Practice Management - Articles

Is the End Really Near?
February 7th, 2023 - Chris Woolstenhulme
What happens once the COVID-19 emergency declarations have ended?
Why Medical Billing Codes Are Critical To Healthcare Delivery
January 30th, 2023 - Find-A-Code
Medical coders play a critical role in determining how healthcare delivery is reported for record keeping and billing purposes. Likewise, the codes they know so well are equally critical. They have been around for decades. They were originally developed and implemented to make reporting and billing easier in a healthcare system that was becoming incredibly more complex. The system is even more complex today.
Medical Bill Denials: How Much Are Clinicians Really Owed?
January 27th, 2023 - Find-A-Code
Imagine owning an auto body repair shop. You and your staff produce millions of dollars of work every year. But then, an end-of-the-year accounting reveals you are only getting 80 cents on the dollar from car insurance companies. How would you feel about that? It turns out that this is exactly what might be happening to individual doctors and independent group practices.
Relative Value Units (RVUs) the Easy Way, Really?
January 26th, 2023 - Chris Woolstenhulme
The Medicare Physician fee schedule was implemented in 1992 using a relative Value scale methodology called RVUs to base payment rates on the resources used to perform the service. This is currently how the Medicare Physician Fee Schedule (MPFS) is set. But beware, there may be an industry-wide change to a Value-Based Payment. We will save that for another time; this article will focus on how the RVUs are calculated and Medicare Fee schedules.
Certification Makes A Difference To Medical Coders And Billers
January 20th, 2023 - Find-A-Code
It is possible to be certified as either a medical coder or biller. Another option is to become a certified health information technician with dual certifications in both billing and coding. Going the health information technician route gives a person greater access to more job opportunities.
5 Medical Billing Trends to Watch in 2023
January 20th, 2023 - Find-A-Code
No doubt the medical billing industry is changing at breakneck speed. As a medical billing specialist in 2023, you will need to keep up with emerging trends if you want to stay in the game. What should you be paying attention to in the coming year? Check out these five possibilities...
Outsourced Medical Billing: What's Driving the Recent Trend?
January 18th, 2023 - Find-A-Code
Medical billing in the U.S. has historically been kept in-house for the most part. Hospitals, private practices, etc. have hired their own medical coders and billers, preferring to maintain tight control over the process. But things are changing, and they are changing in a big way. Outsourcing is the latest trend.

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The Top 4 Reasons Providers Might Outsource Medical Billing To You
November 15th, 2022 - Find-A-Code
Many healthcare providers still try to handle medical billing in-house. When they finally abandon such efforts and start looking for an outsourcing partner, they are hoping to find an organization that can take medical billing off their hands. But they also want an organization that can do it efficiently, cost-effectively, and in full compliance with the law.
Taking On New Clients Leaving Their Current Billing Providers
November 10th, 2022 - Find-A-Code
Many newly certified medical billing specialists are preoccupied by things like diagnostic code lookup and HIPAA compliance. But for those looking to start their own medical billing services, rather than being employed by someone else, there is also the prospect of taking on new clients. Things can get messy.
How Practices Can Increase Medical Billing Efficiency
November 2nd, 2022 - Find-A-Code
Billing is part of running a medical practice. Whether a practice operates independently or as part of a larger group, no one gets paid if billing doesn't occur. The key to doing it right is efficiency.
5 Things Capable of Slowing Down Medical Reimbursements
October 31st, 2022 - Find-A-Code
The U.S. healthcare system relies on a somewhat complex billing and payment system. The system is designed to bridge the gap between patients, providers, and payers. When everything works as it should, reimbursements from payers to providers flow freely. But if just one thing goes wrong, reimbursements can be delayed.
Do You Know The Difference Between NPI and PTAN Numbers
October 24th, 2022 - Find-A-Code
Medicare covers just over 18% of the U.S. population. In 2021 alone, Medicare spent nearly $840 billion covering subscriber medical bills. With that much money going back and forth, fraud is always a concern. Enter National Provider Identifier (NPI) and Provider Transaction Access (PTAN) numbers.
Yes, You Have What It Takes To Lead Your Practice And Your Profession
September 20th, 2022 - Kem Tolliver
If you’ve been in any healthcare role for more than two years, you’ve seen quite a bit of change. And guess what, it’s not over. We are living and working in uncertain times. This climate requires each of us to step outside of our comfort zones to lead exactly where we stand. It’s not required of one to have a “title” to lead. What is required, however, is a willingness to trust your instincts, look for answers and rely on your team.
