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Chronic Care Management

Check 5 Capabilities to Bill Chronic Care Management

Update Notice: This information was updated for accuracy on May 19, 2021. This update reflects the 2021 CPT code changes for Chronic Care Management, specifically the replacement of code G2058 with code 99439. You’ll find this update in the “Facilitate Transitions of Care – Chronic Care Management Options” section below. Whether it’s diabetes, arthritis, or […]
Published Date: November 13, 2019
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2020 Medicare Physician Fee Schedule: TCM Expands, E/M Confirmed

If you don’t have time to comb through the 2020 Medicare Physician Fee Schedule Final Rule, you’re not alone. Most physicians and staff are simply too pressed for time to figure out exactly what parts of the rule are relevant to their practice and specialty. If that’s the case — don’t worry. We’ve sussed out […]
Published Date: November 8, 2019
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Primary Care First Model

Can Primary Care First Model Boost Your Pay?

If you are a primary care provider who treats Medicare patients — and looking to increase your revenue — the Primary Care First model might be just what you’re looking for. Earlier this year, CMS announced its Primary Cares Initiative, consisting of two new Alternative Payment Models (APMs). Both qualify as Advanced APMs for participation […]
Published Date: November 8, 2019
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ICD-10-CM Vaping Coding

CDC Notice: 4 Rules for ICD-10-CM Vaping Coding

Due to the epidemic of vaping related injuries and deaths, the CDC has released ICD-10-CM Vaping Coding Guidance. Based on what is now known about vaping or e-cigarette-related health conditions, the update contains official diagnosis coding guidance for encounters related to e-cigarette or vaping product use associated lung injury (EVALI). The CDC is investigating the […]
Published Date: November 7, 2019
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third-party payer appeals

6 Tips for Successful Third-Party Payer Appeals

When even the slightest mistake on a claim form can lead to a denial or reduced reimbursement, you need to be on your toes. The good news is with some leg work third-party payer appeals can get you paid more of what you are due. While third-party payer appeals are a time-consuming complex process, they’re […]
Published Date: November 1, 2019
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OIG Watch List: Protect Payments from Urine Drug Test Audits

The Office of Inspector General (OIG) added to its Workplan items that contractors will audit or evaluate with a more critical eye. If you bill for urine drug test or speech-language pathology services to Medicare beneficiaries, now’s the time to weigh your compliance risk and fix any issues. OIG Scrutinizes Urine Drug Test, Speech-Language Pathology […]
Published Date: October 31, 2019
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Stark Law 2020 CMS Proposed New Rule

CMS New Rule: Stark Law Promotes Care Over Self-Referral

The 80’s are back, but it’s not fashion you should worry about. First enacted in 1989, the Stark Law is getting significant updates from CMS that benefit patient care, according to a proposed rule issued in October 2019. Comply with these new regulations that open the door to areas previously restricted as conflicts of interest. […]
Published Date: October 30, 2019
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Legal Column: 3 HIPAA Compliance Cases Giving Attorney Nightmares – Heidi Kocher, Esq

There’s a lot at stake if healthcare professionals don’t comply with HIPAA and other government regulations. No one knows this better than myself – a healthcare attorney. The relationship between healthcare attorneys and the practices we serve is a paradox. On the one hand, the healthcare attorney is viewed as the institution’s life raft — […]
Published Date: October 29, 2019
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6 Easy Steps to Unlock Your Well Woman Exams Pay Up

Getting reimbursed for preventive well woman exam claims is tricky – not all third-party payers reimburse for these services and the coverage rules vary for the payers that do. You can’t afford to mess up the ABN or the allowed codes. Remove barriers to get the reimbursement you deserve by following a handy step-by-step guide. […]
Published Date: October 24, 2019
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Medicare Diabetes Prevention Program MDPP

CMS Releases 2020 Payment Rates for Medicare Diabetes Prevention Program MDPP

CMS has released the 2020 payment rates for HCPCS codes for the Medicare Diabetes Prevention Program (MDPP). A provider can receive payments of varying amounts close to $700 per beneficiary. New MDPP 2020 payment rates go into effect Jan. 1. While the rate change is minimal, every dollar makes a difference towards an ounce of […]
Published Date: October 23, 2019
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