/home-health/ .

Hypertension ICD-10-CM Code Reporting Table
November 25th, 2019 - Wyn Staheli, Director of Research

In ICD-10-CM, hypertension code options do not distinguish between malignant and benign or between controlled and uncontrolled. What is important for code selection is knowing if the hypertension is caused by or related to another condition. The following table shows some of these options.

New Medicare Home Health Care Payment Grouper — Are You Ready?
November 25th, 2019 - Wyn Staheli, Director of Research

In 2020, Medicare will begin using a new Patient-Driven Groupings Model (PDGM) for calculating Medicare payment for home health care services. This is probably the biggest change to affect home health care since 2000.

VA: How UCR Charges are Determined
November 20th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS

How does the VA determine charges billed to third party payers for Veterans with private health insurance? According to the VA. "38 C.F.R 17.101 stipulates the basic methodology by which VA bills third party insurance carriers. In order to generate a charge for medical services, VA establishes reasonable charges for five ...

Editors choice articles

VA: How UCR Charges are Determined
November 20th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS

Q/A: Q/A: How do I Code a Procedure for the Primary Insurance so the Secondary Can Get Billed?
November 19th, 2019 - Wyn Staheli, Director of Research

Question: How do you modify a code submitted to the primary insurance company to let them know it is not covered by them so you can bill to a secondary?

Documentation Tips
November 18th, 2019 - Christine Taxin

Documenting Medical NecessityTo receive reimbursement from medical insurers, you need to make a case that proves that dental surgery is necessary for the patient. To make your case, you need to explain your decision process in terms that a medical insurer can understand, using ICD-10 codes and CPT codes. These ...

HIPAA Final Rule Eliminates HPID and OEID
November 12th, 2019 - Wyn Staheli, Director of Research

Final rule eliminates the requirement for health plans to obtain a unique health plan identifier (HPID) and also eliminates the voluntary use of the other entity identifier (OEID). This change becomes effective December 27, 2019.

And Then There Were Fees...
November 11th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS

Find-A-Code offers fees and pricing for just about everything, this article will address two of some of the most common payment systems with CMS. (OPPS) -Outpatient Medicare Outpatient Prospective Payment System. (MPFS)- Medicare Physician Fee Schedule The Fees section on each code page is determined on the type of services...