Welcome! Today s program is sponsored by Health Care Education and Training, Inc., Region X Training Project
|
|
|
- Rosemary Reed
- 6 years ago
- Views:
Transcription
1 Welcome! Today s program is sponsored by Health Care Education and Training, Inc., Region X Training Project
2 Technical Housekeeping Phone:
3 Webcast Tools Handouts and PowerPoint presentation The Ask button to pose your questions Photo of the presenter will be seen here PowerPoint presentation will be seen here
4 Please submit questions using the following subjects, at any point during the presentation: ICD-9 Codes Evaluation and Management Codes Contraceptive Codes General
5 Today s broadcast will be archived for only 60 days only. Please make sure to visit within a week to hear the audio file of today s broadcast.
6 Pre & Post Tests All registered participants are required to complete the pre and post tests provided on Survey Monkey. If you are a Nurse seeking nursing contact hours, you are required to complete both tools and the event evaluation. Prior to the start of today s presentation, you each received the link. Please complete the Pre-Test. ua_3d_3d
7 Post Test All registered participants and those seeking nursing contact hours are required to complete the post test provided on Survey Monkey. Post participation in today s webcast, you will receive a Survey Monkey invitation to a url link to complete the Post Test and event evaluation
8 Raymond Jorgensen, MS, CPC, CHBME Raymond T. Jorgensen is president and Co-Founder of Priority Management Group, Inc. (PMG). Ray is responsible for oversight of consulting operations as well as coding, reimbursement, and payer related issues for the out-sourced billing component of PMG s services (more than 850,000 annual encounters). He has personally trained thousands of providers from over 35 states on coding, billing and reimbursement in addition to authoring two books and dozens of articles. CPC-from the American Academy of Professional Coders CHBME- from the Healthcare Billing & Management Association
9 Priority Management Group, Inc. Presents Priority Management Group, Inc. 700 School Street Pawtucket, RI P: F:
10 Agenda Introduction Contraceptive ICD Overview E&M Visit Appropriateness Contraceptive Coding Options Summary
11 ICD-9 Examples ICD codes are translation of A&P of SOAP note V Codes Typically avoid as primary ICD code with E&M codes EXCEPTION: Preventive Visit & Contraception Management Issues when billed with E&M problem visit codes Possibly avoid use with and Try Anticipatory Guidance & Risk Factor Reduction Codes Elevated Blood Pressure without mention of HTN: Pregnancy Test Results (V72) ACOG recommends: V If the encounter is to test for a suspected pregnancy and the patient leaves w/o knowing the results V If the test is negative V If the test is positive & OB record is not initiated
12 ICD to CPT Linkage Example ICD Codes in order of Provider s Perceived Acuity 1. Pelvic Pain: Exposure to Venereal Diseases: V Negative Urine PT: V Condyloma: ASCUS PAP: Oral Contraceptive Management: V25.01 Rendered Services Linked ICD (Above) A (Level 4 Established Patient Visit) 1, 2, 3, 4, 5, & 6 B (Destruction of Vulva Lesions, Extensive) 4 C (Urine Pregnancy Test) 3 D. Q0091Pap Conveyance 5 E Venipuncture RPR (Outside lab to bill) 2
13 ICD-9 Examples (Continued) Annual Exam V70.0- Annual adult preventive V Annual GYN preventive with or without Pap Encounter for Contraceptive Management (V25); S Codes for FamPACT are best Prescription of OCP: V25.01 Initiation of other contraceptive measures: V25.02 Encounter for ECP: V25.03 Family Planning advice: V25.09 IUD insertion: V25.1 OCP surveillance; V25.41 IUD surveillance: V25.42 Implantable subdermal contraceptive: V25.43 Other FPM surveillance; V25.49
14 ICD-9 Examples (Continued) Abnormal Pap (795) AGUS : ASCUS: ASCUS cannot rule out HGSIL: LGSIL: HGSIL: HPV High Risk DNA Test Positive: Pap with cytological evidence of malignancy: Satisfactory cervical smear lacking transformation zone: Unsatisfactory cervical cytology Smear: Abnormal Glandular Pap of Vagina: Abnormal Pap Smear, Anus & Anal HPV:
15 5 Minute Break Please continue to submit your questions
16 Questions and Answers
17 Outpat. Consult New Pat Problem Focused Exp. Problem Focused E&M: Outpatient New Patients and Consults NEW PATIENTS & CONSULTS (3 of 3 Required: GO TO THE LOWEST) History Exam MDM Time New / Cons Prob. Focused (<1 BA/OS) Exp. Prob. Focused (2-4 BA/OS) Detailed Detailed (5-7 BA/OS) Comprehensive Comprehensive (8+ OS) Comprehensive Comprehensive (8+ OS) Straightforward 10/15 Straightforward 20/30 Low Complexity Moderate Complexity High Complexity NOTE: New Patient Definition: Has not had face to face service by a provider of the same specialty within a group practice in 3 years. 30/40 45/60 60/80 *** 2 nd Opinion Consults deleted 2006 to indicate a consult is mandated by a third party payer use Modifier 32
