Jill M. Young, CPC, CEDC, CIMC Young Medical Consulting, LLC East Lansing, MI 4883
|
|
- Thomas Grant
- 6 years ago
- Views:
Transcription
1 Jill M. Young, CPC, CEDC, CIMC Young Medical Consulting, LLC East Lansing, MI 4883 This material is designed to offer basic information for coding and billing. The information presented here is based on the experience, training, and interpretation of the author. Although the information has been carefully researched and checked for accuracy and completeness, the instructor does not accept any responsibility or liability with regard to errors, omissions, misuse, or misinterpretation. This handout is intended as an educational a guide and should not be considered a legal/consulting opinion 2 1
2 The Social Security Act, Section 1862 (a)(1)(a) states: "No payment will be made... for items or services...not reasonable and necessary for the diagnosis or treatment of an injury or illness or to improve the functioning of a malformed body member. Overarching criterion for the payment for all services billed to Medicare Medical reasonableness and necessity 3 Even if a "complete" note is generated, only the medically reasonable and necessary services for the condition of the particular patient at the time of the encounter as documented can be considered when selecting the appropriate level of an E/M service. Information that has no pertinent to the patient's situation at that specific time cannot be counted. Priority Health 4 2
3 Cut & Paste Macros/ Cloned EHR Compliance Pre- Populated Template Carry Forward 5 CMS does not prohibit the use of templates to facilitate recordkeeping. CMS also does not endorse or approve any particular templates. A physician/lcmp may choose any template to assist in documenting medical information. Some templates provide limited options and/or space for the collection of information such as by using check boxes, predefined answers, limited space to enter information, etc. CMS discourages the use of such templates. Claim review experience shows that that limited space templates often fail to capture sufficient detailed clinical information to demonstrate that all coverage and coding requirements are met. Medicare Program Integrity Manual Chapter 3 Transmittals for Chapter
4 Physician/LCMPs should be aware that templates designed to gather selected information focused primarily for reimbursement purposes are often insufficient to demonstrate that all coverage and coding requirements are met. This is often because these documents generally do not provide sufficient information to adequately show that the medical necessity criteria for the item/service are met. If a physician/lcmp chooses to use a template during the patient visit, CMS encourages them to select one that allows for a full and complete collection of information to demonstrate that the applicable coverage and coding criteria are met. Medicare Program Integrity Manual Chapter 3 Transmittals for Chapter Structured templates have the potential for charting by exception Findings are prerecorded/pre-populated as negative Clinician documenting the record must specifically change a data set to record a positive finding If EMR automatically fills in documentation May lead to "over-document Leads to selecting and billing a higher E/M code than medically reasonable and necessary. 8 4
5 45 out of 100 claims analyzed were paid in error Also noted that patterns of over coding services were found with template-generated records. Trailblazers 9 Providers may use templates, checklists, and/or electronic medical records to assist in documenting services and saving time. Medicare considers these as acceptable documentation. However, the documentation submitted must be specific to the patient and the service in question. 10 5
6 CMS condemns it. Payers won t reimburse for it. Auditors will take you to task for it but vendors flaunt it and physicians embrace it unreservedly. What s wrong with using an EHR to automatically copy information from one patient note to the next? The time-saving practice known as cloning is one of the things that makes EHRs so popular, and yet the government sees it as a breeding ground for fraud and abuse. EHR Intelligence January 'cloning' refers to documentation that is worded exactly like previous entries. This may also be referred to as 'cut and paste' or 'carried forward.' Cloned documentation may be handwritten, but generally occurs when using a preprinted template or an Electronic Health Record (EHR). While these methods of documenting are acceptable, it would not be expected the same patient had the same exact problem, symptoms, and required the exact same treatment or the same patient had the same problem/situation on every encounter. Palmetto Medicare Noridian Medicare 6
7 Cloned documentation does not meet medical necessity requirements for coverage of services. Identification of this type of documentation will lead to denial of services for lack of medical necessity and recoupment of all overpayments made. CGS Medicare Palmetto Medicare Noridian Medicare Cloned documentation will be considered misrepresentation of the medical necessity requirement for coverage of services due to the lack of specific individual information for each unique patient. Identification of this type of documentation will lead to denial of services. They warned doctors that it would refuse to pay them if they submitted cloned documentation. NGS 14 7
