Understand why some payers won’t pay for removals. Many coders confess they’re tearing their hair out when it comes to coding intrauterine device (IUD) claims, because payer policies can widely vary. In other words, some payers will reimburse IUD insertions [...]
Learn which Medicare programs are impacted. Information blocking remains a high priority for enforcement, and a recent proposed rule aims the crosshairs on Medicare providers’ interoperability practices and the impact on incentive payments. In 2016, the 21st Century Cures Act [...]
Warning: Medicare providers are the target demographic. Since the 21st Century Cures Act was enacted in 2016, the feds have methodically executed data sharing regulations — and penalties for violations. Information blocking continues to be a top enforcement concern, and [...]
Plus: Agency beats out 4 other applicants in CON state. The trend of nonprofit hospices affiliating continues, this time in Pennsylvania. Hospice & Community Care in Lancaster and Hospice of Central PA in Harrisburg plan to merge by the beginning [...]
Draw the line between diabetes before pregnancy and gestational diabetes. So you know that a diabetic pregnant patient requires services that are separate from the global package and demand a higher level of management skill — but does your patient’s [...]
Question: What’s the best way to code the vaginoperineoplasty portion of this procedure? FINDINGS: Shortened vaginal outlet secondary to vaginal scarring from second degree laceration after delivery and also 9 cm uterus. DESCRIPTION OF PROCEDURE: The patient was taken to the [...]
Part B claims with modifier GW are getting Medicare’s Comparative Billing Report treatment. Reminder: Modifier GW indicates the claim is for services not related to the hospice patient’s terminal condition. The CBRs cover paid claims with dates of service from [...]
Plus: Multiple nonprofit hospice mergers are underway. If you haven’t heard the name Gentiva in while, it’s back in play. Keep up: Kindred at Home bought the original Gentiva Health Services in 2015, then insurer Humana bought KAH in two [...]
And find out how to code an unsuccessful procedure. While many women prefer to see a gynecologist to discuss and manage their cycles, many choose instead to see their primary care practitioner (PCP). This means that many family medicine practices [...]
January actions include charges for embezzlement, racketeering, and more. Even though we’re just one month into 2023, healthcare fraud cases are already stacking up. And enforcement activity shows that fraudsters continue to push the envelope with their creative ways to [...]
