Since 2017 facilities have been using Modifier JW for reporting the wastage of a drug from a single-use vial or package prior to administration. Due to the fact that modifier JW was not being used correctly if at all, CMS (Centers for Medicare and Medicaid Services) provided clarification and education on the proper use of …
Many medical practices are now receiving letters from Cigna on their intent to review all claims with Evaluation and Management services reported with 99212-99215 for established patient services. This will create unnecessary burden on practices and delay payments. Could this action have been avoided? In a word yes. Since the induction of Modifier 25 it …
In the coding world there is always an emphasis on the importance of documentation. We are all familiar with the saying “If it’s not documented, it wasn’t done”. We must also place equal importance on making sure all the information that is documented is also translated onto the claim. This is important for a …
The importance of accurately reporting ICD10-CM with ultrasounds Read More »
Does the Global Package need unpacking? In order to answer this question, it’s important look at the value (RVU or Relative Value Unit) attached to certain procedures. The Global Package has applied to over 4,000 physician services since 1992. Over time, providers have been concerned about the valuation of many of these services. Inflation and improvements to certain procedures …
Prior Authorization continues to be a significant barrier for patients and providers. It has caused greater financial waste for providers and increased delays for patients. According to the AHA survey, one 17-hospital system reported spending $11 million annually just to comply with health plan prior authorization requirements. Efforts to streamline and standardize have failed …
In 2021, when the Evaluation and Management guidelines were revised, the area with the most confusion was ultimately the amount and/or complexity of data to be reviewed and/or analyzed. Like with other components, misunderstandings with definitions and descriptions were at the root of the problem. It is extremely important to read the full description and …
Every patient that walks through the door has a story to tell about what brought them in that day. How a physician tells that story through documentation is crucial to receive reimbursement that aligns with the payment policies set forth by various third-party payers. One area of reimbursement that can affect payment is the use …
In September 2022, the American Medical Association released the revised E/M guidelines for 2023, bringing the 2021 Guidelines in alignment with other code sets for Evaluation and Management Services. This is part of their ongoing effort to reduce physician documentation burdens. On November 1st CMS released their Final Rule in the CMS-1770-F for revisions to …
There are several things you need to know when choosing the correct administration code
In this article we take a look at the importance of healthcare reimbursement for asymptomatic encounters. We will look at identifying primary diagnosis requirements that drive reimbursement, how to get paid for postoperative treatment visits and underutilized reporting when it comes to Social Determinants of Health. Medical Practices care for patients for a variety of …