Are You Prepared to Avoid Repayments
September 8th, 2022 - Raquel Shumway
Watchful care is needed when submitting claims. The Office of the Inspector General (OIG), after completing an audit on a Medicare Advantage Plan in August 2022, is now demanding repayment of claims to the tune of $3,518,465. Although the payer is contesting that amount, it is possible that they may begin demanding repayments from the providers to cover their costs of repayment.
Washington Continuing To Flex Muscles Via Right Of Access
September 7th, 2022 - Find-A-Code
Though medical billing codes are the main focus here, all of us in the medical billing industry need to be cognizant of HIPAA compliance. In light of that, it is important that medical billers, coding specialists, and the clinicians they work for pay attention to the Right of Access Initiative (RAI). Washington continues to flex its muscles in its enforcement of the initiative.
Navigating Medical Billing's Training vs. Experience Conundrum
September 5th, 2022 - Find-A-Code
Imagine the following scenario: a young person goes to school to earn certification as a medical coder or billing specialist. Upon completion, every job the recent graduate applies for requires experience. But how is this person supposed to get experience without landing that first job? It is a conundrum faced by certificate holders around the country.
Medical Coding And Billing Not The Same Thing
September 3rd, 2022 - Find-A-Code
Medical coding and billing are two careers that relate to translating patient medical data into bills that are ultimately submitted to insurance companies for payment. The two careers overlap to a certain degree, but they are distinctly separate entities. Simply put, medical coding and billing are not the same thing.
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.
Is It Possible to Start an Independent Medical Coding Business?
August 8th, 2022 - Find-A-Code
What is being hailed as the Great Resignation is leading a whole bunch of people to start their own businesses. Some are tired of the rat race and want to work from home. Others just want to be their own bosses. There are plenty of opportunities for starting something of your own, including medical coding and billing.
Billing and Coding: Bone Mass Measurement
August 4th, 2022 - Amanda Ballif
Guidance for billing, coding, and other guidelines in relation to local coverage policy L36460-Bone Mass Measurement.
Mid-Year Coding Updates and A Quick Look at ICD-10-CM Changes
August 4th, 2022 - Aimee Wilcox
Mid-year HCPCS and Category III codes have been released for reporting purposes and at the same time we are being inundated with a large number of ICD-10-CM code changes. What are Category III codes and what changes were made in these coding updates? Read this article and sign up for the upcoming webinar when we will discuss the newest code changes, including an overview of what ICD-10-CM changes will look like.
Cybersecurity & Ransomware Warnings
March 10th, 2022 - Wyn Staheli, Director of Content
Although HIPAA Security protocols have been in effect for some time, as technology advances, if we are not diligent, gaps can be left available for intruders. On top of that, on February 23, 2022, the American Hospital Association issued a cybersecurity advisory. They stated, “there is concern that Russia may retaliate against the U.S. and allied nations with disruptive cyberattacks.”
Cross-A-Code Instructions in Find-A-Code
November 18th, 2020 - Raquel Shumway
Cross-A-Codeis a toll found in Find-A-Code which helps you to locate codes in other code sets that help you when submitting a claim.
How to Search Find-A-Code for Medicare Policies and Guidelines — LCDs, NCDs and Articles —
November 18th, 2020 - Raquel Shumway
Help for Searching Find-A-Code when searching for Medicare Policies and Guidelines — LCDs, NCDs and/or Articles.
Payment Adjustment Rules for Multiple Procedures and CCI Edits
July 9th, 2020 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Surgical and medical services often include work that is required to be done prior to a procedure and post-procedure. When there are multiple procedures done by the same physician, group, or another qualified healthcare professional on the same day, the pre and post work is only required once. Therefore, CMS ...
New ABN Form is Here
July 7th, 2020 - Wyn Staheli, Director of Research
The anticipated changes to the Advanced Beneficiary Notice of Non-coverage (ABN) Form (CMS-R-131) have arrived. This important form is issued to the patient or client by providers, physicians, practitioners, and suppliers in situations where Medicare payment is expected to be denied. You can begin using the new ABN immediately if you so wish. However, it becomes mandatory on August 31, 2020.
Understanding UCR Inpatient Fees used on DRG's
July 1st, 2020 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Find-A-Code uses Usual, Customary, and Reasonable (UCR) fees to help determine the amount paid for a medical service based on a certain geographic area. This article will address the information and pricing for Hospital and Inpatient fees based on Diagnosis Related Groups (DRGs). The UCR fees and...
Getting Your Practice Back on Track
May 12th, 2020 - Wyn Staheli, Director of Research
As we begin returning back to work, we will all face a new normal. The COVID-19 pandemic has changed the face of business. While it has certainly been a challenge to keep up with the ever-changing regulations (that’s likely to continue for a little longer), exciting new opportunities have also been created, such as the expansion of telemedicine. There’s also the maze of government funding that needs to be navigated and an increased awareness of OSHA standards to implement.
