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The place of service (POS) code set provides location information necessary to pay claims correctly. There are times when the health care industry requires a greater need for specificity than Medicare. While Medicare may not require this greater specificity to process and pay claims, it will adjudicate claims with the new codes in order to…
DetailsThe year may have just begun but healthcare billing frauds are already running rampant across the nation. Continue reading to learn about nine of the biggest billing fraud cases taking over the headlines. From Cincinnati-based Bon Secours Mercy Health agreeing to pay $1 million to settle allegations that it improperly billed Medicare, to a Florida…
DetailsThere are often questions and confusion on what is included and acceptable when choosing “Drug therapy requiring intensive monitoring for toxicity” in the Medical Decision-Making Risk category for Evaluation and Management coding. This article reviews the definition and guidelines as provided by CMS and their Medicare Administrative Contractors (MACs). Risk: High MDM – Drug therapy…
DetailsThe No Surprises Act (NSA) has been in effect for a little over a month now, but what exactly is the NSA? The No Surprise Act protects patients from balance billing, however, it is not perfect. Keep reading to learn more about the NSA and the controversy surrounding it, along with what is being done…
DetailsNew developments from the Centers for Medicare & Medicaid Services (CMS) regarding policy changes were released earlier this month. The proposed changes will effect drug programs in 2023 to create more helpful options for Medicare Advantage and Part D consumers. Continue reading below to learn more about the notice. The Centers for Medicare & Medicaid…
DetailsGlobal OB Care Coding and Billing Guidelines By: Sheila Haynes – Coding and Compliance Manager The total obstetric care package, commonly referred to as “Global OB Care”, includes the provision of antepartum care, delivery services and postpartum care. When the same group physician and/or other healthcare professional provides all components of the OB package, the…
DetailsPrivate practice physicians may not have the upper hand when it comes to financial aids that other publicly owned facilities do, but according to a recent study, these private practices may, however, hold the key to high-performing facilities that other big health systems should pay attention to. Keep reading to learn more as to how…
DetailsBy: Sheila Haynes – Coding and Compliance Manager Correct coding and code definitions apply in all circumstances and to all provider types. Whenever a code is billed which includes another service or supply, whether by code definition or by coding guidelines, the included service or supply is not eligible for separate reimbursement. Supplies For Professional…
DetailsRecently announced, the third dose of the Pfizer vaccine was approved for pediatric patients between the age of 5 and 11. A recently issued statement by federal agencies urges all eligible children and teens to receive the vaccine. Continue reading below to learn more. The American Medical Association (AMA) today announced an editorial update to…
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