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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Long Term Care Conference Tips: Stay on the Top of the Latest Survey Changes

CMS had put a new home health agency survey protocol in place which contained in Survey & Certification letter S&C: 11-11- HHA and modified Appendix B of Medicare’s State Operations Manual.

Although the new survey protocol has been in force for quite some time, a lot of HHAs haven’t studied up on it. That could lead to huge survey trouble when surveyors next visit you.

Here are the top survey changes outlined by an expert in a recent long term care conference:

1)  Better surveyor guidance. CMS is offering more guidance to surveyors in spheres for instance when is the time to expand a survey, when is the time to issue a deficiency, and also when to mention a standard-level versus condition-level deficiency.

2) Focus on quality. The novel survey protocol leads surveyors to focus on specific standards most directly related to the delivery of high-quality patient care. CMS is trying to concentrate more on patient care and lesson paper-based compliance.

3) Interviews. Expect to see a whole lot more interviews in your next survey, as the new protocol lays emphasis on questioning staff and patients. You can anticipate surveyors to question each and every one from top management down to the individual who answers your phone.

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4) Lesser threshold for citations. Some bad news in the new survey protocol is that just one difficult finding for a Level 1 standard results in a “standard-level deficiency citation and a partial extended survey.

5) Lesser record reviews and home visits. The new survey protocol includes some good news for HHAs. Surveyors now need lesser record reviews and home visits. Surveyors find the new numbers adequate to discover problems at agencies.

Improve the overall efficiency of your agency with a wide range of long term care conference and home health conference available at AudioEducator.

HIPAA Conference Tip: Ensure Security Rule Compliance

The Privacy Rule, or Standards for Privacy of Individually Identifiable Health Information are those established standards which protect certain health information. On the other hand the Security Rules protect certain health information that is held or transferred in electronic form.

The Security Rule operationalizes the protections contained in the Privacy Rule by addressing the technical and non-technical safeguards that organizations called “covered entities” must put in place to secure individuals’ “electronic protected health information” (e-PHI).

The Security Rule does not particularly disallow the use of email for sending e-PHI. Nevertheless, the standards for access control, integrity and transmission security necessitate covered entities to implement policies and procedures to limit access to, safeguard the integrity of, and protect against the unauthorized access to electronic protected health information sent and received over email communications.

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The transmission security standard has been updated to implement the use of encryption. This implies that each covered entity must evaluate its use of open networks, recognize the available and proper means to protect electronic PHI as it is transmitted, choose a solution, and further document the decision. The Security Rule permits for electronic PHI to be sent over an electronic open network provided that it is sufficiently protected. An end number of HIPAA conferences are available online that give tips and strategies to ensure HIPAA compliance and security standards.

The HITECH Act went into effect in 2010, amending the HIPAA Privacy and Security Rules. One of the most prominent changes is in the penalties for a violation of patient information as a breach of patients’ rights under HIPAA. When HIPAA was initially passed, the maximum penalty for a HIPAA violation was $250,000. Now, the maximum penalty is $1.5 million. As per the standards, fines in addition to criminal penalties can be imposed as well on the violating institution and the individuals who are involved.

The above information on the HIPAA Security Rules is brought to you by AudioEducator: the country’s leading healthcare training provider through a wide range of HIPAA conference and health system conference.