Financial Impact of CARES Act on Healthcare Providers
April 13th, 2020 - Wyn Staheli, Director of Research
The recently enacted Coronavirus Aid, Relief, and Economic Security (CARES) Act has several provisions to ease the financial burden being faced by healthcare providers who have been impacted by the effect of the coronavirus. Learn more about how the Provider Relief Fund and the Accelerated and Advance Payment Program work.
Why is HIPAA So Important?
October 11th, 2019 - Namas
Why is HIPAA So Important? Some may think that what they do to protect patient information may be a bit extreme. Others in specialty medical fields and research understand its importance a little more. Most of that importance lies in the information being protected. Every patient has a unique set of ...
Medical ID Theft
August 16th, 2019 - Namas
Medical ID Theft "So, do you guys think you can do something with that?" John asked angrily at our first meeting with him in August 2017 as he slammed a stack of medical bills, EOBs and collection letters - three inches high - down in front of my partner and I. ...
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 ...
The Role of Chiropractic in Value Based Payment Systems
July 29th, 2019 - Wyn Staheli, Director of Research
Chiropractic care can play a valuable role in overall patient health. It is important to realize that chiropractors can effectively participate in Medicare's new value based payment systems. Read about one organization who has made this transition.
Are These Problems Hurting Your Practice?
July 22nd, 2019 - Wyn Staheli, Director of Research
There are many things that can be missed when trying to run an effective and profitable practice. This article covers some important tasks that are often overlooked such as not reviewing your payer contracts or failing to check eligibility.
Small Breaches Can Be Subject to Large Penalties
June 21st, 2019 - Namas
Small Breaches Can Be Subject to Large Penalties We may have heard about the large fines issued by the Office for Civil Rights (OCR) against big organizations like Anthem or the University of Texas MD Anderson Cancer Center. These organizations have been in the news due to privacy breaches that constituted violations ...
Q/A: Two Payers Both Paid the Claim. Who Gets the Refund?
May 13th, 2019 - Wyn Staheli, Director of Research
Question We have a personal injury situation where we submitted a claim was sent to the patient's auto policy carrier who refused payment. We then submitted it to her other insurance. Eventually, both companies paid her claims. Her auto paid at full value, and her secondary paid at a reduced rate ...
Prioritize Your Patient's Financial Experience
May 13th, 2019 - Wyn Staheli, Director of Research
For many years, the ChiroCode DeskBook has emphasized the need for providers to firmly establish the patient’s financial responsibility through clear communication. We even created a “Patient Financial Responsibility Acknowledgment Form” to help providers with this process. Lately, the lack of pricing transparency has been in the news and even ...
Auditing Chiropractic Services
April 22nd, 2019 - By Evan M. Gwilliam, DC MBA BS CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow Clinical Director, PayDC Chiropractic EHR Software President, Gwilliam Consulting LLC
Chiropractic is unique from other types of health care and auditors need to be aware of the nuances of this field. Chiropractic has become the focus of more and more audits as doctors seem to struggle to create records that properly support the care provided to the patient throughout the entire episode.
Watch out for People-Related ‘Gotchas’
April 15th, 2019 - Wyn Staheli, Director of Research
In Chapter 3 — Compliance of the ChiroCode DeskBook, we warn about the dangers of disgruntled people (pages 172-173). Even if we think that we are a wonderful healthcare provider and office, there are those individuals who can and will create problems. As frustrating as it may be, there are ...
Q/A: What's the Difference Between Q5 and Q6 for a Substitute Provider?
February 22nd, 2019 - Wyn Staheli, Director of Research
It is important to understand that modifiers Q5 and Q6 are not interchangeable. So when do you use each of them?
Understanding NCCI Edits
February 20th, 2019 - Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT
Medicare creates and maintains the National Correct Coding Initiative (NCCI) edits and NCCI Policy Manual, which identify code pair edits. When performed on the same patient, on the same day, and by the same provider, the secondary code is considered an integral part of the primary code, and payment for ...
Attestations Teaching Physicians vs Split Shared Visits
February 1st, 2019 - BC Advantage
Physicians often use the term "attestation" to refer to any kind of statement they insert into a progress note for an encounter involving work by a resident, non-physician practitioner (NPP), or scribe. However, for compliance and documentation purposes, "attestation" has a specific meaning and there are distinct requirements for what ...