18 E&M: Outpatient Established Patients ESTABLISHED PATIENTS (2 of 3 Required: GO TO THE MEDIAN - MIDDLE) CPT History Exam MDM Time PROVIDER NOT REQUIRED Problem Focused Exp. Problem Focused Prob. Focused (<1 BA/OS) Exp. Problem Focused (2-4 BA/OS) Detailed Detailed (5-7 BA/OS) Comprehensive Comprehensive (8+ OS) Straightforward 10 Low Complexity 15 Moderate Complexity High Complexity 25 40
19 E&M Services The Time Component Only used when counseling or coordination of care represents greater than 50% of time spent with the patient Clock time, i.e., 9:01am - 9:58am Spent 20/25 minutes counseling Re:.. Outpatient is face to face: clinician only Inpatient is floor or unit time Does not have to be continuous Phone time does not count > 50%, C 3
20 Coding Examples E&M Service for Contraception New or established BCM check HOPE EC NOT retail sales (window only) Procedure and Office Visit Same DOS (CPT) New/ Est Patient E&M (-25) and Surgical Code and (IUD insert) and & J7307 (Implanon insert & Rx) Preventive Visit & Problem visit at the same encounter (IOM MCPM Chpt. 12 Section ) Contraception does NOT warrant separate problem E&M at time of preventive service *25 Modifier: Significantly, separately identifiable E&M on same day as another E&M service or surgery
21 Coding Examples OCP Distribution Pill sale only (no encounter), pills only (J8499?); No E&M Exam room encounter with pills code E&M and J8499 Emergency Contraception see OCP Distribution (V25.03) Anticipatory Guidance & Risk Factor Reduction Codes: Some payers for OCP & general counseling Package Pricing Include all line items with maximum charge Prompt pay option vs.. scheduled payments CLEARLY defined list of included/excluded services (especially for surgical packages)
22 Coding Examples Injection Coding Surgical service only Analogous to 95115, allergy shot Unless 25 modifier opportunity Depo-Provera Injection: (Therapeutic/diagnostic injection) & J1055 (Depo) Payer Specific Sole reason for visit = injection or only OV for infection or FP / annual Code E&M & & J1055 (96372 may be bundled into payment for E&M)
23 Coding Examples Implantable Contraceptive Capsules 11975: Insertion of Implanon 11976: Removal of Norplant, Implanon 11977: Insertion and Removal J7307: Implanon (supply code) NOT: for non-biodegradable implant IUD 58300: IUD insertion 58301: IUD removal J7300: Intrauterine copper (supply code) J7302: Mirena (supply code) Global Package Concept 0 Days for Contraceptive Procedures
24 Summary Easy to Use Encounter Form (Clinician and Billing Involvement) Coding Accuracy with Supporting Documentation Streamlined Data Flow Front Line Feedback (From Payment Posting) Commit to Educate (Top down) Update Constantly
25 5 Minute Break Please continue to submit your questions
26 Questions and Answers
27 Post Test and Event Evaluation All registered participants and those seeking nursing contact hours are required to complete the post test provided on Survey Monkey. Post participation in today s webcast, you will receive a Survey Monkey invitation to a url link to complete the Post Test and event evaluation
28 Upcoming Trainings What Constitutes a Great Clinical Adult March 18, 2009 LIVE WEBCAST Addressing Key Issues of HIV Disease in Michigan March 26, 2009 LIVE WEBCAST
29 Upcoming Trainings Practical Strategies for Measuring Client Satisfaction April 8, 2009 LIVE WEBCAST Adolescent Sexual Health: Engaging Parents in Sexual Health Decision Making May 28, 2009 LIVE WEBCAST
30 Upcoming Trainings Youth Friendly Reproductive Health Services June 23, 2009 LIVE WEBCAST All Options Counseling July 14, 2009 Audioconference only
31 Questions and Answers
32 Thank you for joining us today Thank You for Joining Us Today! Please remember to complete the Post Test and event evaluation tool. Today s audio file and meeting materials will be posted at within a week. Register for upcoming trainings:
Archived SECTION 10 - FAMILY PLANNING. Section 10 - Family Planning
SECTION 10 - FAMILY PLANNING 10.1 FAMILY PLANNING SERVICES...2 10.2 COVERED SERVICES...2 10.2.A INTRAUTERINE DEVICE (IUD)...3 10.2.B ORAL CONTRACEPTION (BIRTH CONTROL PILL)...3 10.2.C DIAPHRAGMS OR CERVICAL
PREVENTIVE MEDICINE AND SCREENING POLICY
UnitedHealthcare Oxford Reimbursement Policy PREVENTIVE MEDICINE AND SCREENING POLICY Policy Number: ADMINISTRATIVE 238.19 T0 Effective Date: July 1, 2018 Table of Contents Page INSTRUCTIONS FOR USE...
