Shellie Sulzberger, LPN, CPC, ICDCT-CM Coding & Compliance Initiatives, Inc.
|
|
- Jody Horton
- 8 years ago
- Views:
Transcription
1 Shellie Sulzberger, LPN, CPC, ICDCT-CM Coding & Compliance Initiatives, Inc.
2 Reasonable efforts have been made to provide the most accurate and current information on CPT 2015 code changes. However codes, guidelines, and policies are subject to change and interpretation. No guarantee is given that this presentation is free of errors, omissions, misuse, or misinterpretation and this presentation should not be considered a legal or authoritative opinion. This presentation does not replace coding manuals or other authoritative resources. Current Procedural Terminology (CPT ) copyright 2014 American Medical Association.
3 The audience will have a better understanding on the importance of submitting the correct CPT, HCPCS and ICD-9 codes for billing The audience will have a better understanding of how ancillary staff can assist the providers with documentation (i.e. what can the staff perform and document versus the provider)
4 We will outline some areas of documentation mishaps in an EMR and discuss the importance of specific documentation for each patient encounter
5 Proper procedure (CPT/HCPCS) and diagnosis (ICD) coding is not only critical for obtaining full and fair payment, it is also critical to ensuring proper compliance with the law.
6 Eliminating healthcare fraud and abuse has become a top priority for the federal government. "Fraud," "abuse," unbundling, overcoding," incorrect coding," and "compliance" have all become buzzwords in the industry.
7 Investigations are on the rise for providers in Healthcare. OIG Office of Inspector General DOJ Department of Justice CERT Comprehensive Error Rate Testing RAC Recovery Audit Contractors ZPICS Zone Program Integrity Contractors
8 Coding is how we communicate and report data within this federal entitlement system. Coding describes/documents the work and medical necessity for the services.
9 Determine reason for encounter Routine exam Wellness coverage through employer? Medicare patient needing to sign waiver for a complete physical or is this for a covered wellness visit? Medical illness Aids physician in prompting HPI questions Establishes intent of patient
10 Determine lab services Office should charge Resource lab should charge Assure encounter form is complete All charges captured Ancillary services marked Diagnosis indicated for services Record accident information If encounter form does not have this-record it for charge entry Chart services rendered by ancillary staff
11 Complete referral forms (when applicable) Obtain pre-certification/prior authorization Obtain Medicare waivers (ABN) for services that Medicare may not pay for Must have knowledge of LCDs and NCDs
12 Know billing regulations How to assign a level of service based upon the documentation and service rendered Know when you can and cannot charge OV with procedures Know the documentation requirements for billing specific services
13 Proper and needed for diagnosis and treatment of patient s medical condition Provided for diagnosis, direct care, and treatment of patient s medical condition Meet standards of good medical practice Not mainly for convenience of patient or physician Every service billed must indicate specific sign, symptom, or patient complain necessitating the service
14 Ability to evaluate and plan treatment and monitor health over time Communication and continuity of care Accurate and timely claims review and payment Utilization review and quality of care evaluations Data collection
15 1. Medical record should be complete and legible 2. Each encounter should include Reason for encounter, relevant history, physical examination findings, and prior test results Assessment, clinical impression, or diagnosis Plan for care Date and legible identity of observer
16 3. Rationale for ordering diagnostic tests 4. Diagnoses accessible to treating/consulting physicians 5. Identify health risk factors 6. Document patient's progress, response to and changes in treatment, and revision of diagnosis 7. CPT and ICD-9-CM codes on health claim form supported in medical record
17 Must be educated on documentation and coding guidelines Must understand what is required for the levels of E/M coding Must know the individuals providing the education are on their side Must show them what they have done well or need to work on with their own documentation
18 Assign ICD-9 diagnosis codes and may link diagnosis to procedures Assure diagnoses and procedures correlate Wellness exams with V codes E/M services with numeric ICD-9 codes E codes for accidents Understands modifier usage Review the instruction notes in the ICD-9 book Query physician when medical necessity has not been indicated
19 Must always be at least one (can be more) ICD-9 diagnosis The codes must apply to that particular visit The diagnosis code(s) should be linked and correlate with the procedure code(s) each procedure code must have a related ICD-9 diagnosis code
20 ICD-9 codes describe the patient s condition, not what was performed ICD-9 codes generally do not affect reimbursement for professional services, although is useful for physician profiling and for matching level of service to the patient s condition
21
22 Computerized physician order entry (CPOE) Legible Safeguards Improved compliance Timely testing Better patient care Improved tracking of ancillary and diagnostic tests combined Reduce duplicative services Broaden provider access
23 Improved documentation of the service actually provided when the EMR is used correctly Time and date stamping Legible notes Improved storage capabilities Paper charts were limited sometimes patient s had 2 and 3 volume charts Accessible from remote sites
24 Better communication Clinical summary Improved efficiency Allows you to track outcomes for quality care initiatives Improved outcomes Financial incentives More accurate billing and more efficient charge entry
25 There can be cloning notes from previous appointments The word 'cloning' refers to documentation that is worded exactly like previous entries. Medical necessity issues Source: Palmetto GBA Jurisdiction 11 Part B
26 Learning curve for the providers = decreased productivity Inadequate training can lead to increased coding Identical documentation
27 Inadequate training or lack of interest and attention can have negative impact on the provider and/or facility Mistakes Credibility Billing Liability
28 Loss of human touch and individuality Difficult to determine what the provider is recommending for the patient
29 Documentation is not always patient and chief complaint specific Inconsistencies in the documentation Difficult to determine who performed specific elements Power outages and computer crashes
30 Time and date stamping CPOE Templates limitations
31 The EMR can drive a provider to include documentation that is not applicable for the severity of the presenting problem. A 25 year old patient who comes in for a cough has documentation to support a complete review of systems (i.e. 10 or 12 point) and a family history because the EMR can automatically imports such text from the previous visit. Medicare and other payors will look to see whether the severity of the patient s problem matches the documentation, and if it doesn t it s a red flag.