Quality Measures Finalized for 2019
December 18th, 2018 - Wyn Staheli, Director of Research
CMS recently announced that the quality measures for 2019 have been finalized. There are new eligible clinicians so be aware of how that may affect your organization. New ECs are: Physical therapists Occupational therapists Qualified speech-language pathologists Qualified audiologists Clinical psychologists Registered dietitian or nutrition professionals The following are changes to Electronic Clinical Quality Measures (eCQMs) available ...
Auditing looking between the lines
November 30th, 2018 - BC Advantage
When given the task of auditing a group of charts, most often the scope of the audit is well defined. For me, there are times when my natural inquisitive nature turns on and I find my noticing the "timing" of parts of documentation. These are things that you would not...
We've Always Done It This Way and Other Challenges in Education
October 19th, 2018 - BC Advantage
As coders, auditors, and compliance professionals, we are the provider's advocates in closing the gap between what is medically necessary and what is required for documentation. Sometimes that places us in the role where we need to save our clinicians from themselves, and the patterns they have fallen into...
Wolters Kluwer Drug Pricing
October 17th, 2018 - Find-A-Code
Wolters Kluwer provides unit and package pricing for multiple drug price types: Average Wholesale Price (AWP), Wholesale Acquisition Cost (WAC), Direct Price (DP), Manufacturer's Suggested Wholesale Price (SWP), Centers for Medicare & Medicaid Services, Federal Upper Limit (CMS FUL), Average Average Wholesale Price (AAWP), Generic Equivalent Average Price (GEAP). Average...
HIPAA Handling Patient Requests for Medical Record Restriction
September 26th, 2018 - BC Advantage
Healthcare compliance professionals frequently face confusing situations about sharing of protected health information (PHI). The Health Insurance Portability and Accountability Act (HIPAA) supports the protection of privacy of medical records. However, even when a patient does not authorize sharing of his record, there are permitted uses and disclosures, such as...
Q/A: Do I Have to Accept Any New Patient?
September 24th, 2018 - Wyn Staheli, Director of Research
Question: Is it legal for us to not allow a patient to be seen in our office if their parents have bad debt with us?
Getting the Right Eligibility Information for Payment Your Rights and Health Plans Requirement
September 11th, 2018 - BC Advantage
We need timely and accurate patient information to bill health plans and receive appropriate payment. Clinical information is, of course, important. But we also need the "administrative" data - patient demographics and especially the insurance information. Physician offices create their clinical information, but usually rely on patients for information on...
Finalized Confidentiality of Alcohol and Drug Abuse Patient Records Regulations
August 31st, 2018 - Wyn Staheli, Director of Research
In January, the U.S. Department of Health and Human Services (HHS) issued updates to the privacy regulations regarding the confidentiality of patient information of substance use disorder patients (42 CFR Part 2).  This notice included references to better alignment with HIPAA regulations, but did state that Part 2 is more protective ...
Pricing for ASC’s and APC’s
August 27th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
For Medicare purposes, an Ambulatory Surgical Center Resources (ASC) is a distinct entity that operates exclusively to furnish surgical services to patients who do not require hospitalization and in which the expected duration of services does not exceed 24 hours following admission. ASC payment groups determine the amount that...
PSAVE Pilot Program - What Does it Mean to You?
August 20th, 2018 - Wyn Staheli, Director of Research
Noridian's pilot program Provider Self-Audit with Validation and Extrapolation (PSAVE) has been extended which means that it has been successful for the payer, which means that they are saving money. Historically, when a pilot program is proven to be successful, it isn’t too long before other MACs follow. Before signing up to participate, providers need to carefully evaluate the program. Are the benefits worth the costs?
Are incident to services worth the risk
August 13th, 2018 - BC Advantage
Incident-to services allow non-physician practitioners (NPPs) such as nurse practitioners and physician assistants to bill under a supervising physician if they perform services that are incidental to a physician-created plan of care. Incident-to billing offers two key benefits: First, the physician is reimbursed at 100% of the contracted rate with...
Risky Business The CMS HCC Risk Model
July 27th, 2018 - Terry Ketchersid, MD, MBA
Today's catchy title may invoke memories of that risqué movie from the 80's starring a young Tom Cruise famously dancing in his "tighty whities." But today's post is not about that type of risk. Instead we are going to spend some time with a risk adjustment model that's quietly become...
Patients Over Paperwork?! We have Great News!
July 18th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Spend more time with patients and less time documenting? Great Concept! Document meaningful information? Sound good? CMS is proposing just that! CMS released a new proposal July 12, 2018, focused on streamlining clinician billing and expanding access to high-quality care. The goal is to improve and restore the doctor-patient relationship, modernize Medicare ...