Coding and Billing for Lifestyle Medicine
Coding and Billing for Lifestyle Medicine Presented to Tools for Healthy Change June 21, 2014 Agenda Understanding Documentation Guidelines and key components of E/M Services History, Exam, Medical Decision
Gynecologic or Annual Women s Exam Visit & Use of Q0091 (Pap, Pelvic, & Breast Visit)
Manual: Policy Title: Reimbursement Policy Gynecologic or Annual Women s Exam Visit & Use of Q0091 (Pap, Pelvic, & Breast Visit) Section: Evaluation & Management Services Subsection: None Date of Origin:
Conquering Consults. Objectives. Kim Reid,, CPC,, CPC-I,, CEMC
Conquering Consults Kim Reid,, CPC,, CPC-I,, CEMC Objectives Clearing up p cons consult lt conf confusion sion Understanding the consult requirements How do we code/document now that Medicare no longer
Family Planning Services Clinical Coverage Policy No: 1E-7 Amended Date: April 1, Table of Contents
Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1 1.1.1 Regular Medicaid Family Planning (Medicaid FP) and NCHC... 1 1.1.2 Be Smart Family Planning Medicaid
Effective Coding Practices in Reproductive Health Care
National Reproductive Health Conference August 4, 2014, Orlando, FL Effective Coding Practices in Reproductive Health Care Michael S. Policar, MD, MPH Clinical Professor of Ob,Gyn, & RS UCSF School of
Preventive Medicine and Screening Policy
Reimbursement Policy CMS 1500 Preventive Medicine and Screening Policy Policy Number 2018R0013C Annual Approval Date 3/14/2018 Approved By Reimbursement Policy Oversight Committee IMPORTANT NOTE ABOUT
Covered Benefits Rhody Health Partners
Covered s Rhody Health Partners s Covered by UnitedHealthcare Community Plan As member of UnitedHealthcare Community Plan, you are covered for the following services. (Remember to always show your current
Covered Benefits Rhody Health Partners ACA Adult Expansion
Covered s Rhody Health Partners ACA Adult Expansion Abortion Services Adult Day Services AIDS Medical and Non-Medical Case Management Alcohol and Substance Abuse Treatment Cosmetic Surgery Dental Care
Presented for the AAPC National Conference April 4, 2011
Presented for the AAPC National Conference April 4, 2011 Penny Osmon, BA, CPC, CPC-I, CHC, PCS Director of Educational Strategies - Wisconsin Medical Society penny.osmon@wismed.org CPT codes, descriptions
$10 copay. $10 copay. $10 copay $5 copay $10 copay $5 copay. $10 copay. No charge. No charge. No charge
PLAN FEATURES * ** Deductible (per calendar ) Member Coinsurance Copay Maximum (per calendar ) Lifetime Maximum Unlimited Primary Care Physician Selection Required Upon enrollment to a Vitalidad Plus plan,
See the Time chapter for complete instructions regarding how to code using time as the controlling E/M factor.