32 Documentation templates default to multisystem reviews, exams, past problems that are no longer active, but still indicate Active Problems, etc. whether you do them or not. Usually it takes too much time and trouble to edit them out so the providers leave the information in the note for that date of service. Although excellent features of EMR systems, default settings and documentation templates can be dangerous
33 Patient presented with knee pain. A complete review of systems was documented including breasts and ob/gyn this was a male patient and breast and ob/gyn issues would be unrelated and not relevant for knee pain.
34 A specialty provider (cardiologist) saw a patient for heart issues. The provider saw the patient multiple times and on the initial visit the history and review of systems indicated the patient was coughing up blood and also their weight was down 10 pounds. Every note after the initial had the exact same review of systems, however, the history outlined the weight was up by xx pounds, etc.
35 I was asked to review several notes for a Work Comp case because the provider had a very high percentage of I reviewed 5 patients and looked at 3-4 dates of service for each patient. Only a few items changed with each review and there were documentation errors due to pulling the information forward, such as visit #1 when it was the third visit.
36 A gastrointestinal provider had a complete physical including genitourinary when evaluating the patient for a colonoscopy.
37 I was reviewing documentation in a surgeons office and noticed several instances where the ROS was positive for several items that were not addressed (i.e. short of breath, heart palpitations, chest pain, depression, etc.)
38 During a chart audit for a specialty provider I noted several instances where the documentation in the Review of Systems included several positives (i.e. shortness of breath, anxiety, depression, etc.) which may or may not have been related to the presenting problem. The provider did not address the positives anywhere in the record.
39
40 Obtain an independent assessment of your EMR documentation Evaluate the documentation in comparison to the presenting problem Review several dates of services, types of services, etc. Review 2-3 dates of service in for the same patient by the same provider Ask the auditor to look at the templates you have Is the template prompting for more information than required for the presenting problem
41 Ask for a list of everything that automatically pulls forward and a list of everything that can pull forward Query the provider on how they are using the EMR. Print out the note Can you tell who did what work?
42 Training done up front Reduces risk (legal liability) Saves time Saves money Improves compliance Decreases frustration Improves efficiency Assists in more accurate and timely documentation
43 Secret Patient A secret patient is similar to a secret shopper. Ask the patient to see a few of the providers with different issues and then determine if the documentation adequately reflects the work performed. Example: if a complete Review of Systems is documented was a complete Review of Systems performed?
44 Clearly understand who is doing what in the EMR. Audit trails offer a back end view of system use. Technology is only as good as the user. The leading cause of failure for Electronic Medical Record usage is inadequate training. Investing time and effort on the front end will ensure you get the best out of your system.
45 Review multiple E/M services for the same providers and beneficiaries to identify electronic health records (EHR) documentation practices associated with potentially improper payments. Medicare contractors have noted an increased frequency of medical records with identical documentation across services.
46 Is your coding module turned on? Should we turn it on or leave it off?
47 Do your providers understand CPT coding? Do you perform internal and/or external chart reviews? If yes, what is your process? Do you offer lunch and learn sessions? Shadowing? Do the providers have a vested interest in coding correctly or is it not my problem?
48 Purchasing resources or contracting for assistance ask you self the following questions: Will the resource help mitigate compliance risk? Will the resource improved our bottom line? Will the resource improve accuracy? Will the resource help us be more efficient and effective?
49 Maintain your knowledge Specialize Monitor the coding patterns in the office Audit Educate all staff members Build payer relations Monitor appropriate Reimbursement
50
EMR Documentation The Risks and Rewards. Agenda
EMR Documentation The Risks and Rewards Shellie Sulzberger, LPN, CPC Coding & Compliance Initiatives, Inc. Agenda Outline potential compliance issues related to documentation with an electronic medical
More informationShellie Sulzberger, LPN, CPC, ICDCT-CM. Coding & Compliance Initiatives, Inc.
