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Latest articles

Things to Consider Before Upgrading Medical Billing Software
August 11th, 2022 - Find-A-Code
Your practice has utilized the same medical billing software for years. The medical billing staff says it is time for a change. You don't necessarily disagree, but you also don't know where to begin your search for new software. There are so many vendors offering so many products that making sense of it all can be challenging.
Calendar Year 2023 Medicare Advantage and Part C & D Payment Policies
August 9th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Each year CMS publishes an Advance Notice of the upcoming years Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies and asks for comments related to it. Each of the comments are carefully reviewed and responded to and often are impactful to changes seen between the Advance Notice and final publication referred to as the Rate Announcement. With health equity as a primary focus for 2023, CMS announced some policy changes that may impact your organization.
How CMS Determines Which Telehealth Services are Risk Adjustable
August 9th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Medicare Advantage Organizations (MAOs) have gone back and forth on whether or not to use data collected from telehealth, virtual Care, and telephone (audio-only) encounters with Medicare beneficiaries for risk adjustment reporting, but the following published documents from CMS cleared that up once and for all by providing an answer to a question specifically related to this question.
OIG Investigates SCAN Health for Risk Adjustment Overpayments With Surprising Results
July 26th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
We’ve seen a number of OIG risk adjustment data validation (RADV) audits recently where the independent review contractor was simply looking for any codes the payer reported that were not supported by the documentation, in an effort to declare an overpayment was made and monies are due to be repaid. However, it was refreshing to read this RADV audit and discover that the independent review contractor actually identified HCCs the payer failed to report that, while still resulting in an overpayment, was able to reduce the overpayment by giving credit for these additional HCCs. What lessons are you learning from reading these RADV audit reports?
Addressing Trauma and Mass Violence
July 21st, 2022 - Amanda Ballif
After events of mass violence, it’s easy to feel helpless, like there is little we can do. In fact, we can help individuals, families, and communities build resilience and connect with others to cope together. The SAMHSA-funded National Child Traumatic Stress Network has developed a range of resources to help children, families, educators, and communities including the following which you can access via links in this article.

Editors choice articles

PCS Coding for Ankle Fracture - Look Deeper Into the Codes!
May 25th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Coding Lesions and Soft Tissue Excisions
April 29th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
COVID-19 Vaccines
March 10th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Not Following the Rules Costs Chiropractor $5 Million
September 1st, 2020 - Wyn Staheli, Director of Research
Is COVID-19 Causing Risk Adjustment “Gotcha’s”?
August 27th, 2020 - Wyn Staheli, Director of Research

Latest questions/posts

Penile Adhesions
1st    Aug 2nd, 2022 - Aimie

Icd 10 code
   Jul 26th, 2022 - Endocenter 3 

2008 Diagnosis Code?
1st    Jun 27th, 2022 - ArtMonk1981

43264 and 43275
   Jun 27th, 2022 - Endocenter 3 

Claims issues
   Jun 16th, 2022 - billing81 1 

Cerner/Soarian User Manual?
1st    Jun 14th, 2022 - GinaV

Medicare Colonoscopy
   May 31st, 2022 - Endocenter 3 

Medial Nerve Block L3,L4 and L5
   May 27th, 2022 - sharris

billing amounts
   May 22nd, 2022 - nia 4 

Ccm billing
   May 22nd, 2022 - nia 4 

TCM billing
   May 15th, 2022 - nia 4 

Ccm billing
   May 12th, 2022 - nia 4 

Ccm billing
   Apr 26th, 2022 - nia 4 

Ccm billing
   Apr 25th, 2022 - nia 4 

TCM readmissions
1st    Apr 23rd, 2022 - Ellen M 1 

Ccm billing
   Apr 17th, 2022 - nia 4 

Billing/Claims for 4 providers
1st    Apr 14th, 2022 - billing81 1 

Claim Billing question
1st    Apr 6th, 2022 - Nettie1113

Ercp codes
   Mar 16th, 2022 - Endocenter 3 

maximum limit on units claimed
1st    Mar 8th, 2022 - nia 4 

Anesthesia for Colonoscopy/ EGD
   Feb 24th, 2022 - Endocenter 3 

Emergency department 99282 what is included
1st    Feb 18th, 2022 - MFC

   Feb 18th, 2022 - surgicalcoder65 2 

Can someone tell me what the cpt code is for Bilateral segmental tubal excision and ligation by endoscopy?
1st    Feb 15th, 2022 - CCShaw

1st    Jan 14th, 2022 - yd

Parastomal Hernia Repair w/Colostomy Closure
1st    Jan 10th, 2022 - KHill 1 

Bowel wall thickening
   Jan 10th, 2022 - Endocenter 3 

Drainage Catheter Flush
   Dec 30th, 2021 - surgicalcoder65 2 

Portal Hypertensive Gastro-duoenopathy?
1st    Dec 27th, 2021 - Endocenter 3 

Completion Thyroidectomy or Lobectomy
1st    Dec 14th, 2021 - surgicalcoder65 2 


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