Insights on Medicare Appeals in the SNF

Compliance and quality in post-acute care services are fundamental for the facilities, as well as patients who require assisted-living services. In view of the expanding life span of Americans, patients who are recovering from a major health condition look out for quality. On the other hand, the facilities are increasingly adopting electronic health records and using mobile phones for e-prescribing, documentation and sharing of information with patients and family. Therefore, it is essential for them to keep their facility updated about the Feds newest compliance policies.

Urologists Can Maximize Reimbursement By Coding Correctly For Radiological Procedures. Find Out How

Many radiology practices have no office of their own. Mostly services are imparted from a small section that is allotted in hospitals to radiologists. Since general radiologists do not require to see patients, they hardly go in for the typical office setting comprising of receptionist, office manager, file clerk and medical assistants. Only a couple of staff suffices to get the job done.

Also, urologists also perform radiological procedures in their offices. These procedures include CT scans, Doppler scans of urinary tract and sonographic studies too. It is essential to code correctly for these services to avoid denial and overcome costly audits to get deserved pay. With significant code changes this year and ICD-10 implementation around one must have a good and through understanding to avoid common errors.

Radiologists can take up any role and carry out any duty with ease and accuracy. But to ensure this cross-training along with the most updated coding and billing information is highly recommended. ICD-10 will introduce significant changes in radiology practice. But as in other medical specialties, radiology is not limited to specific set of codes. Radiologists get to see a variety of diagnoses and not limited by one codeset that is used as a routine on a daily basis. For instance, radiologists come across patients from urology, orthopedic, ENT or any other specialty on a single day itself.

Moreover, With ICD-10 implementation that will have a huge impact on the coding and billing scenario, all the previous coding and billing guidelines have undergone severe changes or revisions. Expert advice and hands-on training is a big requirement to survive the ICD-10 challenge and keep your practice secure. Preparing well in advance and providing adequate training to your staff is vital as this will help the small unit to take on many roles without being baffled.

One should also not forget that Urologists garner maximum pay through in-office work as compared to reimbursement. So it is also important to gear up with E/M codes to report these services correctly. Not only does it help to maximize profit, it is subjected to intense payer scrutiny.

Stay updated with all the latest coding and billing changes with online medical coding training conferences only on AudioEducator, where you can choose a wide range of webinars on ICD 10 for Radiology, urology coding conferences, coding and billing for radiology practices to stay compliant.

Analysis of Dental care sector shows significant changes

A recent survey of the dental care industry has revealed shifting changes and dental practice needs to keep up with these changes. The American Dental Association has time and again suggested ways of how significant changes in the dental sector will make it more effective and has also compiled the strategic plan to be implemented in 2015-20.

To summarize all the changes, the key factor that was found is in relation to the structural changes that have been felt recently. These changes have no relation with dental coding updates, fall in economy or slow upturn but have been ongoing for years.

According to the report, adults who are working use less dental care services specially those who are young and the ones who cannot afford it like the poor, which was present before recession happened. But because of extensive public insurance programs, use of children’s dental care has been on the rise.

Some other facts of the survey are as follows:

• The use of dental benefits in adults and children is greatly impacted by changes in the dental benefit coverage. Adult dental benefits in the past had suffered consistent loss of benefits affecting the poor and young adults. Some combined factors are responsible for this like the effect of labor market, behavior of employer and exclusion of dental benefits for adults from Medicaid programs.
• Before the economy hit an all time low, there were financial difficulties faced by adults like ever increasing cost of dental services.
• This ongoing trend in use of dental care has also effected the earning of the dentists and dental spending over the years. The report states that the dental spending in USA has not only slowed down but also become stagnant over the years. It also affected the dentists income that also became stagnant and then declined considerably. Although from 2009 onwards there has been some improvement but according to the report it is nothing of great magnitude. Out of five dentists, two said that they were ready to see more patients since they were not busy.

                                                                                                              

Stay updated with all the latest coding and billing changes with online medical coding training conferences only on AudioEducator, where you can choose a wide range of medical billing conferences for dental coding updates to stay compliant.

Ensure A Smooth Transition To ICD-10 For Radiology By Preparing For The Documentation Changes Now

According to experts, every practice must start preparing themselves for the ICD-10 transition next year. To make this learning process hassle-free new strategies need to be introduced as performing, testing, planning and training will take great time and effort.