Shellie Sulzberger, LPN, CPC, ICDCT-CM Coding & Compliance Initiatives, Inc. My connection to coding and documentation My connection to clinical processes My connection to ICD-10 My connection to YOU Coding
More informationCOM Compliance Policy No. 3
COM Compliance Policy No. 3 THE UNIVERSITY OF ILLINOIS AT CHICAGO NO.: 3 UIC College of Medicine DATE: 8/5/10 Chicago, Illinois PAGE: 1of 7 UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE CODING AND DOCUMENTATION
More informationE/M coding workshop. The risk of not getting it right. PAMELA PULLY CPC, CPMA BILLING/CLAIMS SUPERVISOR GENESEE HEALTH SYSTEM
E/M coding workshop. The risk of not getting it right. PAMELA PULLY CPC, CPMA BILLING/CLAIMS SUPERVISOR GENESEE HEALTH SYSTEM Disclaimer This information is accurate as of December 1, 2014 and is designed
More informationEMR Pearls and Perils Presented by Bruce Rappoport, MD, CPC, CHCC
EMR Pearls and Perils Presented by Bruce Rappoport, MD, CPC, CHCC All rights reserved Today s EMR Data Points Support Implementation Regulatory requirements and changes Upgrades EMR documentation EMR coding
More informationEMR Pearls and Perils
EMR Pearls and Perils Presented by Bruce Rappoport, MD, CPC, CHCC All rights reserved Today s EMR Data Points Selection Implementation Upgrades Documentation Payer communications Coding 1 Documentation
More informationEHR s-new Opportunities for the Confident Coder
EHR s-new Opportunities for the Confident Coder Angela Jordan, CPC Chair AAPCCA Board of Directors Manager Coding and Compliance EvolveMD amjordan.cpc@gmail.com Objective EHR basics Basic knowledge of
More informationBasic Medical Record Documentation
Basic Medical Record Documentation Presented by Cahaba Government Benefit Administrators, LLC P rovider O u t reach and Education September 19, 2013 1 Disclaimers This resource is not a legal document.
More informationTitle: Coding Documentation for IHS Affiliated Physician Practices
Affiliated Physician Practices Effective Date: 11/03; Rev. 4/06, 7/08, 7/10 POLICY: IHS affiliated physician practices will code diagnoses utilizing the International Classification of Diseases, Ninth
More informationImportance of Auditing
Medicare 201: Practitioner Importance of Auditing EY Fraud Investigation and Dispute Services Jennifer Shimek, Senior Manager Gretchen Segado, Manager Agenda Importance of Auditing National and Local Coding
More informationHow To Define Medical Necessity
Medical Necessity: What Is It? Documenting to Support Medical Necessity: What CMS and Payors Need Kim Huey, MJ, CPC, CCS P P, CHCC, PCS, CHAP for AAPC Regional Chicago October 2012 Medical Necessity Definition
More informationElectronic Medical Records Friend or Foe?
Friend or Foe? ED Categories Using an EMR In transition to an EMR Shopping for a different EMR There are many positive aspects of using an EMR: Improved Legibility Faster chart completion Prebuilt Templates
More informationHow To Write A Health Insurance Claim Form
Kim Huey, MJ, CPC, CCS-P, PCS, CPCO President, KGG Coding and Reimbursement Consulting April 16, 2015 Elements of Successful Coding in Your Practice Kim Huey, MJ, CPC, CCS P, PCS, CPCO for Medical Association
More informationElectronic Health Records: Issues, Concerns, and Best Practices
Electronic Health Records: Issues, Concerns, and Best Practices Financial Disclosures Paul Larson is a Senior Consultant with Corcoran Consulting Group. He acknowledges a financial interest in the subject
More information6/8/2012. Cloning and Other Compliance Risks in Electronic Medical Records
Cloning and Other Compliance Risks in Electronic Medical Records Lori Laubach, Partner, Moss Adams LLP Catherine Wakefield, Vice President, Corporate Compliance and Internal Audit, MultiCare 1 AGENDA Basic
More informationMitigating Coding Risks. Concerns with electronic records and overcoding. Balancing Medical Necessity and Meaningful Use 2/20/2014
in the EHR Sandy Giangreco, RHIT, CCS, RCC, CPC, CPC H, CPC I, COBGC, PCS Senior Consultant The Haugen Consulting Group Kim Huey, MJ, CPC, CCS P, PCS, CPCO KGG Coding and Reimbursement Consulting, LLC
More information9/15/2015. Learning objectives. Coding and compliance. Coding Compliance for the IDS Environment. Could Your Coding be Costing You Money?
Coding Compliance for the IDS Environment Could Your Coding be Costing You Money? Nancy Enos, FACMPE, CPC-I, CPMA, CEMC MGMA 2015 Annual Conference Learning objectives 1. Discover how administrators of
More informationPatient Progress Note & Dictation Standard
Objective: The patient progress note serves as a basis for planning patient care, documenting communication between the health care provider and any other health professional contributing to the patient's
More information04/03/2015. EMR Documentation and Compliance: The Retina Point of View. Financial Disclosure. Financial Disclosure
EMR Documentation and Compliance: The Retina Point of View William T. Koch, COA, COE, CPC The Retina Institute Kirk A. Mack, COMT, COE, CPC, CPMA Corcoran Consulting Group Financial Disclosure William
More informationThe file and the documentation should create a clean chronological record of the patient and their interactions with the provider.
