Coding

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.

Supporting Compliance in the New World of Remote and Outsourced Coding & Billing.

Rayellen Kishbach's picture

According to a recent HIM Benchmark Report, HIM department managers equally ranked Coder Productivity, Quality, and Managing Financial Metrics as their biggest challenges, while that same report noted that close to 60% of HIM professionals outsource a portion of their coding needs. Even without direct outsourcing, we notice an increase in the opportunity to do coding and billing work remotely.

How do Medical Review professionals keep up?

Rayellen Kishbach's picture

The ever-increasing pace of healthcare benefit and coverage policy change makes it harder than ever for medical review professionals to make quick, completely informed policy and reimbursement decisions. Without the right information and tools, your organization’s exposure to risk increases. This risk is multiplied when you have to monitor and comply with updates across multiple states.

ICD-10-CM: Myths Gone Wild

As the ICD-10-CM implementation date nears, it seems that the buzz has heightened and along with the buzz comes half-truths and misconceptions.   A recent online article in Forbes’s magazine focused on coding.  The article, “Doctors Lag Far Behind On New Medicare Diagnosis Codes,” implies that ICD-10-CM codes are Medicare codes.  Because the United States uses ICD-9-CM (and eventually ICD-10-CM) in the billing process, we have ventured away from real reason we code:  to have an efficient, consistent system of capturing data that supports healthcare decision making in our country.   Do we ca

Maria Bounos from Wolters Kluwer joins "Talk Ten Tuesday" to discuss ICD-10: Now and Then

 Maria Bounos, RN, MPM, CPC-H, Practice Lead Coding and Reimbursement Products from Wolters Kluwer, will appear on ICD10monitor.com’s “Talk Ten Tuesday” on October 14, 2013 at 10am EDT as part of an expert panel to discuss ICD-10: Now and Then. Register Now!

Is ICD-10 really needed in the US?

Key industry players, such as the AMA and MGMA, have questioned whether we really need ICD-10-CM in this country.  They seem to think there will be no benefit to clinicians with the upcoming change in the diagnosis coding system.  I think they’re wrong.  The current system hasn’t been overhauled since 1979.  It’s been updated every year but it can’t move forward to work in the electronic environment and it can’t capture information about current day medical practice.  It’s pretty hard to describe cutting edge medicine with a 34 year old system. 

Medicare and Inpatient Consultations

CMS made a major blooper in their announcement about a new set of claims edits designed to keep providers from reporting new patient evaluation and management (E/M) services more frequently than allowed. But the good news is that they have fixed the edits and you should not run into any problems with them as long as you are following correct E/M coding guidelines. On May 3 CMS issued Transmittal 1231, which explained the new edits. The Transmittal listed the codes that CMS considered to be new patient services.

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