Amongst all the other things, radiologists need to understand the condition of the patient to correctly report it for coding and billing. ICD-10 will be a lot more detailed than ICD-9 codes so after the physician examines a patient and sends the report to the radiologist, who will in turn have a better understanding of the patient condition. This also means that for accurate billing radiologists need the history of the patient to make billing, dictation, and billing smooth and error-free.

Also, document specification is another aspect that will be required in ICD-10 for radiology. Moreover, coding will vary based on whether the procedure is outpatient or inpatient. For inpatient exams and procedures ICD-10 PCS codes are to be used. But since one exam can be performed on the same patient twice, for instance: as inpatient and then as outpatient, the report codes need to be different to mark the difference. There are also three specific sections in ICD-10 for radiology, so radiologists need to accurately pinpoint the images and the type of imaging that is being performed.

Codes in ICD-10 for radiology should be matched correctly with CPT codes. In billing, if correct codes are not reported, then it leads to loss in revenue because of inadequate information. In order to overcome this, radiologists need to be in constant communication with referring physicians. Referring physicians provide vital information like writing orders and stating the reason for the exam, so radiologists need to have a good rapport with them. This will help radiologists to bill correctly with complete information that they receive from the referring physicians. A radiologist can face serious issues if a referring office is unable to provide necessary information or is not incorporating new codes and reporting guidelines. At a time of financial crisis, being outdated will only result in compliance issues and heavy monetary losses that will affect radiologists as well as the practice greatly.

To ensure that the work of the radiologist mainly billing is effortless, one has to make sure that the referring physician is well acquainted with ICD-10. In fact, one can also offer help to enable them to train for ICD-10. ICD-10 will be introduced in order to highlight and report detailed and improved data reporting related to everything in a practice, but one needs to prepare thoroughly and ensure that their referral is adequately trained and equipped to implement all the changes. This will help to cut-out loss in revenue and costly audits. As has been stated by CMS, to ensure that your practice stays compliant, you need to start preparing for the ICD-10 transition now.

Stay updated with all the latest coding and billing changes with online medical coding training conferences only on AudioEducator, where you can choose a wide range of webinars on ICD 10 for Radiology and radiology coding conferences at AudioEducator to stay compliant.

Hospice Coding Guidelines: New Data Included In Claims Will Affect Pay

In the coming year, the data on your hospice claims that you will submit to Medicare will decide your payment rates in the future. Next year, hospice coding guidelines according to CMS points out additional new data must be included in hospice claims like reporting visit for general inpatient care, facility NPI where care was provided if not at the billing hospice facility, and infusion pumps and prescription drugs.

This step has been taken by CMS as according to many the required claims information is inadequate to determine hospice care.

This coming year, Hospices need to report line-item visit data for hospice staff providing GIP to patients in skilled nursing facilities or hospitals with HCPCS code Q5004, Q5005, Q5007 and Q5008, which will also include visits of the nurses, social workers, aides, occupational therapists, physical therapists and language pathologists along with information related to visit and visit length based on line-item. Also, calls and call length also have to be reported that are made by hospice social workers.

Changes are not being made to the GIP visit reporting if the service site is a hospice inpatient unit. Also, there will be no changes for the service of the physician that gets reported in hospice claim. But post-mortem visits for nurses, social workers, aides and therapists need to be reported if it happens on the day of death and billing later on will be impossible because of limitations in claim system.

A PM modifier can be used to mark difference between post-death visits and those that happen before death. Although prescription drugs and infusion pumps can be reported, over-the-counter drugs and other DME items should not be reported.

According to experts, every hospice must start working towards these new guidelines as soon as possible and start reviewing their system of data collection to ensure they achieve the required level of detailing. Also, they need to be familiar with the NDC, pharmacy and DME revenue codes to stay compliant.

Stay updated with all the latest coding and billing changes with online medical coding training conferences only on AudioEducator, where you can choose a wide range of webinars for hospice coding guidelines and long term care coding conference to stay compliant.

Understand E/M coding guidelines for 1995 and 1997 to ensure a compliant orthopedic practice

Insurance carriers closely scrutinize services related to Evaluation and Management as documenting these services requires one to follow innumerable guidelines. The two basic guidelines of 1995 and 1997 have a huge impact on the way claims are being reported that effects reimbursement too.