Documentation and Coding Guidelines for Athletic Trainers Table of Contents What is documentation and why is it important? Documentation and SOAP What do payers want and why? General guidelines of medical
More informationE/M Documentation: Deal or No Deal? Documentation Guidelines. Documentation Elements 3/25/2013
E/M Documentation: Deal or No Deal? Presented by Maggie Mac, CPC, CEMC, CHC, CMM, ICCE and Dennis Mihale, MD Documentation Guidelines 1995 vs 1997 guidelines 95 for? 97 for? General Multi-System? Specialty
More informationBalancing Compliance & Quality Templates, Encounter Forms & Electronic Medical Records..
HCCA Physician Compliance Conference October 7, 2004 Georgette Gustin, CPC, CCS-P, CHC, Director PricewaterhouseCoopers and Marcia Myers, Esq. Partner Schottenstein, Zox & Dunn, Co., LPA Session Agenda
More informationNavigating Compliance Landmines in Electronic Health Record (EHR) Documentation
Navigating Compliance Landmines in Electronic Health Record (EHR) Documentation Brian T. Bates, CPA, CHC, MAc Corporate Compliance Officer University of Alabama Health Services Foundation, P.C. AHLA/HCCA
More information5/16/2014. Revenue Cycle Impact Documentation risks in an EMR AGENDA. EMR Challenges Related to Billing and Revenue Cycle
EMR Challenges Related to Billing and Revenue Cycle Lori Laubach, Principal Health Care Consulting California Primary Care Association Billing Managers Peer Conference May 20 21, 2014 1 The material appearing
More informationGone are the days when healthy
Five Common Coding Mistakes That Are Costing You Fix these problems to increase your bottom line. GREG CLARKE Emily Hill, PA-C Gone are the days when healthy third-party reimbursements meant practices
More informationNavigating Compliance Landmines in EHR Documentation
Navigating Compliance Landmines in EHR Documentation Brian T. Bates, CPA, CHC, Mac Corporate Compliance Officer University of Alabama Health Services Foundation, P.C. DISCLAIMER: The views and opinions
More informationHI-1018: The Electronic Health Record
Course Introduction Course Introduction HI-1018: The Electronic Health Record 6m Chapter 01 - Introduction Introduction History Medical Record History Medical Records Purpose Paper Electronic EMR versus
More informationMANAGING MEDICARE IN 2014: Fighting Back-Managing Claims. California Orthopaedic Association May 30, 2014
MANAGING MEDICARE IN 2014: Fighting Back-Managing Claims California Orthopaedic Association May 30, 2014 Healthcare System Changing Current orthopedic practices are evolving Only thing constant is change
More informationHow To Write A Code Of Conduct
Disclosures Behavioral Health Coding, Contracting and Billing, Part 1 Presented by Mimi Reed, BHSA, CPC A, MCP, MTA, Consultant, SCHA MI Mimi Reed, BHSA, CPC A, MCP, MTA, Consultant, SCHA MI Amy Valimont,
More informationMontefiore Medical Center Billing Compliance Department June 2007
HOUSE STAFF ORIENTATION Basic Coding, Teaching Physician Guidelines and Evaluation & Management Guidelines Montefiore Medical Center Billing Compliance Department June 2007 What is Medical Coding? Coding
More information8/28/2013. Lessons Learned in the EHR. Documentation risks in an EMR AGENDA
Lessons Learned in the EHR Lori Laubach, Partner Health Care Consulting Group 1 The material appearing in this presentation is for informational purposes only and is not legal or accounting advice. Communication
More informationInnerview Reimbursement in the Physician Office Setting * 2014
OVERVIEW This Guide is intended to assist with the process of billing and coding for Innerview, a Mental Health Clinical Decision Support System used in the primary care setting. Billing, coding and payment
More informationBest Practices: Physician Billing/Coding for Hospice & Palliative Care
Best Practices: Physician Billing/Coding for Hospice & Palliative Care Presented by: Christopher P. Acevedo, CHC, CPC Objectives Describe the circumstances that allow physician visits to be separately
More informationTennessee Primary Care Association: 2014 Annual Leadership Conference
CPAs & ADVISORS experience momentum // SETTING YOUR ORGANIZATION UP FOR SUCCESS: UNDERSTANDING THE COMPLEXITIES OF THE FQHC REVENUE CYCLE Tennessee Primary Care Association: 2014 Annual Leadership Conference
More informationLocal Coverage Article: Venipuncture Necessitating Physician s Skill for Specimen Collection Supplemental Instructions Article (A50852)
Local Coverage Article: Venipuncture Necessitating Physician s Skill for Specimen Collection Supplemental Instructions Article (A50852) Contractor Information Contractor Name CGS Administrators, LLC Article
More informationHOW TO PREVENT AND MANAGE MEDICAL CLAIM DENIALS TO INCREASE REVENUE
