The leading cause of death and long-term disability in the U.S., stroke causes loss of neurological function due to a blood clot in the brain or intracranial hemorrhage. One of the most common...
Medicare’s New Health Insurance Market Place Rules – Impact on Risk Adjustment/HCC Coding
The Centers for Medicare and Medicare (CMS) has released new health insurance market place rules which will take effect from January 17, 2017. Referred to as the “payment notice,” the rule is an...
CT Colonography included in 2017 HEDIS Quality Measures
With the National Committee for Quality Assurance (NCQA) proposing several new Healthcare Effectiveness Data and Information Set (HEDIS) quality measures in 2017, payers and physicians need to focus...
Improved Documentation for Drug-related Disorders with ICD-10 Medical Codes
When it comes to psychiatry medical billing, addiction to any drugs can be documented using ICD-10 codes. While these drugs are necessary to treat psychiatric conditions, the sad truth is that they...
Ensure Proper Medical Record Documentation for Risk Adjustment Data Validation (RADV) Compliance
Medicare adjusts payments to Medicare Advantage (MA) organizations for cost variations in providing health care to beneficiaries based on various risk factors, including health status. The goal of...
Real-Time Electronic Prescription Prior Authorization on the Cards
Insurance verification and authorization is the first and probably most important step in the medical billing process. Patient eligibility verification involves checking out the patient’s coverage...
Physician Practice Setting can Improve Reimbursement for Respiratory Therapists
Pulmonary rehabilitation is a multidisciplinary program meant for patients with chronic respiratory conditions, especially for those with chronic obstructive pulmonary disease (COPD). Physicians...
Coding ‘Episode of Care’ – The 7th Character in ICD-10-CM
There are several differences between the format of ICD-9 and ICD-10 coding and this has brought about new medical billing and coding challenges. One of these is the need to assign the 7th character...
Professional HCC Coding Services to Maximize Medical Practice Revenue
One of the significant developments that have impacted Medicare Advantage (MA) plans during the past decade is HCC (Hierarchical Condition Categories) coding. Medicare has used the HCC coding model...