Tag: CMS

A Rebeginner Guide to Peer-to-Peer Appeals

A Rebeginner’s Guide to Peer-to-Peer Appeals

Suggestions for conducting peer-to-peer appeals for denials. If you are wondering why you should read this if you think you are not a rebeginner, well, it is because you actually are one. Beginnings do not disappear, they just reproduce. Novices are just starting, veterans have started over and over. We all begin as beginners and […]
Learn More
The Facts Surrounding The Coding Chronic Kidney Disease

The Facts Surrounding The Coding Chronic Kidney Disease

Chronic Kidney Disease (CKD) is a serious health condition affecting millions of people worldwide. In the United States alone, 15% of adults, or approximately 37 million people, suffer from CKD. This condition, often insidious in its onset, can lead to severe complications and significantly impact quality of life. Key Facts about CKD: Prevalence: More common […]
Learn More
New Rules Issued for Modifiers 59, XE, XS, XP, and XU

New Rules Issued for Modifiers 59, XE, XS, XP, and XU

The Centers for Medicare & Medicaid Services (CMS) issued a policy change modification to the claims processing logic for Modifier 59 Distinct procedural service (and the optional patient-relationship modifiers XE, XS, XP, and XU) on February 15, 2019. These modifiers are only processed when applied to the Column 2 code in a bundled pair, per Correct Coding Initiative […]
Learn More
Medicare Advantage Plans and the Two-Midnight Rule

Medicare Advantage Plans and the Two-Midnight Rule

Controversy continues to swirl around this subject. A recent article of mine focused on the argument that Medicare Advantage (MA) plans have to follow the two-midnight rule. It certainly generated buzz; I received a number of emails with comments and questions. First, I want to note that I love getting comments and questions. I can’t […]
Learn More
MACRA Readiness for Healthcare Organizations

MACRA Readiness for Healthcare Organizations

Without even putting too much effort into listening to or reading the news, you understand that healthcare costs have steadily risen over the last couple decades, and yet we don’t really have any significant and correlating rise in outcomes to show for it.  CMS or the Centers for Medicare and Medicaid Services has also noticed […]
Learn More
x