Billing & Reimbursement Revenue Cycle Management HOW TO PREVENT AND MANAGE MEDICAL CLAIM DENIALS TO INCREASE REVENUE Billing and Reimbursement for Physician Offices, Ambulatory Surgery Centers and Hospitals
More informationOptimizing Coding in Primary Care, Part 1
Learning Objectives Optimizing Coding in Primary Care, Part 1 Understand the financial impact of poor coding Correct common primary care coding errors Bill Dacey, MHA, MBA, CPC The Dacey Group, Inc. Palm
More informationCommon Misunderstandings & Mistakes in Dosimetry Coding & Documentation
Common Misunderstandings & Mistakes in Dosimetry Coding & Documentation AAMD Annual Meeting San Antonio, Texas June 2013 Presenters Kelli Weiss, RT(R)(T) Executive Director Adam Brown, BSRT(T), CMD Consultant
More informationMedical Necessity and Coding
Medical Necessity and Coding NEW MEXICO HEALTH INFORMATION MANAGEMENT ASSOCIATION FALL CODING WORKSHOP September 14, 2012 Hyatt Downtown Albuquerque, NM Presented by: Andrea Busby, RHIA ADHIMA, INC Goals
More informationProfessional Coders Role in Compliance
Professional Coders Role in Compliance Sponsored by 1915 N. Fine Ave #104 Fresno CA 93720-1565 Phone: (559) 251-5038 Fax: (559) 251-5836 www.californiahia.org Program Handouts Monday, June 8, 2015 Track
More informationMedical Documentation Barry H. Block, DPM, JD bblock@podiatrym.com
Medical Documentation Barry H. Block, DPM, JD bblock@podiatrym.com 1 Why is Documentation Important? Why is Documentation Important? Reimbursement 2 EMR DOCUMENTATION ABSURD ICD 10 CODE V97.33XD: Sucked
More informationUnintended Consequences of Electronic Health Records
Financial Disclosure Unintended Consequences of Electronic Health Records Mary Pat Johnson is a Senior Consultant at Corcoran Consulting Group and acknowledges a financial interest in the subject matter
More informationIntroduction 1/12/2015. Healthcare Reform Compliance and Audit Updates. Jon Weeding President CS EYE
Healthcare Reform Compliance and Audit Updates Jon Weeding President CS EYE This material is designed to offer basic information for creating a compliant atmosphere in the small private practice. The information
More informationEVALUATION AND MANAGEMENT SERVICES Q&A: HOW DOES YOUR MAC INTERPRET THE GUIDELINES?
EVALUATION AND MANAGEMENT SERVICES Q&A: HOW DOES YOUR MAC INTERPRET THE GUIDELINES? The following questions and answers were found on Medicare administrative contractors (MACs) web sites. Table cells were
More informationCoding for the Internist: The Basics
Coding for the Internist: The Basics Evaluation and management is the most important part of the practice for an internist and coding for these visits can have an important effect for the bottom line of
More informationWe Bring The Pieces Together For You
Modifier 25 Visit No how-de-do visits in Hematology Oncology MOASC Discussion of Meaningful Information Compliance Education We do it right. We Bring The Pieces Together For You NBC Neltner Billing & Consulting
More informationAAMC Compliance Officers Forum
Appropriate Documentation in an EHR: Use of Information That Is Not Generated During the Encounter for Which the Claim is Submitted: Copying/Importing/Scripts/Templates Purpose The ability of an electronic
More informationCoding for the Future!
Coding for the Future! American Society of Ophthalmic Registered Nurses November 11, 2012 Presented by Joy Newby, LPN, CPC, PCS Newby Consulting, Inc. 5725 Park Plaza Court Indianapolis, IN 46220 Voice:
More informationAMERICAN OSTEOPATHIC ASSOCIATION
AMERICAN OSTEOPATHIC ASSOCIATION October 10, 2012 Department of Practice Management and Delivery Innovations Presents: Audits and Denied Claims Billing & Coding for OMM: Addressing Practice Audits and
More informationEHR Software Feature Comparison
EHR Comparison ELECTRONIC MEDICAL RECORDS Patient demographics Manages the input and maintenance of patient information including demographics, insurance, contacts, referrals, notes and more. Consents
More informationCommon Billing Mistakes Costing Your ASC Money and Correct Modifier & Revenue Code Usage for ASC Claims
Common Billing Mistakes Costing Your ASC Money and Correct Modifier & Revenue Code Usage for ASC Claims October 2013 Beckers 20 th Annual ASC Conference Presenter: Stephanie Ellis, R.N., CPC, Speaker Ellis
More informationProvider Education Webinars. Course 1: Coding in Health Care: Introduction and Purpose
Provider Education Webinars Course 1: Coding in Health Care: Introduction and Purpose Community Health Plan of Washington Provider Education Webinar Course 1: Coding In Healthcare: Introduction and Purpose
More informationForms designed to collect this information will help staff collect all pertinent information.
