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Medical coding news, guidelines, and information about ICD-9-CM, ICD-10-CM, CPT HCPCS level II, and the medical coding industry.

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    By Carol Olson, CPC, CPC-H, CPC-I, CEMC, CCS, CCS-P, CCDS Medicare Advantage (MA) reimbursement can trip you up in ways you didn’t expect. If you are seeing MA patients, be mindful of opportunities and pitfalls. MA health plans are reimbursed based on beneficiaries’ chronic conditions. Submitting an inaccurate diagnosis, or a diagnosis resulting in a different […]

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    By Robert A. Pelaia, Esq., CPC, CPCO It’s foolish to ignore the signs that set off Office of Inspector (OIG) radar. Look around your work environment. If an OIG investigator walked into your office right now, what would he or she see (or not see) that shows compliance is not taken seriously in your practice? […]

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    By Delly Parham, CPC “Take backs” have replaced “pay backs,” thanks to the adoption of paperless business practices. This demands a new approach to overpayment issues. What is a take back, and what does this mean to your practice? A payer automatically deducts dollars for an alleged overpaid claim from a future claim payment. This […]

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    Ideally, ancillary services not only add value to a practice, they also provide care patients want or need, drawing in new clients and keeping the existing patient base on site. AAPC’s VP of Business Development, Dixon Davis, MBA, MHSA, CPPM, was recently interviewed for an article from MD News on this topic of ancillary services […]

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    Monitor financial performance and mitigate risks associated with the pre- and post-transition to ICD-10. By Ken Bradley Now is the time for physician practices to get revenue cycles in order—not six months before ICD-10 implementation. If the transition is anything like the adoption of 5010 transaction standards and national provider identifiers, ICD-10 will lead to more […]

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    Substitute physicians can contribute to a practice’s revenue stream when modifier Q6 is used properly. By LuAnn Jenkins, CPC, CPMA, CMRS, CEMC, CFPC Locum tenens is a Latin phrase that means “(one) holding a place.” In the medical field, locum tenens are contracted physicians who substitute for a physician who has left the practice, or […]

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    Become familiar with new initiatives and payment models, and be willing to adapt. By Lamon Willis, CPC, CPCO, CPC-I, CPC-H Among 191 countries, the World Health Organization ranks the United States as 37th for quality of healthcare, yet we spend a higher portion of our gross domestic product on healthcare than all other countries (The […]

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    Part 1: Begin with solid policies and procedures. By Linda Martien, CPC, CPC-H, CPMA Being a practice manager means you must know where the buck stops in your facility or office: Who is accountable for what? Can you measure staff performance? What is your policy for conflict resolution, collections, appointment no shows, absenteeism, etc.? These […]

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    Take action to bolster revenue and give your practice financial breathing room. There are several reasons why cash flow may be impeded in medical practice, and there are several strategies to mitigate that risk and keep your practice running smoothly and efficiently. Ultimately, you must know your needs and your market, and be ready to […]

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    Medical billers and providers nationwide face difficulty when establishing best medical billing practices for improving practice revenue cycles. With a goal to submit clean claims that support appropriate reimbursement levels, the following tips may help you to establish successful medical billing in your practice: Verify appropriate eligibility and benefits before rendering services. Incorrect insurance information […]

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    Part 2: Fix patient registration errors to restore your practice’s financial health. By Linda Martien, CPC, CPC-H, CPMA The accuracy of patient registration is an important factor in whether claims are paid or denied. Overcoming registration errors is instrumental to the financial health of your practice, and requires consistent policies and procedures, education, and accountability. […]

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    Target where your practice squanders resources and alleviate the waste, long term. By Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC There has been much speculation on the potential benefits of implementing ICD-10-CM and whether physicians will see any benefit — or even if patients will. What I’m suggesting will benefit both. You’ve heard how […]

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    This payment model gives you a better view into patient conditions and care. By Brian Boyce, BSHS, CPC, CPC-I Risk adjustment is known primarily for its role in Medicare Advantage plans, but is now used across all facets of healthcare. There’s more to it than collecting diagnoses to meet fee-for-service (FFS) guidelines. By driving documentation […]

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    Key performance indicators will help you generate a true picture of practice revenue. by Jim Strafford, CEDC, MCS-P Since I began my career in revenue cycle management, formerly called accounts receivable (A/R) management, reporting capacity and functionality have increased exponentially. Back then, a billing cycle manager could access a very basic package of reports to […]

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    Success relies on front desk staff collections and post-claim payment strategies. by Mary Pat Whaley, FACMPE, CPC In the past, collections in medical practices focused predominantly on insurance collections because insurers paid the greater portion of the physician’s fee. Thirty-five years later, the pendulum has swung from the insurance company paying anywhere from 80-100 percent […]

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    Part 3: Billing problems? Consider your charge ticket. by Linda Martien, CPC, CPC-H, CPMA Are you charging for every service you perform? If your practice is like most, the answer is probably “No.” Many estimates suggest a significant portion of annual practice revenue is lost because practices simply do not bill for services and procedures […]

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    Bolster HCPCS Level II revenue with an nine-step supply chain management process. By Chris Varani, MBA, MS Finance, CPC-A As your practice cares for patients throughout the day, you probably use many drug, medical, and surgical supplies. For instance, in orthopaedics, you place an ankle brace on Jim after he “showed” his daughter how to […]

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    Part 4: Establish complete and accurate charge capture and remittance advice. By Linda Martien, CPC, COC, CPMA Charge capture is critical to your overall revenue cycle and it’s important for you have an understanding of how it relates to the livelihood of your practice. Very simply, it’s the acquiring of information for use in a […]

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    When your revenue functions are working in unison, you’re in for a smooth ride. By Michelle Stallings, CPC Revenue capture in a medical practice can be compared to a wheel. The wheel begins to turn the moment a patient calls for an appointment and stops only when the balance on the patient account is zero. Just […]

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    Analyze root cause and resolve issues by encouraging communication across departments. By Tina Hill, CPC, MHA Poor communication throughout a revenue cycle is common and often results in revenue leaks. After a review of revenue cycle management and common communication gaps, we’ll consider solutions for closing any gaps within your organization, so you can quickly realize […]

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