Documentation: Face to Face for Home Health Certification
July 9th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
As a physician, you are responsible for providing appropriate, accurate supporting documentation of your face-to-face encounters (FTF) with your patients regarding home health care. Analysis of the recent errors identified by the Comprehensive Error Rate Testing (CERT) Review Contractor shows a continuing increase in denials related to documentation for the FTF. The ...
The Money in MIPS
June 15th, 2018 - Diana Strubler
Seema Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS), recently announced that 91% participated in the first year of the Quality Payment Program (QPP), barely squeaking by their goal of 90%....
Will Medicare's Proposed Reformations Affect Your Practice?
June 12th, 2018 - Wyn Staheli, Director of Research
Recently, Medicare's Innovation Center released an informal Request for Information (RFI) seeking input on several different system reformation proposals. As the market moves towards more value based payment systems, innovation and new models are being sought to both reduce costs and increase quality. This article outlines the ideas presented in the ...
Three Ways Bundled Payments Can Be a Success
June 7th, 2018 - BC Advantage
Bundled payment models continue to attract interest for their potential benefits over traditional fee-for-service payment models. With bundled payments, also known as episode-based payments or packaged pricing, a group of providers is reimbursed based on a contracted price to cover all of the care and services related to a particular ...
Q/A: Someone Broke into My Office. What do I do Now?
April 23rd, 2018 - Wyn Staheli, Director of Research
My office was broken into last night. I use electronic health records, but we do store some protected health information for my patients in paper files. These files are not secured, so the burglars did have access to them. It did not appear that the files were touched as the burglars were looking for cash. What responsibilities to I have to my patients in a situation like this? Do I need to contact them and advise them that their PHI could have been compromised?
Proper Record Keeping and Documentation
April 19th, 2018 - Christine Taxin
Proper record keeping and documentation is not only essential for today’s dental practitioner, but is also required by law. Moreover, correct, current and accurate records directly enhance patient care by enabling the dentist to plan treatments, monitor progress, and provide essential notations. Clear and concise treatment plans, medical alerts, and ...
Don’t Be Hesitant About Collecting Co-Pays
February 1st, 2018 - Christine Taxin
If you are hesitant about collecting co-pays, consider that you may be paying interest on credit cards, property mortgages, and business loans. Each dollar that you do not collect in co-pays could have been used to pay down the practice debt. Without question, if you are having difficulty finding ways ...
Are Your Computers Vulnerable to Cyber Attacks?
February 1st, 2018 - Wyn Staheli, Director of Research
Healthcare providers must be vigilant in ensuring that software upgrades, also known as patches, are kept current. Failure to do so can lead to a HIPAA Security Breach with all its associated penalties. For example Windows XP no longer has security updates and should not be used in healthcare settings. On ...
Mobile Health: Growing Engagement and New Responsibilities
January 31st, 2018 - Dugan Maddux, MD, FACP
This week I'm blogging about an M-word. Not MACRA or MIPS, but Mobile Health or mHealth....
Developing Coding Policies for Compliance
January 31st, 2018 - Marge McQuade, CMSCS, CHCI, CPOM
Every physician practice depends upon correct coding and billing for their financial success. Coding drives reimbursement. All of the resources available for coding information and guidance are meaningless without the practice manager translating it into provider-specific coding policies and compliance plan. As a practice manager, you need to develop a ...
Prescription Drug Discount Program
January 25th, 2018 - Wyn Staheli, Director of Research
Prescription drugs can be quite costly for those who are uninsured or underinsured. Prohibitive costs have been shown to lead to poor patient outcomes because medications are not taken as prescribed. Medicare has taken steps to address this problem with their Medicare Advantage value based plans (see referenced "Medicare Expands Value ...
Better Office Communication Leads to Stronger RCM
January 24th, 2018 - Ashley Choate
According to a recent Physicians Practice study, one of the top five reasons for denied medical claims is a lack of adequate documentation. While this might seem like an electronic records issue, the problem may be bigger than that. ...
Advance Beneficiary Notice of Noncoverage (ABN) Modifier Guidelines
January 11th, 2018 - Find-A-Code
The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131 may be used for services which are likely to be non-covered, whether for medical necessity or for other reasons. Refer to CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30, for complete instructions.Effective from April 1, 2010, non-covered services should be billed with modifier GA, GX, GY, or GZ, as ...
Diagnosis Coding with Diagnostic Testing
January 4th, 2018 - Marge McQuade, CMSCS, CHCI, CPOM
Adequate documentation is an essential part of selecting a correct code in any setting. When providers order a test, the information that they document regarding the test results determines the primary and secondary diagnosis codes a coder assigns. If a physician confirms a diagnosis based on the results of a diagnostic ...
Does an Informed Consent Really Matter?