2015 EM Survival Guides Chapter 1: Office or Other Outpatient Visit (99201-99215) You should apply 99201-99215 for E/M visits in the office or other outpatient setting. These codes distinguish between
Anthem Blue Cross Effective: January 1, 2018 Your Plan: University of California CORE Plan Your Network: Anthem Prudent Buyer PPO
Anthem Blue Cross Effective: January 1, 2018 Your Plan: University of California CORE Plan Your Network: This summary of benefits is a brief outline of coverage, designed to help you with the selection
Anthem Central Region Clinical Claims Edit
Please compare the claim's date of adjudication to the range of the edit in question. Prior versions, if any, can be found below. Subject: Screening Papanicolaou (Pap Smear) with Evaluation and Management
Getting Paid for What You Do! Coding 2010
Getting Paid for What You Do! Coding 20 Children s Mercy Health Network 11/17/09 Richard H. Tuck, MD, FAAP Disclosure I have financial relationships or interests with proprietary entities producing health
ALABAMA MEDICAID AGENCY ADMINISTRATIVE CODE CHAPTER 560-X-14 FAMILY PLANNING TABLE OF CONTENTS
Medicaid Chapter 560-X-14 ALABAMA MEDICAID AGENCY ADMINISTRATIVE CODE CHAPTER 560-X-14 FAMILY PLANNING TABLE OF CONTENTS 560-X-14-.01 560-X-14-.02 560-X-14-.03 560-X-14-.04 560-X-14-.05 560-X-14-.06 560-X-14-.07
Message Response Message
Message If established pt wouldn't 2 out of 3 still require the level for slide 5? Response Message Can you re-state your question? I am unclear on what you are asking. Thanks You stated that even when
Reporting Preventive Services & Problem-Oriented E & M in RHCs
Reporting Preventive Services & Problem-Oriented E & M in RHCs John Burns, CPMA, CEMC, CPC, CPC-I Vice President, Audit and Compliance Services John.Burns@RuralHealthCoding.com Your Faculty John F. Burns,
Aetna Health of California, Inc.
Easily locate PrimeCare participating providers at www.aetna.com/docfind/primecare PLAN FEATURES Deductible (per calendar year) Member Coinsurance Lifetime Maximum Primary Care Physician Selection Referral
See the Time chapter for complete instructions on how to code using time as the controlling factor when selecting an E/M code.
2015 EM Survival Guides Chapter 4: Initial Hospital Care (99221-99223) You should select the appropriate-level initial hospital care code (99221-99223) using the key E/M criteria of history, examination
OBSERVATION CARE EVALUATION AND MANAGEMENT CODES POLICY
OBSERVATION CARE EVALUATION AND MANAGEMENT CODES POLICY UnitedHealthcare Oxford Reimbursement Policy Policy Number: ADMINISTRATIVE 232.10 T0 Effective Date: March 1, 2017 Table of Contents Page INSTRUCTIONS
Texas Medicaid. Provider Procedures Manual. Provider Handbooks. Women s Health Services Handbook
Texas Medicaid Provider Procedures Manual Provider Handbooks August 2018 Women s Health Services Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid
CA Group Business 2-50 Employees
PLAN FEATURES Network Primary Care Physician Selection Deductible (per calendar year) Member Coinsurance Copay Maximum (per calendar year) Lifetime Maximum Referral Requirement PHYSICIAN SERVICES Primary
Core Services Provided in Federally Clinical Coverage Policy No: 1D-4 Qualified Health Centers and Amended Date: October 1, 2015 Rural Health Clinics
Qualified Health Centers and Amended Date: October 1, 2015 Rural Health Clinics Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Federally Qualified Health Centers... 1
Deleted Codes. Agenda 1/31/ E/M Codes Deleted Codes New Codes Changed Codes
February 2013 Jean C. Russell, MS, RHIT jrussell@epochhealth.com Richard Cooley, BA, CCS rcooley@epochhealth.com 518-430-1144 2 2013 E/M Codes Deleted Codes New Codes Changed Codes Agenda Documentation
February Jean C. Russell, MS, RHIT Richard Cooley, BA, CCS
February 2013 Jean C. Russell, MS, RHIT jrussell@epochhealth.com Richard Cooley, BA, CCS rcooley@epochhealth.com 518-430-1144 2 2013 E/M Codes Deleted Codes New Codes Changed Codes Agenda Documentation
CALIFORNIA Small Group HMO Aetna Health of California, Inc. Plan Effective Date: 04/01/2007. Aetna Value Network* HMO $30/$40
PLAN FEATURES Deductible (per calendar year) Member Coinsurance Lifetime Maximum Primary Care Physician Selection Referral Requirement PHYSICIAN SERVICES CALIFORNIA Small Group HMO Primary Care Physician
The MITRE Corporation Plan
Benefit Type Plan Year Type Calendar Year Annual Medical Out of (for certain services) Employee Employee + 1 Family Annual Prescription Drug Out of Employee Employee + 1 Family Copayments: One copay per
Preventive and Sick Visits Same Day. Objectives
Preventive and Sick Visits Same Day Brenda Chidester-Palmer CPC, CPC-I, CEMC, CCS-P AAPC National Conference June 8, 2010 Nashville, Tennessee Objectives Preventive visit definition Services included in
Mid-Level Providers: What You Need to Know to Use Them Successfully in Your Practice
Mid-Level Providers: What You Need to Know to Use Them Successfully in Your Practice Presented by Sarah Reed, BSE. CPC Senior Managing Consultant Medical Revenue Solutions, LLC AAPC 2016 Disclaimer The
Procedure Code Job Aid
Procedure Code 99211 Job Aid Definition for 99211: Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician. Usually,
Family Practice. P r e s e n t e d B y : D i n a R a e h s l e r, R H I T J u n e 2 8,
Family Practice CODING P r e s e n t e d B y : D i n a R a e h s l e r, R H I T J u n e 2 8, 2 0 1 0 New Patient/ Consultation New Patient Patient has not received any professional services from the physician,
Primary Care practice clinics within the Edmonton Southside Primary Care Network.
