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APCs Insider
This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations. Topics include the outpatient code editor (OCE), complex coding issues, beneficiary co-payment discounting, and cross-department APCs tracking.
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Issue 47, December 18, 2015
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Outpatient coding, billing errors continue to lead to majority of automated denials
Outpatient coding and billing errors lead to more than half of all automated denials by Recovery... -
Q&A: Prepare for requirements when reporting biosimilars
Q: Last week, you said there is a code for reporting the biosimilar for filgrastim. How is CMS... -
Tip: Check claims submitted during the ICD-10 transition
Providers should also make sure claims submitted over the ICD-10 transition date of October 1 are... -
Trivia
Which U.S. president attempted to ban Christmas trees at the White House in a bid to encourage...
Issue 46, December 11, 2015
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CMS gives providers a chance to comment on 2-midnight rule payment methodology
Small tweaks to the 2-midnight rule in the 2016 OPPS final rule should help providers, but a... -
Q&A: Which code do I use to report a biosimilar of filgrastim?
Q: Our doctors have started prescribing a form of filgrastim that the pharmacy tells me is called a... -
Tip: Determine whether an urgent care center needs to report modifier -PO
Hospital-owned urgent care centers are subject to modifier -PO (services, procedures and/or... -
Pay-per-view: NCCI logic could lead to no payment for claims including comprehensive APCs
Providers need to be careful when reporting multiple services with status indicator J1 on the same... -
Trivia
Who was once given a key to the city of Detroit?
Issue 45, December 4, 2015
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CMS adds 10 new comprehensive APCs for 2016
CMS did not change the logic for comprehensive APCs (C-APC) or complexity adjustments in the 2016... -
Q&A: How will CMS handle device edits related to procedures in 2016?
Q: Is CMS going to resurrect the device-to-procedure and procedure-to-device edits for 2016? They... -
Tip: CMS issues revision of October I/OCE update
CMS issued a revision of the October 2015 I/OCE update that included changes for HCPCS code Q5101... -
Pay-per-view: Making sense of modifier -PO
Provider-based clinics and departments are increasingly common, but the rules for provider-based... -
Trivia
Which property on the Monopoly board is misspelled?
Issue 44, November 20, 2015
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Are you ready for modifier -CT in 2016?
As providers work to implement policies and regulations introduced by CMS in the 2016 OPPS final... -
Q&A: Requirements for reporting value code FD
Q: Are we still required to report value code FD (credit received from the manufacturer for a... -
Tip: Leveraging technology to manage ICD-10 implementation
Technology can play a key role in reducing the administrative burden of sending queries to... -
Pay-per-view: Predicting ICD-10 losses and tracking key performance indicators
After several delays, ICD-10 implementation is finally here. The healthcare industry has spent... -
Trivia
Which of the following was invented for Ronald Reagan on the occasion of his 1981 presidential...
Issue 43, November 13, 2015
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Provision in 2016 OPPS final rule on 2-midnight rule is positive for providers
Most policies in the OPPS final rule are not effective until the following January, but providers... -
Q&A: CMS makes annual updates for items with pass-through status
Q: Is CMS adding any items with pass-through status for 2016? We are starting to look at... -
Tip: Minimize ICD-10-CM denials by focusing on key performance indicators
To help minimize the impact ICD-10-CM can have on key performance indicators, start by ensuring you... -
Pay-per-view: Providers need more time to analyze CMS’ proposed bundled payment model
Providers know the drill for addressing and operationalizing CMS' annual IPPS and OPPS updates... -
Trivia
The first official copper penny authorized by the U.S. Confederation Congress included what phrase...
Issue 42, November 6, 2015
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Providers dodge a bullet as CMS limits data collection modifier in 2016 OPPS final rule
The 2016 OPPS final rule certainly has some provisions that providers won’t be happy about... -
Q&A: Receive payment for low-dose CT lung cancer screening
Q: We have been providing lung cancer screening using a low-dose computed tomography (LDCT) scan... -
Tip: Analyze CMS' proposed bundled payment model
The idea behind CMS’ Comprehensive Care for Joint Replacement model is that payments for hip... -
Pay-per-view: Beware of the limitations of GEMs
After years of delays, industry and legislative pushback, and millions spent on technology upgrades... -
Trivia
Before the advent of mechanical clocks in the Late Middle Ages, the most sophisticated clocks...
Issue 41, October 30, 2015
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CMS releases promising update on early ICD-10 claims data
CMS issued its first update this week on how ICD-10 implementation has impacted the industry and... -
Q&A: Billing injections and infusions in the ED prior to surgery
Q: I have a question about billing infusion/injections in the ED prior to a decision for surgery... -
Tip: Determine how to report cause of injury codes in ICD-10-CM
When a body part meets with an external object and the result is an injury, you must explain what... -
Pay-per-view: Review ICD-10-CM coding for common cardiac conditions
Heart disease is the most common cause of death for both men and women in the U.S., according to... -
Trivia
The first woman to be appointed to the U.S. Cabinet served under which president?
