sam-mi, Author at revMD

Is your Radiation Oncology Coding Compliance being Taken Seriously Enough? 10 Questions to Ponder

Is your Radiation Oncology Coding Compliance being Taken Seriously Enough? 10 Questions to Ponder

sam-mi2013-07-23T09:44:02+00:00

If an OIG investigator were suddenly to appear on your Radiation Oncology practice's doorstep, would you be prepared for the scrutiny? You may very well be waving compliance red flags in your Radiation Oncology revenue cycle management—and not even know it—that send messages your compliance is not being taken seriously enough. It's time to take a hard look around your work environment and review the 10 telltale signs in a list provided by Robert A. Pelaia, Esq., CPC, CPCO. Each sign indicates to investigators they should delve deeper in your compliance activities. Note these are in no particular order: 1. Patient [...]

Is your Radiation Oncology Coding Compliance being Taken Seriously Enough? 10 Questions to Pondersam-mi2013-07-23T09:44:02+00:00

Assured Return Offers Medical Practice Billing Advantage and Mitigates Healthcare Risk

Assured Return Offers Medical Practice Billing Advantage and Mitigates Healthcare Risk

sam-mi2013-07-19T09:22:30+00:00

"At risk." Two words that might just make you think twice about the practice of medicine. But once you know what the biggest risks are to your medical practice and how to mitigate them, you'll actually have the advantage. Risks for medical practices and physician medical billing are continually evolving. Growing numbers of regulations (12,000 and counting in the new Affordable Care Act alone), concerns over the increasing cost of healthcare and new technologies expose you and your patients to greater risks. Examples of some of today's biggest risks include: HIPAA Audits Fraud and abuse Identity theft Other compliance issues Compliance [...]

Assured Return Offers Medical Practice Billing Advantage and Mitigates Healthcare Risksam-mi2013-07-19T09:22:30+00:00

Seeing Red? Tips for Better Coding Help Stop the Bleeding, Increase Control of Radiology Revenue Cycle Management

Seeing Red? Tips for Better Coding Help Stop the Bleeding, Increase Control of Radiology Revenue Cycle Management

sam-mi2013-07-16T10:43:38+00:00

Did you ever think the words "hemorrhaging" and "vulnerable" would pertain to your radiology coding and billing? More than likely, they do. That's because your healthcare revenue cycle management is actually more susceptible to errors which, when you add them up, can cost as much as a full time radiology coding professional on average. It's a fine line radiologists walk every day. Under-coding leads to lost revenue, while over-coding threatens compliance. The most common challenges stem from either inadequate documentation, which leaves coders without all the details necessary to maximize radiology reimbursement, or incomplete knowledge of latest coding practices. Poor and [...]

Seeing Red? Tips for Better Coding Help Stop the Bleeding, Increase Control of Radiology Revenue Cycle Managementsam-mi2013-07-16T10:43:38+00:00

Claim Denial Again: Why Your Urology Medical Coding and Billing are at Risk

Claim Denial Again: Why Your Urology Medical Coding and Billing are at Risk

sam-mi2013-07-11T09:00:16+00:00

Few things are more frustrating than providing care to a patient expecting fair payment in return, only to be informed that your Urology medical practice coding and billing claim is being denied because the payer doesn't think the service was medically necessary. You've ensured your revenue cycle management process is up to speed, or so you think. Yet, you're still faced with a good percentage of denied insurance claims. And it's beginning to affect your bottom line because your medical practice reimbursement is taking a hit. What's going on? While there are plenty of reasons an insurer might deny your claims, [...]

Claim Denial Again: Why Your Urology Medical Coding and Billing are at Risksam-mi2013-07-11T09:00:16+00:00

Medical Necessity for Joint Replacements Requires Heightened Orthopedic Medical Coding Documentation

Medical Necessity for Joint Replacements Requires Heightened Orthopedic Medical Coding Documentation

sam-mi2013-07-09T09:49:23+00:00

How often are you faced with denied claims for joint replacements or those slow to be reimbursed because medical necessity is being reviewed or questioned? One of the most challenging aspects of your orthopedic surgery practice these days is when you provide a service to a patient who genuinely needs a joint replacement only to find later that reimbursement has been denied. Substantiating the need for joint replacement surgery requires detail, detail and more detail in order to avoid claim denial and keep your orthopedic revenue cycle management flowing smoothly. The following CMS guidelines are provide to help you avoid claim [...]