Well Women Health Visit and Pelvic Exam with Specimen Collection Last Review: November 2016 Intervention(s) and/or Procedure: Practice Setting: Authorized Implementers: Competencies and Educational Requirements:
Transition Care Management Update: Practical Applications for 2016
60 th Annual Greenville Postgraduate Seminar: A Primary Care Update Transition Care Management Update: Practical Applications for 206 Nick Ulmer, MD CPC VP Clinical Services and Medical Director of Case
Summary of Benefits Full PPO Savings Two-Tier Embedded Deductible 1500/2700/3000
Summary of Benefits Full PPO Savings Two-Tier Embedded Deductible 1500/2700/3000 Group Plan PPO Savings Benefit Plan This Summary of Benefits shows the amount you will pay for Covered Services under this
2019 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.
DEFINITION OF AN ENCOUNTER A billable encounter is defined as a face- to-face visit with a physician, physician assistant, midwife or nurse practition
ILLINOIS DEPARTMENT OF HEALTHCARE & FAMILY SERVICES Federally Qualified Health Centers (FQHC) Rural Health Centers (RHC) 09-28-11 DEFINITION OF AN ENCOUNTER A billable encounter is defined as a face- to-face
Compendium of Sample Agreements and Policies
Compendium of Sample Agreements and Policies The following examples related to partnerships, collaborations, and mergers were sourced from various NFPRHA members. Because every organization differs in
Schedule of Benefits
Schedule of Benefits ANTHEM Small Business Health Options Program (SHOP) This is a brief schedule of benefits. Refer to your Anthem Certificate of Coverage (Booklet) for complete details on benefits, conditions,
William J. Ennis D.O.,MBA University of Illinois at Chicago Professor Clinical Surgery, Chief Section wound healing and tissue repair
William J. Ennis D.O.,MBA University of Illinois at Chicago Professor Clinical Surgery, Chief Section wound healing and tissue repair What are the revenue streams What are the expenses How does the hospital
Care Transition Strategies: The 2013 Transition Care Management Codes
Care Transition Strategies: The 203 Transition Care Management Codes Sponsored by The Carolinas Center for Medical Excellence (CCME) and The South Carolina Partnership for Health (SC PfH) E. G. Nick Ulmer,
OVERVIEW OF ESSENTIAL CHARTING ELEMENTS FOR THE EMERGENCY DEPARTMENT
OVERVIEW OF ESSENTIAL CHARTING ELEMENTS FOR THE EMERGENCY DEPARTMENT ALL CHARTING NEEDS TO BE FINISHED AT THE END OF YOUR SHIFT PRIOR TO LEAVING THE ED IF YOU HAVE ANY QUESTIONS, ASK FOR HELP! All of the
HEDIS TOOLKIT FOR PROVIDER OFFICES. A Guide to Understanding Medicaid Measure Compliance
HEDIS TOOLKIT FOR PROVIDER OFFICES A Guide to Understanding Medicaid Measure Compliance TABLE OF CONTENTS WHAT IS HEDIS 1?... 1 ANNUAL HEDIS TIMELINE... 2 HEDIS MEDICAL RECORD REQUEST PROCESS:... 2 TIPS
Observation Care Evaluation and Management Codes Policy
Policy Number Observation Care Evaluation and Management Codes Policy 2017R0115A Annual Approval Date 3/8/2017 Approved By Reimbursement Policy Oversight Committee IMPORTANT NOTE ABOUT THIS You are responsible
Evaluation and Management
Evaluation and Management CPT CPT copyright 2011 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by
February Jean C. Russell, MS, RHIT Richard Cooley, BA, CCS
February 2013 Jean C. Russell, MS, RHIT jrussell@epochhealth.com Richard Cooley, BA, CCS rcooley@epochhealth.com 518-430-1144 2 2013 E/M Codes Deleted Codes New Codes Changed Codes Agenda Documentation
News Flash. Self Funding Program
FOR NETWORK PROVIDERS OF KAISER PERMANENTE networknews JUNE 2006 Produced by Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. with the Mid-Atlantic Permanente Medical Group, P.C. Kenya Neal,
Changes in Coding 2017 Presented by: Cynthia Robinson, RT, CPC
Changes in Coding 2017 Presented by: Cynthia Robinson, RT, CPC All Rights Reserved 2 Overview of ICD-10 Over 69,000 codes ( ICD-9 had approximately 17,000) Codes start with an alpha character, except U
HEALTH DEPARTMENT BILLING GUIDELINES