8 Definition When each entry in the medical record for a beneficiary is worded exactly like or similar to the previous entries. When medical documentation is exactly the same from beneficiary to beneficiary Cutting-and-pasting the information entered in the Electronic Medical Record (EMR) from one date of service to another Cloned documentation does not meet medical necessity requirements for coverage of services Lack of specific, individual information Documentation must be specific to the patient and her/his situation at the time of the encounter Priority Health 15 Cloning of documentation is considered a misrepresentation of the medical necessity requirement for coverage of services. Falsification of medical record Do not pertain to specific visit to which they are added Identification of this type of documentation will lead to denial of services for lack of medical necessity and recoupment of all overpayments made. Failure to provide appropriate documentation to support a billed service Priority Health 16 8
9 Study by the Society of Critical Care Medicine 82% of medical residents and 74% of attendings copy and paste more than 20% of their EHR patient progress notes from one session to the next. The authors found that after a vacation day, 94% of attendings copied information from their own notes, with cloned information making up an average of 61% of the new progress note. 17 HHS Only 24% of hospitals have any policy regarding cut and paste 61% of the policies shift the responsibility to the user to verify data is correct 44% hospitals audit log systems could record whether cut and past was used to enter data 44% hospitals can delete contents of internal audit logs anytime 18 9
10 unique information should be entered into EHRs for every yp patient, but notes that EHR vendors should not necessarily be blamed if physicians over-rely on default features. Instead, EHR users should keep communications with vendors open in order to customize their EHR software. Jeremy Duca NGC warns against cloned notes 19 Computers do not have logic Computers do not have common sense Document what was done E&M codes must be based on medical necessity 20 10
11 Alphabetizing diagnoses Counseling & Coordinating care Although total time and counseling time were entered, final printout only shows greater than 50% What does final report actually look like How does normal translate for ROS or Exam ROS negative except for HPI 21 Physicians selecting diagnosis code numbers Training Specificity Coding guidelines 22 11
12 Defined as Examination of the entire colon From the rectum to the cecum May include examination of the terminal ileum or small intestine proximal to an anastomosis. Additional comments in section Use of modifier 52 & 53 CMS has defined four new HCPCS modifiers to selectively identify subsets of Distinct Procedural Services (-59 modifier) as follows: XE - Separate Encounter, A Service That Is Distinct Because It Occurred During A Separate Encounter XS - Separate Structure, A Service That Is Distinct Because It Was Performed On A Separate Organ/Structure XP - Separate Practitioner, A Service That Is Distinct Because It Was Performed By A Different Practitioner XU - Unusual Non-Overlapping Service, The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service 12
13 These modifiers, collectively referred to as - X{EPSU} modifiers, define specific subsets of the -59 modifier. CMS will not stop recognizing the -59 modifier but notes that CPT instructions state that the -59 modifier should not be used when a more descriptive modifier is available. The -X{EPSU} modifiers are more selective versions of the -59 modifier so it would be incorrect to include both modifiers on the same line. Old with or without New including when performed Old bowel New intestine 13
14 Under the new process, payment changes will go through notice and comment rulemaking before being adopted beginning for We are also proposing to define screening colonoscopy to include anesthesia so that beneficiaries do not have to pay coinsurance on the anesthesia portion of a screening colonoscopy when furnished by an anesthesiologist. jill@youngmedconsult.com 28 14
15 15
Lessons Learned in the EHR
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 informationCloning 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 informationAddressing Documentation Insufficiencies
Objectives Addressing Documentation Insufficiencies ICAHN June 9,2015 Glenn Krauss, BBA, RHIA, CCS, FCS, PCS,CCS-P, CPUR, C-CDI, CCDS, C- DAM Understand and appreciate physician frustrations with the EHR
More informationCoding, Corroboration, and Compliance How to assure the 3 C s are met
Coding, Corroboration, and Compliance How to assure the 3 C s are met Sue Roehl, RHIT, CCS sroehl@eidebailly.com 701-476-8770 OIG 1996 - $23.2 Billion errors Figure 1 Insufficient/No documentation 46.76%
More informationElectronic Health Records - Advantages and Pitfalls of Documentation
Electronic Health Records - Advantages and Pitfalls of Documentation Kansas City, KS HCCA Regional Conference September 25, 2015 1:00 P.M. 2:00 P.M. Presented by: Cynthia A. Swanson, RN, CPC, CEMC, CHC,
More informationGeneral Documentation Compliance. Review for Provider Reappointment
U N C U H N E C A L H T E H A L C T A H R E C A S R Y E S T E M General Documentation Compliance Review for Provider Reappointment May 2018 Objectives 1 2 Review the principles of compliant billing and
More informationManaging Towards Compliance
Managing Towards Compliance Presented by Bruce Rappoport, MD, CPC, CPCO AAPC National Conference April 14, 2014 Disclaimer This presentation is designed to provide educational information in regard to
More information9/17/2018. Critical to Practices
Critical to Practices Provides: Reviewing quality of care provided to patients. Education to providers on documentation guidelines. Ensuring all services are supported, and revenue captured. Defending
More informationThe EHR says it s a 99215
The EHR says it s a 99215 Angela Jordan, CPC, COBGC, AAPC Fellow Senior Managing Consultant AAPC National Advisory Board, Southwest AAPCCA BOD Chair 2012-2013 Leveling E/M services in an EHR can be perilous.
