Culture of Compliance, EGRC

Claims Adjudication and Payer Rules under ICD-10

Rayellen Kishbach's picture

Because we process thousands of LCDs updates weekly for our Coding Suite, we often get some insights that we can share. With the implementation of ICD-10, a significant drop off in the number of local coverage determinations (LCDs) and coverage articles published by the Medicare Administrative Contractors (MACs) has occurred. (See table in the white paper link below). While this may be partly due to MAC consolidation, it has left providers with less guidance than before about the proper coding and billing of covered services.

Understanding non-covered codes – help for denials management and pre-payment review edits

Rayellen Kishbach's picture

Wouldn't it be great if there was just ONE LIST of procedure codes published somewhere by Medicare to identify non-covered services? Unfortunately, there isn’t one, but a quick review of the information that is provided by Medicare can get you there.

Policy Management

Maintaining consistent policies, documentation and compliance procedures, particularly across multiple facilities, locations and across multiple states, is difficult and often done after the fact.

Be There or Be Square: HCCA's Annual Compliance Institute

Darci Friedman's picture

HCCA's Annual Compliance Institute is just 25 days away! I attend the Compliance Institute every year, but this year I am really looking forward to it. Part of my eagerness is motivated by the fact that I write this from the greater Boston area. This has been a really rough winter for even the heartiest of New Englanders and it just seems as though there is no end in sight. It is a cold 21 degrees today. Brrrrr!  Lake Buena Vista, Florida - where this year's Compliance Institute is being held is projected to have a high in the mid-eighties today.  I'll take it!

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