HEALTH DEPARTMENT BILLING GUIDELINES Acknowledgement: Current Procedural Terminology (CPT ) is copyright 2017 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative
E/M: Coding Opportunities- Documentation is key
E/M: Coding Opportunities- Documentation is key Compiled and Presented by: Suzan Berman CPC, CEMC, CEDC The duplication of this presentation, all or in part, without the expression permission of the presenter,
CLASSIC BLUE SECURE/BLUE CROSS BLUE SHIELD COMPLEMENTARY Monroe County Benefit Summary/Comparison (Over 65 Retirees)
WHO IS COVERED Enrollment Requirement Members must be enrolled in both Medicare Parts A and B Members must be enrolled in both Medicare Parts A and B Type of Tier Single only Single only Dependent/Student
E/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
Services Covered by Molina Healthcare
Services Covered by Molina Healthcare As a Molina Healthcare member, you will continue to receive all medically-necessary Medicaid-covered services at no cost to you. The following list of covered services
Focus On Observation
Focus On Observation Introduction CPT and CMS Requirements CPT Codes Documentation Requirements Observation Coding: Facility Considerations 2 LogixHealth s unsurpassed service stems from the fact that
Empire BlueCross BlueShield Professional Reimbursement Policy
Subject: Bundled Services and Supplies NY Policy: 0008 Effective: 02/24/2014 06/30/2014 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and
POLICY TRANSMITTAL NO April 7, 2011 OKLAHOMA HEALTH CARE AUTHORITY
POLICY TRANSMITTAL NO. 11-14 April 7, 2011 HEALTH POLICY OKLAHOMA HEALTH CARE AUTHORITY TO: SUBJECT: STAFF LISTED MANUAL MATERIAL CHAPTER 30. MEDICAL PROVIDERS-FEE FOR SERVICE OAC 317:30-3-59, 30-3-60,
This policy describes the appropriate use of new patient evaluation and management (E/M) codes.
Private Property of Florida Blue. This payment policy is Copyright 2017, Florida Blue. All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission
FQHC Wrap Payment Guidelines. NM Rev. 1 09/17
FQHC Wrap Payment Guidelines NM 10.001014 Rev. 1 09/17 Overview of Methodology Managed care organizations (MCO s) will concurrently pay contracted rate, wrap payment, and any fee for service (FFS) payments
HEALTHCHOICE MANUAL FOR PROVIDERS SELF-REFERRAL AND EMERGENCY SERVICES
HEALTHCHOICE MANUAL FOR PROVIDERS OF SELF-REFERRAL AND EMERGENCY SERVICES August 2010 TABLE OF CONTENTS INTRODUCTION Pages 3-8 CHILD IN STATE-SUPERVISED CARE-INITIAL MEDICAL EXAM Pages 9 EMERGENCY SERVICES
Billing and Coding Tidbits for Not Leaving $$ on the Table
Billing and Coding Tidbits for Not Leaving $$ on the Table Presented by Sarah Reed BSE, CPC, CPC-I Senior Managing Consultant Medical Revenue Solutions, LLC AAPC 2016 Presentation Objectives Review some
How does one report the performance of both a screening mammogram on the right breast and a diagnostic on the left breast at the same encounter?
1 of 6 05/27/2008 4:21 PM FAQ Wisconsin Medical Society FAQ If you have any questions regarding the following, please direct all your questions to: efaq@wismed.org. Medicare / Medicaid Medicare does not
E & M Coding. Welcome To The Digital Learning Center. Today s Presentation. Course Faculty. Beyond the Basics. Presented by
Welcome To The Digital Learning Center Presented by Your Partner In Building High Performance Practices Today s Presentation E & M Coding Beyond the Basics Course Faculty R. Thomas (Tom) Loughrey, MBA,
HC 1930 HC 1930 ICD-9-CM III/CPT Coding II
South Central College HC 1930 HC 1930 ICD-9-CM III/CPT Coding II Course Information Description Total Credits 4.00 Total Hours 80.00 Types of Instruction This course is a continuation of HC 1920, 1925,
1:35. 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
Services Covered by Molina Healthcare
Services Covered by Molina Healthcare Because you are covered by Medicaid, you pay nothing for covered services. As a Molina Healthcare member, you will continue to receive all medically necessary Medicaid-covered
Review case problems to differentiate code linkage of diagnosis and procedure.
