10 Best Practices to Ensure Successful Credentialing

Whether you operate an in-house credentialing program or outsource your credentialing, there are many best practices to follow to ensure your program delivers timely credentialing and re-credentialing results that do not keep your physicians from providing care. Here are 10 helpful tips to help ensure your physicians are successfully credentialed and re-credentialed, and provide the […]

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 […]

Free Training Course on ICD-10 Diagnosis Codes

The Centers for Medicare & Medicaid Services (CMS) offers a free web-based training (WBT) course on “Diagnosis Coding: Using the ICD-10-CM.” It includes ICD-10 implementation guidance, information on the new ICD-10-CM classification system and coding examples. By the end of the training, CMS indicated participants should be able to: Recognize the ICD-10-CM/PCS implementation date; Identify […]