November 27th, 2017 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Yes, it does matter! A lack of informed consent could possibly be considered any of the following, misconduct, crime, medical malpractice, negligence or battery. The concept of using an informed consent began around 1972, in 1992; the U.S. Supreme Court ruled that informed consent laws are...
The Importance of Attitude and Continuing Education
November 10th, 2017 - Betty Stump, MHIA, RHIT, CPC, CCS-P, CPMA, CDIP
Coders, auditors, even physicians, and other healthcare professionals recognize their career paths will require ongoing education......
Physicians Reciprocal Billing Arrangements
October 18th, 2017 - Chris Woolstenhulme, CPC, CMRS
A reciprocal billing arrangement is when there is an agreement between physicians to cover each others practice. A physician or his practice may set up reciprocal billing arrangements with one or more physicians to cover another practice or their own practice. There is certain criteria that must...
Stark Law for Healthcare Providers
September 29th, 2017 - Brandy Brimhall
Be aware of physician self-referral laws and how they affect your practice.
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, ...
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 ...
Password Tips
July 31st, 2017 - Wyn Staheli
How secure are your passwords? What is your organization doing to protect itself from unauthorized access?
Wanna Cry?
June 30th, 2017 - Ann Bachman, BS MT(ASCP), CLC(AMT)
The WannaCry (short for WannaCrypt) ransomware* attack experienced worldwide in mid-May 2017 affected some 300,000 computers running Microsoft Windows operating systems in more than 150 countries. It affected healthcare institutions, communications providers, gas stations, and banks. The attack began on Friday, May 12, 2017, encrypting data and demanding ransom payments in ...
Treating Diabetic Patients in Your Office?
June 30th, 2017 - Shannon DeConda
CMS will be rolling out an Expanded Diabetes Prevention Plan January 1, 2018 as well as new Durable Medical Equipment (DME) supply codes for Continuous Glucose Monitors (CGM) July 1, 2017. These services will offer your practice the opportunity to better assist your diabetic patient's needs. Remember that prior to providing ...
The Difference Between Leadership and Management
June 30th, 2017 - Kelly Ogle, BSDH, MIOP, CMPM, CHOP
"The best leader is the one who has sense enough to pick good men to do what he wants done, and the self-restraint to keep from meddling with them while they do it." -Theodore Roosevelt When a person wants to secure a topnotch position in their company, are they willing to ...
Profit Depends on Efficiency
June 29th, 2017 - NAMAS
To us, the most fascinating thing about process improvement within a medical practice is how it has a clear clinical counterpart: differential diagnoses. In a typical scenario, a patient presents with a chief complaint ("I don't feel well"), and it's the provider's job to figure out just what is wrong ...
NAMAS Announced New Auditing Credential!
June 29th, 2017 - Shannon DeConda, CPC, CPC-I, CEMC, CMSCS, CPMA
At NAMAS, we strive to be the industry expert in auditing and compliance education. Each year, we carefully select our weekly webinar topics, annual conference sessions, and speakers to provide you with the type of training and education you need to succeed in your role. We are excited to share ...
CMS Overpaid Providers $729 Million in Incentive Payments
June 16th, 2017 - Chris Woolstenhulme, CPC, CMRS
Medicare paid hundreds of millions in electronic health record incentive payments that did not comply with federal requirements according to the OIG.  The OIG estimated CMS inappropriately paid $729,424,395 to EPs who did not meet the requirements for meaningful use. Eligible professional’s (EP’s) are physicians, dentists, podiatrists, optometrists or chiropractors, if ...
Negotiating Free Rent – For Medical Professional Tenants
June 15th, 2017 - Jeff Grandfield and Dale Willerton – The Lease Coach
Free rent is just one negotiable factor in a commercial lease. To be clear, free rent is a period of time where you are not paying the Base or Minimum Rent (but are, typically, paying your Operating Costs) and you are open for business. Many medical professional tenants confuse this ...
Bulk Risk Scores
May 25th, 2017 - Chris Woolstenhulme, CPC, CMRS
Do you need help with cases and calculating groups of Risk Scores? Per customers request, Find-A-Code now offers BULK entry for calculating for Risk Scores.  The HCC Risk tool offers two options for calculating risk scores, we now offer a BULK calculation for cases or the calculation for a single enrollee. To use the BULK calculation for cases Create ...
Risk Adjustment Calculator
May 25th, 2017 - Chris Woolstenhulme, CPC, CMRS
Risk Adjustments are used to access an illness or severity and comparing classifications of diseases using diagnosis codes. Find-A-Code gives you the ability to search for risk codes used for calculations on an individual code or calculator for a group of codes to quickly calculate a risk score. Keep in mind prior ...
Less Efficiency with New Employee - What to do?