South Central College HC 1928 CPT Coding I Course Information Description This course is the introduction of CPTcoding and provides and in-depth review of the coding and reimbursement system used in outpatient
Billing Guidelines for Federally Qualified Health Center, Rural Health Clinic or Encounter Rate Clinic
Provider Memorandum Billing Guidelines for Federally Qualified Health Center, Rural Health Clinic or Encounter Rate Clinic Molina Healthcare of Illinois (Molina) has implemented billing guidelines for
Gateway to Practitioner Excellence GPE 2017 Medicaid & Medicare
Gateway to Practitioner Excellence GPE 2017 Medicaid & Medicare Recognizing and Rewarding Excellent Practices Improving the Health of Gateway Members PRACTICE ELIGIBILITY (see PCMH slide #27 for separate
The Institute of Medicine Committee On Preventive Services for Women
The Institute of Medicine Committee On Preventive Services for Women Testimony of Hal C. Lawrence, III, MD, FACOG Vice President for Practice Activities American Congress of Obstetricians and Gynecologists
99 - No response error No Medical records were received.
1 May 2017 HCPCS Code Type Error Error Identified by CERT Anesthesia Services 00140 MISSING: 1) Signature attestation statement or signature log for the illegibly signed Pre-Anesthesia evaluation and illegibly
CONRAD INDUSTRIES, INC. S2489 NON GRANDFATHERED PLAN BENEFIT SHEET
BENEFIT SHEET GENERAL PLAN INFORMATION Coordination of Benefits Standard COB Dependents Children to age 26 Filing Limit 12 months from date of service Mailing Address & PPO Company. PPO Co.: PPO CIGNA
Corporate Medical Policy Bundling Guidelines
Corporate Medical Policy Bundling Guidelines File Name: bundling_guidelines Policy Number: ADM9020 Origination: 1/2000 Last Review: 03/2006 Next Review: 03/2007 Discussion Related to Blue Care, Blue Choice,
Coding for the Outpatient Hospital Setting. Webinar Subscription Access Expires December 31.
Coding for the Outpatient Hospital Setting 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
follow-up for pneumonia
Questions How long can I access the on demand version. Where can I ask questions after the webinar? Can the CC be used as an element of HPI? I have a co-worker who believes it cannot be used at all towards
Adult Learning. Initiation Client identifies adult learning need(s). Date
Birth Adult Learning Client identifies adult learning need(s). Date Partner with client to establish and review educational and/or career goals. Document goal(s) and desired outcome(s). Goals: Assist client
Advanced 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
RSNA EMPLOYEE BENEFIT TRUST PLAN II S2502 NON GRANDFATHERED PLAN BENEFIT SHEET
BENEFIT SHEET GENERAL PLAN INFORMATION Coordination of Benefits Standard COB Dependents Children birth to age 26 Filing Limit 1 year from date of service Mailing Address & PPO Company. Remit claims to:
Standard Work: Triage
Standard Work: Triage Triage: Triage staff will ask specific questions to understand what the client has presented for, quickly determine what services the client should receive, and schedule an appointment
101: The Dirty Dozen of Coding Documentation Compliance
101: The Dirty Dozen of Coding Documentation Compliance HCCA: Clinical Practice Compliance Conference 10/13/14 Maggie Mac, CPC CEMC CHC CMM ICCE maggie@maggiemac.com ekunz@bellsouth.net Disclaimer This
DEMOGHRAPHICS INSURANCE INFORMATION
DEMOGHRAPHICS Name: Date of Birth: / / AGE: Street Address: City: State: Zip: Home Phone #: ( ) Cellular Phone :( ) Social Security Number: E-mail: Marital Status: Single Married Divorced Widowed Employer:
Skilled nursing facility visits
Modified Premier HMO 20 Non Union This Summary of Benefits is a brief overview of your plan's benefits only. For more detailed information about the benefits in your plan, please refer to your Certificate
PLAN 1 (Traditional Premier 10/100%) October 1, Your Anthem Blue Cross HMO Plan. RT Premier 10/100% Traditional Modified
PLAN 1 (Traditional Premier 10/100%) October 1, 2017 Your Anthem Blue Cross HMO Plan RT00244-1 1017 Premier 10/100% Traditional Modified Combined Evidence of Coverage and Disclosure Form Anthem Blue Cross