1 CPT AUDIT TOOL INSTRUCTIONS The Nursing Consultants from the Public Health Nursing and Professional Development Unit based on multiple Evaluation & Management audits across the state have developed these
More informationCoding, billing and documentation tips for effective reimbursement. Beth Milligan, MD, FAAFP, CHCOM, CPE
Coding, billing and documentation tips for effective reimbursement Beth Milligan, MD, FAAFP, CHCOM, CPE Objectives Explain the importance of clinical documentation Understand the principles of documentation
More informationBilling, Coding and Reimbursement Guide
Billing, Coding and Reimbursement Guide Revised April 2014 Disclaimer: The information in this document has been compiled for your convenience and is not intended to provide specific coding or legal advice.
More informationUnderstanding Coding & Reimbursement for SBI. Presented By: Jen Cohrs CPC, CPMA, CGIC Director of Educational Strategies Wisconsin Medical Society
Understanding Coding & Reimbursement for SBI Presented By: Jen Cohrs CPC, CPMA, CGIC Director of Educational Strategies Wisconsin Medical Society CPT codes, descriptions and material only are Copyright
More informationAudit Challenges with E/M Services. Webinar Subscription Access Expires December 31.
Audit Challenges with E/M Services Questions Answers Webinar Subscription Access Expires December 31. How long can I access the on demand version? You will find that in the same instructions box you utilized
More information5/2/2014. Beginning Biller / Coder 101 Thursday, May 8 1:00 p.m. to 2:30 p.m. Disclaimer. Stay in touch through Facebook Please note
Disclaimer Beginning Biller / Coder 101 Thursday, May 8 1:00 p.m. to 2:30 p.m. Presented by: Judy B Breuker, CPC, CPMA, CCS P, CDIP, CHC, CHCA, CEMC, AHIMA Approved ICD 10 CM/PCS Trainer The class is intended
More informationPalliative Care Billing, Coding and Reimbursement
Palliative Care Billing, Coding and Reimbursement Anne Monroe, MHA Physician Practice Manager Hospice of the Bluegrass and Palliative Care Center of the Bluegrass Kentucky 1 Objectives Review coding and
More informationE/M Learning Tips INTRODUCTION TO EVALUATION. Introduction to Evaluation and Management (E/M) Coding for the Child and Adolescent Psychiatrist
INTRODUCTION TO EVALUATION AND MANAGEMENT (E/M) CODING FOR THE CHILD AND ADOLESCENT PSYCHIATRIST Benjamin Shain, MD, PhD David Berland, MD Sherry Barron-Seabrook, MD Copyright 2012 by the American Academy
More informationHow To Know If You Can Test For A Mental Health Test On A Medicare Card
Billing, Coding and Reimbursement Guide Updated January 2007 Disclaimer: The information in this document has been compiled for your convenience and is not intended to provide specific coding or legal
More information1. ICD-10-CM, SKILLED NURSING FACILITIES, AND LAB SERVICES
1. ICD-10-CM, SKILLED NURSING FACILITIES, AND LAB SERVICES 1.1 ICD-10-CM, SKILLED NURSING FACILITIES, AND LAB SERVICES Welcome to the ICD-10-CM, Skilled Nursing Facilities, and Lab Services training. Please
More informationUNRAVELING THE MYSTERY OF INSURANCE AUDITS. Deborah J. Winegard Of Counsel Whatley Kallas, LLP
UNRAVELING THE MYSTERY OF INSURANCE AUDITS Deborah J. Winegard Of Counsel Whatley Kallas, LLP 1 PHYSICIANS ADVOCACY INSTITUTE PAI Founded in 2006 as Result of MDL Managed Care Litigation, in which MSNJ
More informationProtect and Improve Profitability in Your Practice. Positioning Your Organization for a RAC Audit
Protect and Improve Profitability in Your Practice Positioning Your Organization for a RAC Audit 2011 Annual Educational Seminar March 9, 2011 Presented By: Cindy Tipton-Cain, Exec. Director Physician
More informationTHE VALUE OF A COMPLETE CODING QUALITY AUDIT PROGRAM. By Lisa Marks, RHIT, CCS, Coding Audit Director, Precyse
THE VALUE OF A COMPLETE CODING QUALITY AUDIT PROGRAM By Lisa Marks, RHIT, CCS, Coding Audit Director, Precyse TRUE OR FALSE: One coding audit a year of a random sample of 30 charts per coder is sufficient
More informationMEDICAL AUDITS: TOP TEN TIPS FOR PHYSICIANS TO ANTICIPATE, RESPOND AND PROTECT THEIR PRACTICES
MEDICAL AUDITS: TOP TEN TIPS FOR PHYSICIANS TO ANTICIPATE, RESPOND AND PROTECT THEIR PRACTICES The pressure on both governmental and private payers to reduce the cost of healthcare and the often mistaken,
More informationModifiers 25 and 59. Modifier 25
Modifiers 25 and 59 This article discusses the appropriate use of modifier 25, Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure
More informationThe Third National Medicare RAC Summit
The Third National Medicare RAC Summit Major Hospital Vulnerabilities II: Medical Necessity and Clinical Documentation Issues in Medicaid and RAC Audits Edmund L. Lafer, MD Temple University Health System
More informationEMRs Are Great...Look at all the Documentation They Do for Me!