More informationAdvanced E/M Auditing: Secrets to Success
Advanced E/M Auditing: Secrets to Success Presented by Carrie Severson CPC, CPC-H, CPMA, CPC-I Senior Auditor, AAPC Client Services Why We Are Here OIG Report (OEI-04-10-00180) Coding Trends of Medicare
More informationCoding Complexities of Critical Care
Coding Complexities of Critical Care Jill Young, CPC, CEDC, CIMC Young Medical Consulting, LLC East Lansing, Michigan 1 Disclaimer This material is designed to offer basic information for coding and billing.
More information1/21/2011. Cindy C. Parman, CPC, CPC H Coding Strategies, Inc.
Cindy C. Parman, CPC, CPC H Coding Strategies, Inc. www.codingstrategies.com The format and/or content of this presentation is copyright 2011 by Coding Strategies, Inc. (CSI), Powder Springs, GA. This
More informationProviderNews2015. a growing issue TEXAS. Body mass index and obesity: Tips and tools for tackling
TEXAS ProviderNews2015 Quarter 2 Body mass index and obesity: Tips and tools for tackling a growing issue For adults, overweight and obesity ranges are determined by using weight and height to calculate
More informationEvaluation and Management Auditing Back to the Basics. Objectives. Audit Start with the benchmarks CMS MEDPAR by specialty 4/22/2013
Evaluation and Management Auditing Back to the Basics E&M Audit Sonda Kunzi, CPC, CPMA, CPPM, CPC-I Associate Director, Cohen Healthcare Consulting Ltd. Objectives Discuss good basic audit techniques Review
More informationThe Electronic Medical Record: Auditing the Copy and Paste Function
The Electronic Medical Record: Auditing the Copy and Paste Function Presented by: Kathleen Enniss CPC CHC Compliance Analyst UW Medicine Compliance University of Washington kenniss@uw.edu The EMR: Positive
More informationCertified Ophthalmic Executive (COE) Review Day
Certified Ophthalmic Executive (COE) Review Day Compliance Plan & Chart Audits Financial Disclosure The instructor acknowledges a financial interest in the subject matter of this presentation. Presented
More informationE&M Coding Pitfalls Jill Young, CPC, CIMC, CEDC. Young Medical Consulting, LLC East Lansing, Michigan
1 E&M Coding Pitfalls Jill Young, CPC, CIMC, CEDC Young Medical Consulting, LLC East Lansing, Michigan 2 Disclaimer This material is designed to offer basic information for coding and billing. The information
More informationPayment Policy: High Complexity Medical Decision-Making Reference Number: CC.PP.051 Product Types: ALL
Payment Policy: High Complexity Medical Decision-Making Reference Number: CC.PP.051 Product Types: ALL Effective Date: 6/2017 Last Review Date: See Important Reminder at the end of this policy for important
More informationEVALUATION AND MANAGEMENT: GETTING PAID FOR WHAT YOU DO
EVALUATION AND MANAGEMENT: GETTING PAID FOR WHAT YOU DO Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO Sandy Giangreco, RHIT, CCS, CCS-P, CHC, CPC, COC, CPC-I, COBGC Agenda 2014 OIG Report CMS Documentation
More informationEvaluation and Management Services
Evaluation and Management Services Print 1. If a physician sees a patient in the morning and again in the afternoon for a new or worsened condition, do we report modifier 25 for the second visit? 2. When
More informationCompliant Documentation for Coding and Billing. Caren Swartz CPC,CPMA,CPC-H,CPC-I
Compliant Documentation for Coding and Billing Caren Swartz CPC,CPMA,CPC-H,CPC-I caren@practiceintegrity.com Disclaimer Information contained in this text is based on CPT, ICD-9-CM and HCPCS rules and
More informationCOMPLIANCE ALERT. Department Chairs, Compliance Leaders, and UFJPI Management
UNIVERSITY OF FLORIDA COLLEGE OF MEDICINE - JACKSONVILLE Office of Physician Billing Compliance 653-1 West 8 th Street, LRC-3 Jacksonville, Florida 32209 Phone: (904) 244-2158 Fax: (904) 244-5323 COMPLIANCE
More informationA Physician Led Comprehensive Coding Compliance Program: Datamining to Disciplinary Action Plans. Optimizing revenue from a compliance perspective
A Physician Led Comprehensive Coding Compliance Program: Datamining to Disciplinary Action Plans Keith Ponitz, M.D. October 16,2012 Agenda Background Optimizing revenue from a compliance perspective Mitigate
More informationAgenda. National Landscape. Background. Optimizing revenue from a compliance perspective. Mitigate the risk: Data mining and coding audits
A Physician Led Comprehensive Coding Compliance Program: Datamining to Disciplinary Action Plans Keith Ponitz, M.D. October 16,2012 Agenda Background Optimizing revenue from a compliance perspective Mitigate
More informationDoris V. Branker, CPC, CPC-I, CEMC
Doris V. Branker, CPC, CPC-I, CEMC 1 Identify the common sources for missed reimbursement in the specialty practice Identify the common sources for reduced reimbursement in the specialty practice Identify
More informationChronic Care Management. Sharon A. Shover, CPC, CEMC 2650 Eastpoint Parkway, Suite 300 Louisville, Kentucky
Chronic Care Management Sharon A. Shover, CPC, CEMC 2650 Eastpoint Parkway, Suite 300 Louisville, Kentucky 40223 502.992.3511 sshover@blueandco.com Agenda Chronic Care Management (CCM) History Define Requirements
More informationAcromioclavicular Joint Billing
Acromioclavicular Joint Billing October 27, 2016 When our physician performs an injection into the acromioclavicular (AC) joint of a patient in the office, can we bill 20610 for a large joint arthrocentesis?