Medical Necessity for Joint Replacements Requires Heightened Orthopedic Medical Coding Documentationsam-mi2013-07-09T09:49:23+00:00

New ICD-10 Codes Include ‘Bizarre’ Ones Rarely Used in Medical Practice Coding and Billing

New ICD-10 Codes Include ‘Bizarre’ Ones Rarely Used in Medical Practice Coding and Billing

sam-mi2013-06-27T10:14:10+00:00

The growing pains of transitioning to ICD-10 can only be surpassed by the pain of adding a slew of new codes that are far from the standard run of the mill ones you utilize every day. Among the 68,000 new ICD-10-CM diagnosis and procedure codes (compared to 18,000 in ICD-9), CMS has created ICD-10 codes that are considered by some to be among the most bizarre. In fact, Power Your Practice has gone one step further to create the "Awards for the Most Bizarre ICD-10 codes." Bizarre or not, these more specific codes are provided as an example of how much [...]

New ICD-10 Codes Include ‘Bizarre’ Ones Rarely Used in Medical Practice Coding and Billingsam-mi2013-06-27T10:14:10+00:00

Radiology at Risk: Radiology Coding Expertise Reduces Overpayments, Audits

Radiology at Risk: Radiology Coding Expertise Reduces Overpayments, Audits

sam-mi2013-06-25T10:00:38+00:00

This year's OIG report includes priorities for finding fraud and waste in Medicare, which continues to include imaging services. Bottom line, your diagnostic radiology group's medical practice billing is under closer examination. If there was ever a time when you needed a healthcare revenue cycle management team that understands the nuances of radiology billing, coding and collections, it's now, when CMS is increasing audits resulting from overpayments. The federal government's goal is to cut the Medicare FFS improper payment rate by half and reduce overall payment errors by $50 billion nationwide. OIG is reviewing Medicare payments for high-cost diagnostic radiology tests [...]

Radiology at Risk: Radiology Coding Expertise Reduces Overpayments, Auditssam-mi2013-06-25T10:00:38+00:00

Heightened Overpayment Risk Mitigated with Emergency Coding Expertise

Heightened Overpayment Risk Mitigated with Emergency Coding Expertise

sam-mi2013-06-20T09:32:00+00:00

In emergency medicine, you're at risk every day. With the dizzying array of procedures conducted in the ER, chances are good that inadequate, noncompliant documentation in medical practice billing will result leading to overbilling and high paid claim error rates. And with PPACA phasing in and ICD-10 looming...it's enough to make you feel faint and need a gurney in your own department. If there was ever a time when you needed a healthcare revenue cycle management team that understands the intricate nuances of emergency medicine coding, billing and collections, it's now, when CMS is increasing audits resulting from overpayments. When it [...]

Heightened Overpayment Risk Mitigated with Emergency Coding Expertisesam-mi2013-06-20T09:32:00+00:00

At Risk? Reduce Overbilling Audits with Neurosurgery Coding Expertise

At Risk? Reduce Overbilling Audits with Neurosurgery Coding Expertise

sam-mi2013-06-18T08:55:00+00:00

Scalpel. If there was ever a better time to perform surgery on your neurosurgery coding, it's now. Why? Your practice is at increased risk for overpayments and high paid claim error rates. A cerebral analysis of your neurosurgery billing will minimize your risk. If you haven't felt the effects of increased federal government scrutiny of your neurosurgery coding, you very well might—and soon. CMS has increased medical practice audits across the board resulting from overpayments. The right healthcare revenue cycle management team will understand your unique neurosurgery billing nuances as the government continues to cut the Medicare FFS improper payment rate [...]

At Risk? Reduce Overbilling Audits with Neurosurgery Coding Expertisesam-mi2013-06-18T08:55:00+00:00

Reduce Risk of Total Joint Overpayment Audits with Orthopedic Coding Expertise

Reduce Risk of Total Joint Overpayment Audits with Orthopedic Coding Expertise

sam-mi2013-06-13T12:04:26+00:00

Your medical practice is under scrutiny. That's because both state and federal agencies are lowering the boom on overpayments. If there was ever a time when you needed a healthcare revenue cycle management team that understands the intricacies of orthopedic coding, billing and collections, it's now, when CMS has increased audits resulting from overpayments. Since 2010, the federal government's goal has been to cut the Medicare FFS improper payment rate and reduce overall payment errors. Among those areas in the spotlight within orthopedic physician medical billing is total joint replacement surgeries and documentation of their medical necessity. This isn't to say [...]

Reduce Risk of Total Joint Overpayment Audits with Orthopedic Coding Expertisesam-mi2013-06-13T12:04:26+00:00

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