Paula LeSueur MSN, CNP
HEDIS Measures 2014 Presented at Envision NM Telehealth April 24, 2014 Paula LeSueur MSN, CNP 1 NEW To connect audio, please telephone 1-877-551-7185. Conference Code 1578316654# Please mute/un-mute your
Procedural 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
STANDARDS OF CARE HIV AMBULATORY OUTPATIENT MEDICAL CARE STANDARDS I. DEFINITION OF SERVICES
S OF CARE Oakland Transitional Grant Area Care and Treatment Services J ANUARY 2007 Office of AIDS Administration 1000 Broadway, Suite 310 Oakland, CA 94612 Tel: 510. 268.7630 Fax: 510.268-7631 AREAS OF
Updated: 10/01/12 Page : 1
PLAN FEATURES Deductible (per calendar year) $1,000 Individual $3,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable. Once Family Deductible is met, all family
PacifiCare SignatureValue Advantage Offered by PacifiCare of California
CALIFORNIA SMALL GROUP PacifiCare SignatureValue Advantage Offered by PacifiCare of California 30-40/500d HMO Schedule of Benefits Effective March 1, 2010 These services are covered as indicated when authorized
Corporate Reimbursement Policy
Corporate Reimbursement Policy Code Bundling Rules Not Addressed in ClaimCheck or Correct File Name: code_bundling_rules_not_addressed_in_claim_check Origination: 6/2004 Last Review: 12/2017 Next Review:
Webinar 2: CPT Coding and Compliance. July 20, 2015
Webinar 2: CPT Coding and Compliance July 20, 2015 Toni Woods, CCS, CPC AHIMA Approved ICD 10 CM/PCS Trainer R.T. Welter & Associates, Inc. www.rtwelter.com 303.534.0388 tmw@rtwelter.com Meet Your Presenter
HIMSS Davies Enterprise Application --- COVER PAGE ---
HIMSS Davies Enterprise Application --- COVER PAGE --- Applicant Organization: Hawai i Pacific Health Organization s Address: 55 Merchant Street, 27 th Floor, Honolulu, Hawai i 96813 Submitter s Name:
professional Covered services and limitations module
professional Covered services and limitations module Professional CMS-1500 Covered Services and Limitations Module Ambulance Services...3 Ambulatory Surgical Center (ASC)...7 Covered Procedures...7 Limitations...7
Transitioning to ICD-10: An Action Plan for Practices
Transitioning to ICD-10: An Action Plan for Practices By Nancy M Enos, FACMPE, CPMA, CPC-I, CEMC 1 viterahealthcare.com/icd10 The Four T s of Transition to ICD-10: Timing, Training, Testing and Technology
How To Document and Select Outpatient Levels of Evaluation and Management (E&M) Service in RHC
How To Document and Select Outpatient Levels of Evaluation and Management (E&M) Service in RHC John F. Burns, CPC, CPC-I, CPMA, CEMC Vice President, Audit and Compliance Services jburns@ruralhealthcoding.com
GLOBAL HEALTH ADVANTAGE 2 to 20
GLOBAL HEALTH ADVANTAGE 2 to 20 Benefits Proposal Prepared specially for Marathon Petroleum Effective Date: 01/01/2018 112336 8/17 Offered by: Cigna Health and Life Insurance Company, Connecticut General
Payment Transformation: Essentials of Patient Attribution An Introduction for Internal Staff
Payment Transformation: Essentials of Patient Attribution An Introduction for Internal Staff May 6, 2016 Payment Transformation Will Address Key Goals In Pursuit of Māhie 2020 - Maximize Value to Members,
Independent RHC Billing Introduction Session 3 Spring, 2018
Independent RHC Billing Introduction Session 3 Spring, 2018 Contact Information Mark Lynn, CPA (Inactive) RHC Consultant Healthcare Business Specialists Suite 214, 502 Shadow Parkway Chattanooga, Tennessee
Global Period for Surgery. Is it billable?
Global Period for Surgery. Is it billable? August 10, 2017 Question: My patient presented to the ED with an infection at the incision site from a surgery that I did 4 weeks ago. It has a 90 day global.
Excellus BluePPO Option K
Excellus BluePPO Option K Contraceptives Only Benefit Time Period: 01/01/2018-12/31/2018 NYS Automobile Dealers Assoc. General Information Cost Sharing Expenses Deductible - Single $0 $1,000 Deductible
Kaiser Permanente Group Plan 301 Benefit and Payment Chart
301 Kaiser Permanente Group Plan 301 Benefit and Payment Chart 10119 CITY AND COUNTY OF SAN FRANCISCO About this chart This benefit and payment chart: Is a summary of covered services and other benefits.