March 29th, 2017 - Brandy Brimhall
Q:  I have recently hired a new staff person.  We have conducted training and I feel like she is a great addition to my practice.  However, a couple of the basic job duties and required procedures we have in place aren't being done as efficiently as they had been with ...
Requirements for Physicians Orders for DME/HCPCS
March 2nd, 2017 - Chris Woolstenhulme, CPC, CMRS
Effective July 1, 2013, certain DME/HCPCS codes require a valid detailed written order prior to delivery. There are very specific rules and requirements requiring medical necessity and orders/prescriptions. It is also required to keep a copy in the patients chart. If billing CMS and commercial payers payers, the DME prescribed ...
Using Modifier EY
March 2nd, 2017 - Chris Woolstenhulme, CPC, CMRS
Some Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items require a detailed Written Order Prior to Dispensing (WOPD), while others require a Detailed Written Order (DWO) prior to billing. The specific requirements for an order are specified in the Medical Policy (Local Coverage Determination and/or Policy Article) for the ...
Using Time Span Codes
February 24th, 2017 - Find-A-Code
The date of service (DOS) is the reference point for determining the frequency of code submission and subsequent reimbursement during that period, generally if the service was provided in a different calendar month, the service would qualify for reimbursement. Modifiers will not override a time span code if it is billed with ...
Telehealth Growth Continues
February 23rd, 2017 - Wyn Staheli
Telehealth is proving to be the wave of the future as the number of practices offering these services continues to grow. An online poll by Medical Economics asked those who visited their site about the implementation of telehealth services implemented by their individual practices this year. As of February 2, 2017, the results were significant: 30% ...
Care Plan Oversight Services
February 23rd, 2017 - Chris Woolstenhulme, CPC, CMRS
Care Plan oversight services is commonly done but rarely billed. The following codes can only be billed once every 30 days. The use of the following codes are determined by the complexity and approximate time spent by the physician or other health care professional within a 30-day period. G0179 MD re-certification HHA ...
DOJ Announces $4.7 Billion in False Claims Act Recoveries: But What Does That Really Mean?
December 30th, 2016 - Paul Weidenfeld
The Department of Justice (DOJ) recently announced that it had recovered $4.7 billion in False Claims settlements and judgments making it the "third best year" in "False Claims Act History." Trumpeted by many as a return to DOJ's record setting years, an examination of the numbers over time reveals that ...
December 20th, 2016 - Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP
This handy FAQ addresses the uses and mis-uses of the ABN form.
Know how you can leverage your practice performance with 6 revenue cycle metrics
December 20th, 2016 - Ango Mark
Are you one of those busy physicians who pay just a cursory glance at monthly collections? Then you should be prepared to lose revenue every single day like this obgyn practice in southeast Georgia. It is essential for medical practices to track financial performance metrics, as every dollar that...
December 19th, 2016 - Wyn Staheli, Director of Research
Benchmarking is simply a standard or point of reference against which things may be compared or assessed. For all businesses, it is a way of comparing your business processes to another business in the same industry to determine where shortfalls exist or improvements can be made to maintain profitability.
Shift Your Focus: The New Generation of Dental Billing
October 3rd, 2016 - Christine Taxin
More and more information emerges each day about the connection between certain serious medical conditions and poor oral health. Consider these headlines found in a recent dental journal: “Periodontal disease may have even more of an impact on overall health than previously thought,” and, “Biomarkers in Saliva Help Detect Early-Stage ...
Vaccines are Not Just for Kids
August 16th, 2016 - Find-A-Code
National Immunization Awareness Month (NIAM) is an annual observance held in August to highlight the importance of vaccination. All adults should get vaccines to protect their health. Even healthy adults can become seriously ill, and can pass certain illnesses on to others. Talk to your Medicare patients about vaccines they ...
ICD-10 Roundup: Private Practice Radiologists Share How Prepared They Were for ICD-10
June 7th, 2016 - Practice Suite
In October 2015, the entire U.S. medical community made a controversial shift to the 10th Edition of International Classification of Diseases (ICD-10). The road to ICD-10 was marked with multiple delays, primarily due to concerns that physician-owned practices were not prepared for the ...
How group practices are surviving the value based payment model in 2016!
June 3rd, 2016 - Adam Smith
As the healthcare industry undergoes dramatic transformation, group practices are facing a lot of turbulence to their financial structuring. Moving away from fee-for-service business models to value-based reimbursement setup is a daunting endeavor, but, that’s where the industry is heading...
Are you ready for the value based payment model?
March 15th, 2016 - Victoria
Healthcare professionals are being forced to move out of their comfort zones. Sweeping changes are being made to change the way healthcare is provided and paid for. 40% of in-network payments are tied to value. And the traditional fee for service model is expected to disappear over the horizon in...