More informationCPT and HCPCS Modifiers Payment Policy
Policy Blue Cross Blue Shield of Massachusetts (Blue Cross*) accepts industry-standard modifiers to allow for clear provider reporting of services and accurate claims processing. Modifiers designate a
More information1:35. NPP April Young Medical Consulting, LLC. Non-Physician Practitioner Coding and Billing. Disclaimer
Non-Physician Practitioner Coding and Billing Jill Young - CPC, CEDC, CIMC, East Lansing, Michigan 1 Disclaimer This material is designed to offer basic information for coding and billing. The information
More informationMeet the Presenter. HCPCS Reimbursement Impacts the Bottom Line. Welcome to PMI s Webinar Presentation. On the topic:
Welcome to PMI s Webinar Presentation Brought to you by: Practice Management Institute pmimd.com Meet the Presenter Rhonda Granja CMC, CMIS, CMOM, CPC, CPM, MCS Faculty Practice Management Institute On
More informationEMR Issues with Documentation, Coding and Audits
Financial Disclosure EMR Issues with Documentation, Coding and Audits Donna McCune, CCS-P, COE, CPMA Vice President Corcoran Consulting Group The instructor is a consultant for Corcoran Consulting Group
More informationThe Transition to Version 5010 and ICD-10
The Transition to Version 5010 and ICD-10 An Overview Denise M. Buenning, MsM Director, Administrative Simplification Group Office of E-Health Standards and Services Centers for Medicare & Medicaid Services
More informationAre they coming to get you! Todd Thomas, CCS-P
Are they coming to get you! Todd Thomas, CCS-P Who is coming for you? Medicare Administrative Contractors (MACs) Recovery Audit Contractors (RACs) Medicaid Recovery Audit Contractors (MACs) Comprehensive
More informationMedicare Reimbursement Challenges. Financial Interest CPOE. Current Issues CPOE CPOE. Rose & Associates
Medicare Reimbursement Challenges Financial Interest ASCRS-ASOA Symposium & Congress Practice Management Program San Diego, California April 17-21, 2015 Presented by: E. Ann Rose I acknowledge a financial
More information2019 Evaluation and Management Coding Advisor. Advanced guidance on E/M code selection for traditional documentation systems
2019 Evaluation and Management Coding Advisor Advanced guidance on E/M code selection for traditional documentation systems POWER UP YOUR CODING with Optum360, your trusted coding partner for 32 years.