EMRs Are Great...Look at all the Documentation They Do for Me! Sandy Giangreco, RHIT, CCS, CPC, CPC-H, CPC-I, PCS - Director of Consulting Coding Strategies, Inc Agenda Why move to an EMR Journal of AHIMA
More informationThe Business of Optometry
The Business of Optometry Carl H. Spear, OD, MBA, FAAO April Jasper, OD, FAAO Optometry is a Business A Five Year Picture Would you recommend your children go to Optometry School? Total U.S. Vision Care
More informationMedical Necessity LMHS Medical Staff Education Presented by:
Medical Necessity LMHS Medical Staff Education Presented by: Lee Memorial Health System Corporate Compliance Department 1 June 2014 Medical Necessity Is it Reasonable and Necessary? Medicare Definition:
More informationWilliam Rusty Huseman 3733 University Blvd. West, Suite 305-A Jacksonville, FL 32217
William Rusty Huseman est, Email: Rusty@husemanhealthlaw.com 1 Audit & Compliance Audit Who can audit your practice? What to expect? What to do if you are audited? Compliance 2 What you MUST have in place
More informationIMPLEMENTING AND MAINTAINING ELECTRONIC MEDICAL RECORDS
IMPLEMENTING AND MAINTAINING ELECTRONIC MEDICAL RECORDS A Guide to EMR Utilization and Compliance Risks for s, IT Professionals, and Administrators Prepared by: Dawnese Kindelt, CPC, CHC - System Compliance
More informationThe Collaborative Models of Mental Health Care for Older Iowans. Model Administration. Collaborative Models of Mental Health Care for Older Iowans 97
6 The Collaborative Models of Mental Health Care for Older Iowans Model Administration Collaborative Models of Mental Health Care for Older Iowans 97 Collaborative Models of Mental Health Care for Older
More informationRevenue Cycle Responsibilities. Revenue Cycle. Objectives 4/9/2013
Revenue Cycle Kathryn DeVault, RHIA, CCS, CCS-P AHIMA 2013 Objectives Identify responsibilities within the Revenue Cycle Focus on management of the revenue cycle process Discuss the revenue cycle process
More informationNon-Physician Practitioner Services Coding & Reporting. Karla R. Peter, RHIT, CCS, CCS-P, CPC Avera Health September 6, 2013
Non-Physician Practitioner Services Coding & Reporting Karla R. Peter, RHIT, CCS, CCS-P, CPC Avera Health September 6, 2013 Medical Necessity Overarching Criterion Medicare Claims Processing Manual, Chapter
More information5/1/2015. Mary Ellen Duffy, MBA, FACMPE, CHBME
Mary Ellen Duffy, MBA, FACMPE, CHBME 1 To crack down on the people and organizations who abuse the system and cost Americans billions of dollars each year. Detroit: 2013 brought charges in fraud schemes
More informationRegion V Training Project 3rd Party Billing Practices for Title X Clinics Outline October 13, 2011
1 Region V Training Project 3rd Party Billing Practices for Title X Clinics Outline October 13, 2011 The "Affordable Care Act" is coming on-line and has significant implications for the provision of Reproductive
More informationEvaluation and Management Services Documentation and Level of Service
Evaluation and Management Services Documentation and Level of Service The purpose of this article is to remind providers that medical necessity and the patient s condition are the foundation for correctly
More informationE&M Coding- It s All About The Documentation
E&M Coding- It s All About The Documentation Presented for Anthem Blue Cross and Blue Shield By: Penny Osmon, BA, CPC Coding & Reimbursement Educator WI Medical Society Wisconsin Medical Society, Copyright
More informationDocumentation Guidelines for Physicians Interventional Pain Services
Documentation Guidelines for Physicians Interventional Pain Services Pamela Gibson, CPC Assistant Director, VMG Coding Anesthesia and Surgical Divisions 343.8791 1 General Principles of Medical Record
More informationHot Topics in E & M Coding for the ID Practice
Hot Topics in E & M Coding for the ID Practice IDSA Webinar February, 2010 Barb Pierce, CCS-P, ACS-EM Consulting, LLC barbpiercecoder@aol.com www.barbpiercecodingandconsulting.com Disclaimer This information
More informationA GUIDE TO EVALUATION & MANAGEMENT CODING AND DOCUMENTATION
A GUIDE TO EVALUATION & MANAGEMENT CODING AND DOCUMENTATION Produced by ConnectiCare, Inc. in conjunction with its affiliate Group Health Incorporated TABLE OF CONTENTS Summary and Overview...Page 3 Part
More informationEHR: The Good, Bad, and Ugly
EHR: The Good, Bad, and Ugly Jonathan W. Lohr President Unibase Healthcare Solutions Kevin J. Corcoran, COE, CPC, CPMA, FNAO President, Corcoran Consulting Group Founder, Corcoran Compliance Connection
More informationBe Prepared or Be Prey
