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 […]
FAQs About Medicare Coverage of Chiropractic Services
CMS has addressed more than a dozen of the most frequently asked questions about Medicare coverage of chiropractic services over the years. These questions — and the responses provided by CMS, edited for readability — are as follows: Q: Are there any visit caps or limits for chiropractic services? A: No. There are no caps/limits […]
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 […]
Medicare Provides Guidance on Proper Coding of Facet Joint Injections
Over the years, Medicare has provided guidance on how to properly code facet joint injections. This education effort largely began after the Medicare Recovery Audit Program identified facet joint injection claims resulting in overpayments. Medicare has noted that it will consider facet joint blocks to be reasonable and necessary for chronic pain (persistent pain for […]
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 […]
January 2023 Bulletin: Billing Reminders Part 2: Secondary Payers
Billing Reminders for the New Year – Part 2 Medicare Secondary Payer: Sometimes, a member will have Medicare as a secondary payer. In this case, it is mandatory that the Medicare Secondary Payer (MSP) code be entered on the claim form. This can be found on Availity or the Medicare web portal. Common MSP codes […]
January 2023 Bulletin: Billing Reminders Part 1 – Eligibility & Benefits
Billing Reminders for the New Year – Part 1 Eligibility & Benefits: With a new year comes new insurance policies for patients across the country. It is important to remember that many patients change plans at the start of a new year so verifying benefits and eligibility is a must. While some patients keep the […]
December 2022 Bulletin – COVID-19 Vaccine Updates
COVID-19 Vaccine Updates The holiday season has the potential to bring a new wave of COVID-19, so understanding what vaccines are right for you is vital to keep you and your family members safe. As of December 22, 2022, the Centers for Disease Control and Prevention (CDC) provided updates on what you need to know […]