Coding Suite

Shared Services – Truth In Billing

By Jana Weis, Principal, Gill Compliance Solutions, LLC.

As consultants in the healthcare industry, we are asked all kinds of questions on a daily basis.  Yet, if I were to add up the number of times clients ask about shared services, it would likely be on the top of the list.  Shared services seem like an easy concept, two providers’ participation in the care of a patient, right?  Well, almost right. 

Let’s first take into consideration the CMS language surrounding shared services:

Webinar Replay - Auditing Your Interventional Radiology Reports to Insure Complete and Compliant Reimbursement

CPT coding for Interventional Radiology (IR) services has always been viewed as one of the more complex services lines to master, let alone understand!  Component coding, complete procedure coding “hybrid” bundled coding—all techniques and options are in play.  As a professional responsible for assigning the CPT codes for these services, what are best practices?  Pitfalls?  How should documentation be structured?

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.

How health care economics teams communicate with payers (and other healthcare entities)

Rayellen Kishbach's picture

In January 2017, the FDA released draft guidance specifying the nature of communications between manufacturers and payers: The first draft guidance, entitled “Drug and Device Manufacturer Communications with Payers, Formulary Committees, and Similar Entities--Questions and Answers,” provides answers to common questions regarding communications of health care economic information (HCEI) about their approved prescription drugs to payers.

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