More informationMelody S. Irvine CPC, CPMA, CEMC, CFPC, CPC-I, CCS-P, CMRS
Melody S. Irvine CPC, CPMA, CEMC, CFPC, CPC-I, CCS-P, CMRS This presentation is for general education purposes only. The information contained in these materials, lecture, ideas and concepts presented
More informationCompliance Advisory 3 A Challenge for the Electronic Health Record s of Academic Institutions : Purpose Background
Compliance Advisory 3 A Challenge for the Electronic Health Records of Academic Institutions: Physicians combining documentation or using information documented by others when billing for a professional
More informationModifier Reference Policy
REIMBURSEMENT POLICY Modifier Reference Policy Policy Number 2018R0111A Annual Approval Date 11/15/2017 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You
More informationMedicare Reimbursement Challenges. Financial Interest. Current Issues. Rose & Associates
Medicare Reimbursement Challenges ASCRS-ASOA Symposium & Congress Practice Management Program Boston, Massachusetts April 25-29, 2014 Presented by: E. Ann Rose Financial Interest E. Ann Rose is President
More informationModifier Reference Policy
Modifier Reference Policy Policy Number 2017R0111I Annual Approval Date 11/15/2017 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS You are responsible for submission of accurate
More informationICD-10 Frequently Asked Questions
ICD-10 Frequently Asked Questions September 2015 pulseinc.com + 1.800.444.0882 We care for your practice, as if it were our own. Acknowledgments Document Number: 01 Date: September 7, 2015 Pulse Systems
More informationCoding for the Practitioner
Coding for the Practitioner Prepared for Coalition of State Rheumatology Organizations National Rheumatology Fellows Conference February 2018 Presented by: Jean Acevedo, LHRM, CPC, CHC, CENTC Disclaimer
More informationCotiviti Approved Issues List as of February 26, 2018
Cotiviti Approved Issues List as of February 26, 2018 All physician/npp specialties 32 Ambulance Providers 34 Ambulatory Surgery Center (ASC), Outpatient Hospital 38 Inpatient Hospital 40 Inpatient Hospital,
More informationCDx ANNUAL PHYSICIAN CLIENT NOTICE
CDx ANNUAL PHYSICIAN CLIENT NOTICE - 2018 CDX Diagnostics is providing this annual notice in accordance with the recommendations made by the Office of Inspector General (OIG) as part of our CDx Compliance
More informationGetting Started with OIG Compliance
Getting Started with OIG Compliance Kathy Mills Chang, MCS-P CCPC Do You Feel Like This? Or This? Does Your Business Deserve the Same Focus Your Patients Do? How This Training Will Protect You! Stay within
More informationBEFORE THE ALASKA OFFICE OF ADMINISTRATIVE HEARINGS ON REFERRAL FROM THE COMMISSIONER OF HEALTH AND SOCIAL SERVICES
BEFORE THE ALASKA OFFICE OF ADMINISTRATIVE HEARINGS ON REFERRAL FROM THE COMMISSIONER OF HEALTH AND SOCIAL SERVICES In the Matter of: ) ) FAMILY MEDICAL CLINIC ) OAH No. 10-0095-DHS ) DECISION I. INTRODUCTION
More informationCMS Meaningful Use Incentives NPRM
CMS Meaningful Use Incentives NPRM Margret Amatayakul MBA, RHIA, CHPS, CPHIT, CPEHR, CPHIE, FHIMSS President, Margret\A Consulting, LLC Faculty and Board of Examiners, Health IT Certification, LLC Notice
More informationElectronic Medical Record (EMR) How to Audit the Risks. Schawn Pedersen, CPC, CPC-E/M Manager Moss Adams LLP
Electronic Medical Record (EMR) How to Audit the Risks Schawn Pedersen, CPC, CPC-E/M Manager Moss Adams LLP Health Care Compliance Association 6500 Barrie Road, Suite 250, Minneapolis, MN 55435 888-580-8373
More informationAdvanced Evaluation and. AAPC Regional Conference Chicago 10/27/12
Advanced Evaluation and Management AAPC Regional Conference Chicago 10/27/12 Jaci Johnson, CPC,CPMA,CEMC,CPC H,CPC I President, Practice Integrity, LLC jaci@practiceintegrity.com Disclaimer Information
More informationResponsibility and Liability of Compliance Officer
Responsibility and Liability of Compliance Officer Cheryl Forino Wahl, VP, Chief Compliance Officer, University Hospitals Lori Oberholzer, JD, MS, RT(R), Director, Compliance and Risk Management, OSUPhysicians
More informationCHRONIC CARE MANAGEMENT TOOL KIT What Practices Need to Do to Implement and Bill CCM Codes
CHRONIC CARE MANAGEMENT TOOL KIT What Practices Need to Do to Implement and Bill CCM Codes Understanding CCM Chronic Care Management (CCM) is defined as the non-face-to-face services provided to Medicare
More information2014 CODING & DOCUMENTATION UPDATE. Healthcare Services Group November 2013
2014 CODING & DOCUMENTATION UPDATE Healthcare Services Group November 2013 Overview of Topics ICD-10 Implementation 2013 OIG Work Plan Physician, ASC and Hospital 2014 CPT Code Changes 2 ICD-10-CM & ICD-10-PCS
More informationAnesthesia Services INDIANA HEALTH COVERAGE PROGRAMS. Copyright 2017 DXC Technology Company. All rights reserved.
INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE M ODULE Anesthesia Services L I B R A R Y R E F E R E N C E N U M B E R : P R O M O D 0 0 0 1 9 P U B L I S H E D : D E C E M B E R 1 2, 2 0 1 7 P O
More informationMODIFIER REFERENCE POLICY
Oxford MODIFIER REFERENCE POLICY UnitedHealthcare Oxford Reimbursement Policy Policy Number: ADMINISTRATIVE 026.20 T0 Effective Date: November 1, 2017 Table of Contents Page INSTRUCTIONS FOR USE... 1 APPLICABLE
More informationPatient Insurance Guide
Patient Insurance Guide Patient Pre-authorization Form 1 Dear Parent: Most dental procedures can be accomplished without sedation. However, children who are very young, anxious, uncooperative, have special
More informationCODING vs AUDITING Does it all boil down to Medical Necessity?
PERFORM REGULAR AUDITS You provide routine maintenance for your car- but what about your documentation? CODING vs AUDITING Does it all boil down to Medical Necessity? EDUCATE WISELY Be sure and discern
More informationNAMAS Weekly Auditing Tips for Members
NAMAS Weekly Auditing Tips for Members (2014 Samples) 1/10/14 Give Credit for Managed Conditions One area where auditors struggle is correct assignment in medical decision making when patients have multiple
More informationObservation Coding and Billing Compliance Montana Hospital Association
Observation Coding and Billing Compliance Montana Hospital Association Sue Roehl, RHIT, CCS sroehl@eidebaill.com 701-476-8770 IP versus Observation considerations Severity of patient s signs and symptoms
More information9/25/2012 AGENDA. Set the Stage Monitoring versus Audit Identifying Risk Strategies related to an audit plan Corrective Action Plans Examples
The Art and Science of Designing a Physician Practice Audit : Unique Techniques Lori Laubach, Partner MOSS ADAMS LLP 1 AGENDA Set the Stage Monitoring versus Audit Identifying Risk Strategies related to
More informationE/M Auditing: History is the Key
E/M Auditing: History is the Key By Brandi Tadlock CPC, CPC-P, CPMA, CPCO CPC, CPMA, CEMC, CPC-H, CPC-I SUMMARY Review the history component in your E/M documentation to make sure it tells the patient
More informationCare360 EHR Frequently Asked Questions
Care360 EHR Frequently Asked Questions Table of Contents Care360 EHR... 4 What is Care360 EHR?... 4 What are the current capabilities of Care 360 EHR?... 4 Is Care 360 EHR an EMR?... 5 Can I have Care360
More informationState Medicaid Recovery Audit Contractor (RAC) Program
State Medicaid Recovery Audit Contractor (RAC) Program Section 6411 of the Patient Protection and Affordable Care Act 2010 (ACA) requires by December 31, 2010 each state Medicaid program to contract with
More informationProviderNews JUNE. Proud of it. The compassion to provide care
ProviderNews JUNE 2018 Proud of it The compassion to provide care She has the compassion it takes to provide care to someone, Ray Drake, Ph.D., age 79, of Hayward, said of Security Health Plan Care Manager
More informationReimbursement Policy. Subject: Professional Anesthesia Services
Reimbursement Policy Subject: Professional Anesthesia Services Effective Date: 01/03/17 Committee Approval Obtained: 01/03/17 Section: Anesthesia ***** The most current version of our reimbursement policies
More informationMedical Records Documentation Standards
Manual: Policy Title: Reimbursement Policy Medical Records Documentation Standards Section: Administrative Subsection: None Date of Origin: 1/1/2000 Policy Number: RPM039 Last Updated: 10/5/2017 Last Reviewed:
More information8/28/2014. Compliance and Practical Challenges When Using Scribes: Just What the Doctor Ordered? Objectives of the Presentation
Compliance and Practical Challenges When Using Scribes: Just What the Doctor Ordered? Jerry Williamson MD. MJ. CHC. LHRM Objectives of the Presentation Definition of a Scribe Duties of a Scribe Regulatory
More informationTexas Tech University Health Sciences Center Billing Compliance Program Policy and Procedure
4.2 Teaching Physician Requirements for Evaluation & Management Services Provided under Medicare s Primary Care Exception (PCE) Rule Approved: May 5, 2011 Effective Date: May 5, 2011 Latest Revision: June
More informationAmerican Health Information Management Association Standards of Ethical Coding
American Health Information Management Association Standards of Ethical Coding Introduction The Standards of Ethical Coding are based on the American Health Information Management Association's (AHIMA's)
More informationMedical Manager v12 includes the following features and functionalities to assist you with your ICD-10 transition:
ICD-10 Readiness Vitera Medical Manager FAQs 1. Which version of Vitera Medical Manager supports ICD-10? Vitera Medical Manager version 12 fully supports ICD-10 and is preloaded with the full ICD-10 code
More informationFroedtert Health Billing Compliance Policy. description. Policy Number. Supersedes. Purpose. Definitions