It is important to have extensive medical billing and coding training to understand the documentation requirements to file error-free claims.

Example: In orthopedic practice, if one has to bill for a comprehensive exam, according to the 95 guideline what body area or organ does one need to address. Can body areas and organ systems be mixed when elements for the exam will be counted.

Solution: The physician has to decide the organ system and body should be examined. Every medical record is scrutinized for reasonable and medically necessary services, so it is the duty of the provider to execute the work and based on it decide what level of service needs to be billed. The physician’s clinical judgment determines the extent of the exam performed and documented the nature of the problem and the medical necessity of the case.

In the 1995 E/M guidelines, the multi organ system physical examination has been stated and in the 1997 guidelines, the general multi system and single organ system examinations have been stated. Also in the 1997 guidelines, musculoskeletal examination has been mentioned and the physician may determine the bullet points in the examination charts.

The 1997 Exam rules are well-defined and makes following the rules quite easy giving confidence before any audit. According to an auditor, this is a good way to define Exam Level by the bullets. An essential thing is that physicians should use exam templates which contain the most clinically relevant bullets, whereas the 1995 Exam guidelines lack such solid guidelines.

If you are looking for online medical coding training conferences, AudioEducator is the place where you can choose a wide range of webinars for medical billing and coding training and dental coding training to stay compliant.

CMS Documentation Guidelines for FY 2014 Inpatient Payment Rule

The Medicare program, PPS payment system, and consolidated billing are updated every year by CMS. It has a profound impact on practices so it is essential to understand each and every CMS documentation guideline. Recently CMS issued the final version that updates FY 2014 Medicare payment policies and rates related to general acute care and LTCHs. This new rule brings about an improvement in the value and quality related to hospital care and provides an explanation regarding the circumstances under which a patient can be admitted to the hospital. It also addresses recent concerns related to prolonged Medicare beneficiary stays in the hospital outpatient department.

The FY2014 final IPPS rule has increased overall payment for hospitals by $1.2 billion. The Affordable Care Act has also made reforms related to health care delivery system along with this rule. It includes a program that will help to improve safety in hospitals and bring clarity to the Hospital Readmissions Reduction program.

The IPPS operating rate will be increased by 0.7% with the final rule, after taking into account inflation and other changes that the law requires. A temporary reduction of 0.8% occurs due to the increase to imply the American Taxpayer Relief Act’s requirement to get back all the previous overpayments which is the result of a new patient classification system that helps to identify the extent of the illness.

0.2% reduction is also being made to make up for increase in spending that has been projected associated to changes in the review process of medical and admission for inpatient services. There will be a hike of nearly 1.3% in LTCH PPS payments as projected by CMS in FY 2014.

The changes to Medicare quality incentive programs will help to decrease the reporting trouble that providers face in the EHR and IQR program. This will also enable to finalize new procedures for Hospital Inpatient Quality Reporting Program, the Hospital Value-Based Purchasing program, and LTCHs, PPS.  But cancer and Inpatient Psychiatric Facilities are excluded.

If you are looking for online medical coding training conferences, AudioEducator is the place where you can choose a wide range webinars that provide CMS documentation guideline and CMS hospital training so that you can master all the coding and billing changes and stay compliant.

Medicare Guidelines: Boost Your Medicare Payments

For a lot of medical practices, Medicare payments make up a large percentage of accounts receivables. For maximized reimbursements, providers are required to take proactive measures. Following are few simple ways to enhance your Medicare payments.
1. Use Accurate Diagnosis: While billing Medicare, you must report the appropriate ICD-9 diagnosis medical codes that match the patient’s symptoms, complaints, conditions, illnesses as well as injuries detailed in the patient’s medical record. Correct diagnosis coding reduces the risk of claims denying for not supporting medical necessity. You must always list the primary diagnosis code initially and then list any additional diagnosis codes in order of importance.

2. Provide the Medicare Patient an ABN: As per Medicare guidelines, a provider must give the Medicare Patient an ABN or cannot bill them for the service in case Medicare doesn’t cover the service.

