Category: Blog

Humana Adds 7 New States To Bundled Payment Portfolio

The Louisville-based Humana is expanding a value-based payment model into seven additional states, while the Medicare agency has yet to set a clear course for how to handle such models. Humana announced last week it would start offering its bundled payment model for hip and knee replacements under Medicare Advantage plans to members in Alabama, […]
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Look Ahead at ICD-10-CM Coding in 2018

The ICD-10-CM Tabular List of Diseases and Injuries 2018 Addenda provides insight to future diagnosis coding. Let’s review what is new, deleted, and revised in chapters 1-7. In future months, we will cover additional chapters. Chapter 1: Certain Infectious and Parasitic Diseases (A00-A09) Two codes are added under A04.7: A04.71 Enterocolitis due to Clostridium difficile, […]
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Multiple Procedure Payment Reductions (MPPR)

The multiple procedure payment reduction (MPPR) means that if a healthcare provider performs multiple procedures during a single patient encounter, Medicare (and many commercial insurers) typically will pay “full price” for only the highest-valued procedure. The reason is explained in Chapter 1 of the National Correct Coding Initiative (NCCI) Policy Manual: Most medical and surgical […]
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The Providers Role in the New Medicare ID Transition

The one thing doctors should be doing is making sure their patients have their address correct with Medicare. The patient won’t get a new card if their address is not correct. This simple reminder could diminish ongoing problems for providers in the massive transition underway to distribute new Medicare ID numbers. Since its inception in […]
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5 New HCPCS Q Codes Effective July 1, 2018

Get a jump on five new HCPCS Level II codes going into effect July 1,2018. All are Q codes and they help patients with opioid addiction, knee pain, cystic fibrosis, and hemophilia. Q9991         Injection, buprenorphine extended-release (Sublocade), less than or equal to 100 mg Q9992         Injection, buprenorphine extended-release (Sublocade), greater than 100 mg Sublocade is […]
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8 Useful Insights To Win The Prior Authorization Game

There is nothing more frustrating to physicians than knowing a patient needs a certain diagnostic test or medication and having them not be able to get it because their health insurance company won’t cover it. All too often, many services require prior-authorization (PA). It wouldn’t be so bad if the insurance companies made the guidelines […]
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Don’t Make These Mistakes When Billing For Endoscopy Services

Learn the right way to code ‘incomplete’ colonoscopies Billing Medicare and other payers for endoscopy services is pretty different from billing for other types of procedures. And if you’re like most coders/billers, you’re probably making some common mistakes that can cost you lost time and valuable reimbursement dollars. When billing for endoscopy services, you need […]
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The Best Way to Code for Critical Care

Key: Amount of time spent with the patient indicates which code to use. Coding for physician inpatient services, especially critical care, is deceptively straightforward. The reality is that the details of each code requirement can complicate things to the point of complete confusion. Despite the challenges, there are specific strategies you can use to correctly […]
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