As of Jan. 1, your practice can insist of electronic funds transfer payments from payers
February 16th, 2014 - Scott Kraft
One provision of the Affordable Care Act (ACA) that can work to your practice’s advantage is Section 1104, which gives you the right to insist on electronic funds transfer (EFT) as your method of payment. As of Jan. 1, 2014, you are entitled to EFT payments upon your request under standards...
Charging Medicare Patients for Missed Appointments
June 20th, 2013 - Cyndee Weston
Previously, each Part B office had their own requirements regarding charging Medicare patients for missed appointments. TRICARE (TriWest Healthcare Alliance) regulations required providers to establish office practice policies regarding "no show" fees and required beneficiaries to sign an...
Get Started Going Paperless
May 15th, 2013 - Debra Sanders
Do you get a lot of emails and some you need to keep, some delete? Or maybe you have some documents in your drawer you reference once in a while but you have nowhere else to keep them but in your drawer or pinned on your walls? If you use Outlook Express at work, it's pretty much the same as...
How to Manage a Hospital, 101
May 1st, 2013 - Robert Jordshaugen
CEO - stop "Making decisions." If the data and metrics are correct, the decisions are self evident. Spend time instead developing your team, your culture of communication, and ensuring that you are measuring the right activities. Stop managing departments and start managing patients. The...
Charge capture: Paper and Electronic Encounter Forms
May 1st, 2013 - Codapedia Editor
Physicians and Non-Physician Practitioners (NPPs) may want to distance themselves from coding, but implementing an Electronic Health Record (EHR) moves them in the opposite direction. If using an EHR, after completing the note, the clinician selects the CPT® and ICD-9 codes (the procedure and...
No Claim Left Behind
March 22nd, 2013 - Shannon Bosley
Call me crazy, but it is always exciting to me when I assist a practice in getting reimbursed on unpaid or delinquent claims. Claims that were denied, viewed as uncollectable, past filing deadline, or a multitude of other reasons. I even have a little dance that I do! Why not? We need to get...
Advance Into Technology and Increase Your Revenue
March 22nd, 2013 - Debra Sanders
Everything seems to be going just fine and all of a sudden we have a new policy on how we are to do our jobs now. We have been doing our jobs just fine the past 5 years and I don't see anything wrong with the way we're doing it. Changes are sometimes hard to understand because we've only one...
Primary Care Billing Profiles
October 14th, 2009 - Codapedia Editor
For most primary care physicians, Evaluation and Management services comprise the highest percentage of services performed, and account for most of the revenue. Primary care physicians should regularly compare their profile with the norm for their specialty. These specialty norms are included as a...
Never Events
September 30th, 2009 - Codapedia Editor
In 2007, Medicare instituted a new policy, regarding "never events." Never events are those hospital incidents that should never happen, patient falls, stage III and IV pressure ulcers, objects left in surgical patients, certain infections. Never events are serious and costly...
ROS Checklist
April 22nd, 2009 - Rikki Runyon
Review of Systems CHECKLIST: -General- ? Weight loss or gain ? Fatigue ? Fever or chills ? Weakness ? Trouble sleeping ----------------------------------------------------------------------------------- -Skin- ? Rashes ...
Real Time Claims Adjudication (RTCA)
March 31st, 2009 - Codapedia Editor
Real time claims adjudication (RTCA) is a software interface between a physician's practice management information system and a payers claims processing system that allows the practice to submit a claim at the time of checkout, and receive a response from the insurance company while the patient is...
Denial tracking
March 30th, 2009 - Codapedia Editor
Claims denials have the following outcomes, none of them good: Collection of revenue is delayed Collection for the service never happens Staff members spend time and energy researching and resubmitting claims The denial is lost in the A/R system and never worked There are...
Copying insurance cards
March 30th, 2009 - Codapedia Editor
Is your office copying insurance cards? I have three words of advice: Just stop it. I am amazed at how often I see front desk staff doing this. They ask for the card. Get up from the desk. Walk to the copier. Hopefully, no one else is using it right then. Copy the front. Wait. Take the copy...
The cost of no-shows
March 30th, 2009 - Codapedia Editor
What is a no show in your practice? a huge relief: now we can get caught up lost revenue you can never make up Of course, the answer is both. From a financial perspective, it is critical to keep no shows to a minimum. It is a good idea to track no-shows, to see what they are costing...
How to analyze and diagnose a low collection rate
March 5th, 2009 - Elizabeth Woodcock
Woodcock & Associates has provided a diagnostic tool for you to download. Click the Resources link above to get the PDF file.

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