Be Prepared or Be Prey By Evan M. Gwilliam MBA, DC, CPC, CPC-I, CCPC, CPMA, NCICS, CCCPC, MCS-P SUMMARY Compliance is not a dirty word; it s the opposite. It makes an office cleaner, and it s now mandatory
More informationAreas of Compliance. Compliance. What Are the Compliance Plan Objectives? Plan Relevance. The Plan Formalizes the Objectives. Compliance Plan Benefits
Areas of Compliance Compliance Medicare rules and regulations HIPAA Patient privacy Security of data Patient Identity Protection (FACTA) Red-flag rules Plan Relevance The Compliance Plan is similar to
More informationCo$tly Coding Errors AMERICAN ACADEMY OF OPHTHALMOLOGY AMERICAN ACADEMY OF OPHTHALMIC EXECUTIVES
Co$tly Coding Errors Financial Disclosure Sue Vicchrilli, COT, OCS AAO Director, Coding & Reimbursement has no financial interests or relationships relative to this live activity to disclose. Error #1
More informationQuality Coding on a Shoestring Budget, aka Surfing for Success Websites
Quality Coding on a Shoestring Budget, aka Surfing for Success Websites Resources for Coders: http://www.aapc.com/resources/index.aspx Search Engines: http://www.google.com http://www.yahoo.com http://www.askjeeves.com
More informationThe Official Guidelines for coding and reporting using ICD-9-CM
Reporting Accurate Codes In the Era of Recovery Audit Contractor Reviews Sue Roehl, RHIT, CCS The Official Guidelines for coding and reporting using ICD-9-CM A set of rules that have been developed to
More informationMEDICARE PAYMENTS FOR DIAGNOSTIC RADIOLOGY SERVICES IN EMERGENCY DEPARTMENTS
Department of Health and Human Services OFFICE OF INSPECTOR GENERAL MEDICARE PAYMENTS FOR DIAGNOSTIC RADIOLOGY SERVICES IN EMERGENCY DEPARTMENTS Daniel R. Levinson Inspector General April 2011 OEI-07-09-00450
More informationUniversity of Utah Health Sciences Center DEPARTMENT OF PEDIATRICS COMPLIANCE PLAN
University of Utah Health Sciences Center DEPARTMENT OF PEDIATRICS COMPLIANCE PLAN May 2006 Table of Contents PREAMBLE... 1 OVERVIEW... 1 DEPARTMENTAL COMPLIANCE OVERSIGHT... 1 Department Compliance Liaison...1
More informationFAQs on Billing for Health and Behavior Services
FAQs on Billing for Health and Behavior Services by Government Relations Staff January 29, 2009 Practicing psychologists are eligible to bill for applicable services and receive reimbursement from Medicare
More informationSession 303 How to Use Scorecards to Manage Revenue Cycle Compliance
Session 303 Manage Revenue Cycle Compliance M. Aaron Little, CPA CPAs & ADVISORS BKD, LLP Managing Director mlittle@bkd.com Patrick Brown, MBA, MS Penn Home Care & Hospice Services Chief Financial Officer
More informationEnsure that coders and physicians understand the intricacies of medical necessity
Ensure that coders and physicians understand the intricacies of medical necessity JANUARY 14, 2009 JustCoding.com - January 14, 2009 by Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, PCS, FCS, C-CDIS Medical
More informationDocumenting an Outpatient Visit
Documenting an Outpatient Visit Part 1: Overview of Basic Principles This education is Part 1 of a 9 -part series on documenting and selecting the level of service for outpatient visits. All presentations
More informationHow To Use An Ehr
Compliance Considerations in the World of an EHR Jackie Smith, CHC, CHPC Network Privacy & Compliance Officer Community Health Network April 8, 2014 Community Health Network 7 Hospitals, 12 Outpatient
More informationEssential Vocabulary Common Procedural Terminology Relative Value Update Committee Relative Value Units
Billing and Coding Prepared for the AAOS: Business, Policy and Practice Management in Orthopaedics William Beach, MD Orthopaedic Research of Virginia Julie Balch Samora, MD, PhD, MPH The Ohio State University
More information10 ways to improve medical practice profitability
10 ways to improve medical practice profitability How M-Scribe document specialists with coding and billing expertise can help you get there Learn how to achieve maximum reimbursement, and still avoid
More informationHow Physicians Get Paid: It's as Easy as: CMS, RVUs, ICD-9, and CPT
How Physicians Get Paid: It's as Easy as: CMS, RVUs, ICD-9, and CPT Aaron Michelfelder, M.D. Associate Professor of Family Medicine, and Bioethics & Health Policy Goals Define the Acronyms CMS, RVU, ICD-9,
More informationDisclaimer CODING 101 BOOT CAMP CODING SEMINAR FOR NEW PHYSICIANS
CODING 101 BOOT CAMP CODING SEMINAR FOR NEW PHYSICIANS AND STAFF Chicago Dermatological Society January 26, 2013 Presented by Joy Newby, LPN, CPC, PCS Newby Consulting, Inc. 5725 Park Plaza Court Indianapolis,
More information