 

3. Medicare Eligibility: It is essential that the providers validate their patient’s insurance eligibility each and every time services are provided. Verifying Medicare coverage is just as vital as verifying coverage for any other payer. Verifying Medicare eligibility will offer information for instance active coverage, commencement and termination of coverage.
4. Avoid  Duplicate Claims Submission

Medicare will reject claims as duplicate in case the same claim has been earlier billed. In case a claim is being submitted owing to the changes to the patient account, ensure to wait until the claim has been received and processed by Medicare prior to submitting a corrected claim. Then you should file the claim using the proper frequency code “7 – Replacement of Prior Claim or Corrected Claim” to avoid a duplicate claim denial and include the Medicare DCN (document control number).
5. Use suitable Modifiers: Choose and report the accurate modifiers with the CPT or HCPCS medical codes on the claim as per the Medicare guidelines. Improper coding of procedure code modifiers can cause a delay or reduction in payment.

Visit AudioEducator for more information on recent Medicare guidelines and appropriate medical codes for maximized reimbursements.

OASIS-C Training: Ace M1320 with These Tips

CMS provides enough guidance on answering M1320 (Status of most problematic pressure ulcer). However, you’ll still required to use your clinical decision to choose the right answer. Go through these OASIS-C training tips and know more.

1. It’s your call to select the criterion for “most problematic.” It could be the largest pressure ulcer, the one at the most advanced stage, the most complex to access for treatment, or one in the area most difficult to relieve pressure. In case there is merely one pressure ulcer, that one is the most problematic.

2. Remember that Stage II pressure ulcers which are reported at M1320 are at all times 3 — Non-healing. That’s for the reason that stage II pressure ulcers don’t granulate and newly epithelialized stage II pressure ulcers are considered healed and no longer considered to be a pressure ulcer.

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3. The most problematic pressure ulcer might be of a lower stage. For instance, assume your patient has a pressure ulcer of the heel that was stage I although has advanced to stage II and is getting worse. Plus, he also has a stage III pressure ulcer of the sacrum which is now healing well. You might mark the stage II pressure ulcer as the most problematic, and that’s fine.

4.  An intact serum-filled blister resulting from pressure must be reported as a stage II pressure ulcer. While reporting such an ulcer in M1320, our expert suggested in an OASIS-C training conference, you would select 3 — Non-healing as the fluid-filled blister stops it from healing.

5. Deep tissue injuries reported in M1320, whether suspected or confirmed are marked as 3 — Nonhealing. Keep in mind that deep tissue injuries do not granulate and thus would not be covered with new epithelial tissue. Instead, a suspected deep tissue injury can take one of two paths to heal.

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ICD 10 Training Online: Different Between ICD-9 and ICD-10 Systems

In a lot of ways, ICD-10-CM is quite related to ICD-9-CM. The guidelines, conventions, and rules are very similar. The organization of the both code sets is very similar. Anyone who is eligible to code ICD-9-CM must be able to make the smooth transition to ICD-10-CM coding.

A lot of improvement has been made to diagnosis coding in ICD-10-CM. For instance, a particular code can report a disease and its existing manifestation (i.e., type II diabetes with diabetic retinopathy). In fracture care, the code distinguishes an encounter for an initial fracture; follow-up of fracture healing in general; follow-up with fracture in malunion or nonunion; or follow-up for late effects of a fracture. Similarly, the trimester is selected in obstetrical codes.

 

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Whereas much has been said about the enormous increase in the number of codes under ICD-10-CM, some of this growth is owing to laterality. Although an ICD-9-CM code may classify a condition of, for instance, the ovary, the parallel ICD-10-CM code categorizes four codes: unspecified ovary, right or left ovary, or bilateral situation of the ovaries.

ICD-10-PCS is a code set intended to substitute Volume 3 of ICD-9-CM for inpatient procedure reporting. It will be used by both hospitals and the payers. ICD-10-PCS is considerably dissimilar from Volume 3 and from CPT codes and will need considerable training for users. The system was planned by 3M Health Information Management for the Centers for Medicare and Medicaid.

ICD-10-PCS will not have an effect on coding of physician services in their offices. Nevertheless, physicians must be aware that documentation requirements under ICD-CM-PCS are quite dissimilar; as a result their inpatient medical record documentation will be affected by this change.

ICD-10-PCS has almost 79,000 seven-digit alpha-numeric diagnosis codes. A lot of audio conferences provide efficient ICD 10 training online that could help you master the nuances of the new diagnosis system.

 

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