Documentation Checklist Bulletproof Your Claims

Documentation Checklist Can Bulletproof Your Claims

Provider documentation is your only defense if you’re faced with an audit. It must be rock-solid to support the claims you submit to payers. But how can you ensure this happens when each clinician has his or her own style and perspective when documenting a patient encounter? The answer is good basic, defensible documentation. Here […]
Time-Based Coding

Tackle Time-Based Coding to Ethically Boost Your Reimbursement

If your practice isn’t using time-based codes correctly, you are leaving money on the table. Or worse, opening yourself up for massive fines per misuse. The truth is, most coders and their physicians steer clear of these codes out of fear of the consequences of getting it wrong.  But, there’s no need to avoid these […]
CMS’ Audit List

Stay Off of CMS’ Audit List

The number of physician practices being audited each year continues to rise. As a result, more and more providers committing fraud, or just making mistakes, are being identified and required to pay massive penalties or have even been sentenced to jail time.   In many instances, the violation wasn’t intentional, but because they had no way […]
Modifier 51 over 59

When To Use Modifier 51 over 59

When would I use modifier 51 instead of modifier 59? If you would have asked me that question 10 years ago, I would have told you not to use a 51 modifier because it causes bundling reimbursement. But 51 is now in your CPT book for when you are doing skin or endoscopic procedures. There […]
2018 ICD-10 Update

2018 Update to ICD-10-CM is Here

As of October 1st, your outpatient claims will be expected to incorporate the new 2018 ICD0-10-CM code, which include 360 new, 142 deleted, and 226 revised codes going live.  Just like last year’s changes, many of the new codes provide more specificity to your diagnoses. This means you’ll need to work with your clinicians to […]
Infusion Administration

Recognize Infusion Administration Types to Ensure Proper Payment

Coding infusions is far from run-of-the-mill, and if you don’t get it right, you’ll likely see reduced — if not denied — claims. One of the key concepts when reporting this service is understanding the type of infusion you’re providing. Get it right, and your claim sails through, but get it wrong, and you’ll be […]
ICD-10 Diagnosis

Get Specific: Encounter Type Often Drives 7th Character … and Medical Necessity

When choosing the most accurate ICD-10 diagnosis code, you’re often required to include all seven characters to prove the medical necessity for a procedure or office visit. If not, your chances of having the claim denied are significantly increased. Nailing down that seventh character can be vital for getting your claims paid the first time […]
Chronic Care Management

Get on Board With CCM and Stop Leaving Money on the Table

Although Medicare began paying for chronic care management (CCM) services in 2016, the Centers for Medicare and Medicaid Services (CMS) reports that many practices are not taking advantage of the new coverage, even after more than a year. And if you’re not billing this service for those who are likely your sickest patients, you’re losing […]