Froedtert Health Billing Compliance Policy description Hospital and Professional Billing Compliance Policy, Provider Billing, Provider Coding, Billable Providers, Billing Compliance, Compliance, Revenue
More informationCRCE Exam Study Manual Update for 2017
CRCE Exam Study Manual Update for 2017 This document reflects updates made to the instructional content from the Certified Revenue Cycle Executive (CRCE-I, CRCE-P) Exam Study Manual - 2016 to the 2017
More informationJaci Johnson, CPC,CPMA,CEMC,CPC H,CPC I President, Practice Integrity, LLC Disclaimer
Advanced Evaluation and Management More than a roll of the dice? History Exam Medical Decision Making Jaci Johnson, CPC,CPMA,CEMC,CPC H,CPC I President, Practice Integrity, LLC jaci@practieintegrity.com
More informationBilling Policies and Procedures WVU Physicians of Charleston
Billing Policies and Procedures WVU Physicians of Charleston POLICY/PROCEDURE NO.: B-10 10/1/15 Section: Chapter: Policy: Compliance Billing Teaching Physician Requirements Evaluation and Management (E/M)
More informationICD-10 STARTS WITH PROVIDERS
ICD-10 STARTS WITH PROVIDERS Steve Arter, CPC Managing Member Hawaii, LLC 765 Amana Street, Suite 302, Honolulu, HI 96814 hcchhawaii.com 808.947.2633 THANK YOU FOR JOINING US WHO IS HERE TODAY HEALTHCARE
More informationPECULIARITIES OF BILLING AND CODING IN LTC OCTOBER 14, 2011
PECULIARITIES OF BILLING AND CODING IN LTC OCTOBER 14, 2011 PRESENTED BY ALVA S. BAKER, MD, CMD Maine Medical Directors Association Faculty Disclosures: Dr. Baker has disclosed that he has no relevant
More informationMedicare Preventive Services
Medicare Preventive Services Presented by Part B Provider Outreach & Education December 16, 2015 Event Instructions Today s event is a teleconference Slides will not be advanced during the presentation
More informationUsing the Hospice PEPPER to Support Auditing and Monitoring Efforts: Session 1
Using the Hospice PEPPER to Support Auditing and Monitoring Efforts: Session 1 March, 2016 Kimberly Hrehor Agenda Session 1: History and basics of PEPPER PEPPER target areas Percents and percentiles Comparison
More informationFindACode.com Presents: Integrating NPP into E/M for Compliance and Quality Care. Excerpts from:
FindACode.com Presents: Integrating NPP into E/M for Compliance and Quality Care Excerpts from: Practical E/M: Documentation and Coding Solutions for Quality Patient Care by Dr. Stephen R. Levinson To
More informationCMS Observation vs. Inpatient Admission Big Impacts of January Changes
CMS Observation vs. Inpatient Admission Big Impacts of January Changes Linda Corley, BS, MBA, CPC Vice President Compliance and Quality Assurance 706 577-2256 Cellular 800 882-1325 Ext. 2028 Office Agenda
More informationProcedural andpr Diagnostic Coding. Copyright 2012 Delmar, Cengage Learning. All rights reserved.
Procedural andpr Diagnostic Coding What is Coding? Converting descriptions of disease, injury, procedures, and services into numeric or alphanumeric descriptors Accurate coding maximizes reimbursement
More informationCREATING AN AUDIT PLAN FOR PHYSICIAN OFFICES. Katherine Abel, CPC, CPB, CPMA, CPPM, CPC-I, AAPC Fellow Director of Curriculum AAPC
CREATING AN AUDIT PLAN FOR PHYSICIAN OFFICES Katherine Abel, CPC, CPB, CPMA, CPPM, CPC-I, AAPC Fellow Director of Curriculum AAPC OIG Compliance Guidance Implementing written policies, procedures and standards
More informationCotiviti Approved Issues List as of April 27, 2017
Cotiviti Approved Issues List as of April 27, 2017 Ambulatory Surgery Center (ASC); Outpatient Hospital 23 Inpatient Hospital 25 Inpatient Hospital; Inpatient Psychiatric Facility 27 Inpatient; Outpatient;
More informationSharpen coding skills and reimbursement strategies during ICD-10 delay The Centers for Medicare & Medicaid Services (CMS) once again has extended the
Ambulatory Surgery Centers Sharpen coding skills and reimbursement strategies during ICD-10 delay The Centers for Medicare & Medicaid Services (CMS) once again has extended the deadline to begin using
More informationRURAL HEALTH REIMBURSEMENT OPPORTUNITIES & UB-04 BILLING CHANGES FOR 2016
WEBINAR FOLLOW-UP QUESTIONS Thank you for attending our webinar on March 9, 2016. In follow-up to that webinar, we have compiled the following summary of all attendee questions and answers received. Pertinent
More informationQuanum Electronic Health Record Frequently Asked Questions
Quanum Electronic Health Record Frequently Asked Questions Table of Contents... 4 What is Quanum EHR?... 4 What are the current capabilities of Quanum EHR?... 4 Is Quanum EHR an EMR?... 5 Can I have Quanum
More informationCalifornia Ambulance Association September Presented by: Medicare Part B Provider Outreach and Education
California Ambulance Association September 2017 Presented by: Medicare Part B Provider Outreach and Education Disclaimer This information release is the property of Noridian Healthcare Solutions, LLC.
