Tag: CMS Update

Chronic Conditions: Code or Not to Code MCCs

  Understanding the correct use of chronic condition codes in the coding process. Unexpected and inaccurate medical bills can be alarming and shocking. Coders are often confused regarding when they should code co-morbid chronic conditions and when they should not. This leads to inaccurate coding of levels, or sometimes missing out on the opportunity of […]
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Why Hospitals Without Robust Revenue Cycle Support are Losing Millions?

A frequent knock on electronic health records (EHRs) has been that they’re just glorified billing systems that fail to provide enough clinical functionality to make a significant difference in the quality of care. So it’s somewhat incongruous that a recent Black Book report on revenue cycle management (RCM) system adoption would say that 26 percent of hospitals don’t have an effective […]
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Are Chargemasters Making Medical Billing More Transparent?

When it comes to a trip to the hospital we all know costs can add up quickly, but do you really know exactly what you’re paying for? Well, since January 1, a federal regulation has required hospitals to post machine-readable documents detailing everything they charge for called chargemasters. Though a debate has been raised into […]
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Full MACRA Implementation Needed to Advance Value-Based Care

Failing to execute full MACRA implementation by excluding over half of providers is impeding the transition to value-based care, the industry group told Congress. AMGA is urging Congress to enforce MACRA implementation as policymakers intended by no longer excluding providers from the Merit-Based Payment Incentive Program (MIPS). “MIPS was designed as a viable transition tool […]
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CMS Eliminates Reporting of Functional Limitation Codes

  CMS also has updated its therapy manuals, making elimination of FLR official. Many therapy providers, at hospital outpatient departments and private-practice clinics alike, were reluctant to stop submitting functional limitation reporting codes and impairment modifiers until they could see the guidance clearly written in black and white in the associated therapy policy manuals. While […]
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AHIMA Coding Productivity Study and Preparing for ICD-11

  Planning is underway now for ICD-11. The American Health Information Management Association (AHIMA) has been getting involved in the development of ICD-11 through its participation in the World Health Organization’s (WHO’s) activities, as well as providing members with high-level overviews of what to expect with the new classification system. ICD-11 has yet to be […]
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Ensure Proper MIPS Payment Adjustments with a Targeted Review

Right out of the gate, Medicare Incentive-based Payment System (MIPS) adjustments were incorrectly applied to non physician services and supplies. This error is being corrected by the Centers for Medicare & Medicaid Services (CMS), but what if no one caught it? MIPS eligible clinicians and clinician groups could have improperly lost or gained considerable revenue. […]
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Prepare Now for These Mid-Year CPT Code Updates

In addition to the annual release of CPT® code changes, the American Medical Association (AMA) likes to keep medical coders on their toes by releasing mid-year changes. The following Vaccine codes and Category III codes were accepted and/or revised at the September 2018 CPT Editorial Panel meeting for the 2020 CPT® production cycle. These codes are effective July […]
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New Medicare Enrollment Application

There is a new version of the CMS-855I Medicare Enrollment Application, which physicians and non-physician practitioners may begin using immediately. Medicare Administrative Contractors will accept the previous version of the application (7/2011) through April 30, and then require you to use the new version (12/18). What’s Changed? The Centers for Medicare & Medicaid Services (CMS) has made the […]
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