10 Tips for Complying With Laboratory Services Documentation Requirements

The Centers for Medicare & Medicaid Services (CMS) reported that the majority of improper payments for laboratory services identified by the Comprehensive Error Rate Testing (CERT) Program were attributable to insufficient documentation. Insufficient documentation means that something was missing from the medical records (e.g., signed physician order, documentation to support intent to order, documentation to […]

Free Urology Coding and Billing Resource: American Urological Association’s Urological Surgery Procedures Q&A

The American Urological Association provides a free, valuable urology coding and billing resource that you can access regardless of whether or not you are a member of AUA. On its website, the AUA addresses several urology surgical procedure coding and billing questions. These questions include the following: A cystectomy and continent diversion was performed on […]

Insufficient Documentation Triggering Improper Payments for Laparoscopic Hernia Repair

Insufficient documentation has long been understood as a cause of many improper payments for laparoscopic hernia repairs. This was validated a while back when a Comprehensive Error Rate Testing (CERT) contractor conducted a special study of medical billing claims for laparoscopic hernia repairs. When CERT reviews a claim, all lines submitted on the claim undergo […]

Medicare Provides Guidance on Billing for Implantable Automatic Defibrillators

At one time, Centers for Medicare & Medicaid Services (CMS) found that approximately 85% of improper payments relating to the billing of implantable automatic defibrillators were due to insufficient documentation. The figure was determined through a Comprehensive Error Rate Testing (CERT) program’s special study of Healthcare Common Procedure Coding System (HCPCS) code 33249 (Insertion or […]

August Bulletin – National Coverage Determination Updates

National Coverage Determination Updates Effective October 1, 2022, there will be several updates to the National Coverage Determination (NCD) guidelines that are implemented by the Centers for Medicare & Medicaid Services (CMS). The following NCDs are being updated to include changes for the 2023 fiscal year: NCD 150.3 Bone Density Studies NCD 160.18 Vagus Nerve […]