More informationCourse Overview Expected Outcomes Lessons/Topics Lesson 1-
Course Overview: This course provides the comprehensive coverage needed to understand and work with medical insurance related to the application of ICD-10-CM, CPT and HCPCS codes. The course teaches students
More informationOIG Work Plan Darci Friedman, Director of Regulatory Products Lynne Rinehimer, Sr. Healthcare Solutions Consultant
OIG Work Plan 2014 Darci Friedman, Director of Regulatory Products Lynne Rinehimer, Sr. Healthcare Solutions Consultant Agenda Introduction to, and how to interpret, the OIG Work Plan Review of Hospital
More informationDIVISION OF HEALTHCARE FINANCING CMS 1500 ICD-10. October 1, 2017
DIVISION OF HEALTHCARE FINANCING CMS 1500 ICD-10 October 1, 2017 General Information Overview Thank you for your willingness to serve clients of the Medicaid Program and other medical assistance programs
More information2011 Guidelines for CEU Approval
AAPC CEU Mission All members and business associates of AAPC must uphold a higher standard in education. Certified Professional Coders must choose continuing education that stretches their skill levels.
More informationTelemedicine and Reimbursement
Telemedicine and Reimbursement Presented for : March 14 th 2018 About Acevedo Consulting Incorporated Acevedo Consulting Incorporated prides itself on not providing cookie-cutter programs, but a quality
More informationDisclosure Statement
2017 Coding and Medicare Changes for Physician Fee Schedule Billing Presented by Jean Acevedo, CHC CPC CENTC LHRM Disclosure Statement No financial relationships to disclose. 1 Disclaimer The information
More informationResponding to Today s Health Care Regulatory Environment
Responding to Today s Health Care Regulatory Environment St. Joseph s Health Michael R. Holper SVP, Compliance and Audit Services October 26, 2016 2014 Trinity Health. All Rights Reserved. 1 We operate
More informationPhysician Providers include any attending physicians (MD, DO, DPM or dentists).
TITLE: ELECTRONIC HEALTH RECORD (EHR) DOCUMENTATION STANDARDS AND GUIDELINES MANUAL: MEDICAL STAFF POLICIES AND PROCEDURES Page 1 of 5 Effective Date: 6/28/2016 Reviewed/Revised: Approval /s/ Jeannette
More informationRisk Adjustment for EDS & RAPS Webinar Q&A Documentation
Risk Adjustment for EDS & RAPS Webinar Q&A Documentation 11:00 a.m. 12:00 p.m. EDS Duplicate Logic Q1. Will CMS consider validation of diagnosis codes for the EDS duplicate logic? A1. At this time, CMS
More informationPolicy No: Page Number: 1 of 5 Effective Date: 08/12/15 ATTACHMENT II
Page Number: 1 of 5 ATTACHMENT II TITLE: PURPOSE: USE OF CLONED DOCUMENTATION IN THE ELECTRONIC HEALTH RECORD The purpose of the health record is to provide a basis for planning patient care and for the
More informationOUTPATIENT DOCUMENTATION IMPROVEMENT
OUTPATIENT DOCUMENTATION IMPROVEMENT Pam Brooks, MHA, COC, PCS, CPC Coding Manager Wentworth-Douglass Hospital Dover NH Disclaimer This presentation is for general education purposes only. The information
More informationAuditors Desk Reference
DESK REFERENCE 2019 Auditors Desk Reference A comprehensive resource for code selection and validation Power up your coding optum360coding.com Contents Chapter 1. Auditing Processes and Protocols... 1
More informationAll ten digits are required when filing a claim.
34 34 Psychologists Licensed psychologists are enrolled only for services provided to QMB recipients or to recipients under the age of 21 referred as a result of an EPSDT screening. The policy provisions
More informationUnintended Consequences of Electronic Health Records
Financial Disclosure Unintended Consequences of Electronic Health Records The instructor acknowledges a financial interest in the subject matter of this presentation. Kirk A. Mack, COMT, CPC, COE Senior
More information