Issue 40, October 23, 2015
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Congressional concern may not matter for OPPS negative payment adjustment
Members of Congress have thrown their support behind providers in an effort to get CMS to... -
Q&A: We?re getting denials for correct vaccine administration claims
Q: We are receiving denials for pneumococcal and influenza vaccine administrations due to an... -
Tip: Review critical care criteria for the ED
Angina occurs when the heart doesn't get enough blood due to narrow or blocked coronary arteries... -
Pay-per-view: E/M reporting remains a challenge in the ED
Because CMS has not created any national ED E/M guidelines, providers must create their own... -
Trivia
In 1901, Connecticut became the first state to institute what car-related law?
Issue 39, October 16, 2015
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ICD-10 transition appears to be going smoothly for most providers
It’s been more than two weeks since ICD-10 became the official code set and the sky... -
Q&A: What are the risks associated with providers only initializing orders?
Q: We are having a difficult time getting our practitioners to sign their orders. We have a hybrid... -
Tip: Review critical care criteria for the ED
Coders may report critical care provided in the ED. Critical care is defined as the direct delivery... -
Tip: Review critical care criteria for the ED
Coders may report critical care provided in the ED. Critical care is defined as the direct delivery... -
Pay-per-view: Reporting ICD-10-CM external causes is no joke
When a patient suffers a traumatic injury or poisoning, we need to report how he or she became... -
Pay-per-view: Reporting ICD-10-CM external causes is no joke
When a patient suffers a traumatic injury or poisoning, we need to report how he or she became... -
Trivia
Which of the following is illegal in North Carolina? -
The week in Medicare updates
Normal 0 false false false EN-US X-NONE X-NONE... -
Upcoming CMS events
http://www.medicarecompliancewatch.com/network-events/cms-events
Issue 38, October 9, 2015
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Public comments highlight provider concerns with CMS' 2016 OPPS proposals
Despite dealing with the final touches for ICD-10 implementation, providers submitted more... -
Q&A: Does CMS' ICD-10 guidance apply to medical necessity?
Q: CMS released guidance this summer about not auditing or counting errors for the specificity of... -
Tip: How to report activity codes in ICD-10-CM
Code category Y93 in ICD-10-CM provides coders with many activities to identify what exactly the... -
Pay-per-view: Prepare for ICD-10-CM implementation by reviewing common cardiac conditions
Heart disease is the most common cause of death for both men and women in the U.S., according to... -
Trivia
Which day of the week are workers most productive, according to numerous surveys of human resource... -
The week in Medicare updates
The week in Medicare updates
Issue 37, October 2, 2015
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Providers concerned about reporting unspecified ICD-10 codes and seventh characters
ICD-10 is finally here. After several delays, both by CMS and Congress, and continued pressure by... -
Q&A: Rejections for compounded drug combinations
Q: We have been receiving rejections on claims including a line item for a compounded drug. We... -
Tip: Reporting heart failure in ICD-10-CM
Codes for heart failure are located in ICD-10-CM category I50. Coders should note the list of... -
Pay-per-view: E/M reporting remains a challenge in the ED
Because CMS has not created any national ED E/M guidelines, providers must create their own... -
Trivia
What did the U.S. Supreme Court declare unconstitutional in 1895? -
This week in Medicare updates
This week in Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 36, September 25, 2015
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Court gives providers a chance to comment on 2-midnight rule payment reduction
CMS proposed relatively small tweaks to its controversial 2-midnight rule in the 2016 OPPS... -
Q&A: How do we report antibiotic injections during cataract surgery?
Q: Our ophthalmologists have begun using injections of antibiotics during cataract surgery rather... -
Tip: CMS proposes new C-APCs for 2016
CMS proposes adding new comprehensive APCs (C-APC) in 2016, but did not change the logic or... -
Pay-per-view: CMS proposes to expand ancillary services packaging policies
CMS proposes to continue expanding its policies for packaging ancillary services one year after... -
Trivia
Which of the following mammals does not have sweat glands?
Issue 35, September 18, 2015
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CMS offers alternatives for providers having difficulty submitting ICD-10 claims
Despite years of lead time and numerous delays, it’s almost certain that some providers... -
Q&A: October updates for skin substitutes
Q: Did CMS make any changes to skin substitutes for October? -
Tip: CMS looks to add new modifier to identify services performed prior to C-APCs
Providers anticipated an update to the 2-midnight rule in the 2016 IPPS final rule released April... -
Pay-per-view: Industry stakeholders respond to physician concerns with ICD-10 implementation
A few days after Briefings on APCs conducted the interview that appeared in last... -
Trivia
It’s well-known that Coca-Cola’s original recipe included cocaine, but what... -
The week in Medicare updates
The week in Medicare updates
Issue 34, September 11, 2015
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CMS grants extension to state Medicaid programs unprepared for ICD-10
By now, providers are no doubt familiar with the group of entities required to switch to... -
Q&A: Reporting injections of bulking substances
Q: Our physicians are injecting a lot of bulking substances, such as those for strengthening the... -
Tip: CMS looks to add new modifier to identify services performed prior to C-APCs
CMS notes that as comprehensive APC (C-APC) policies expand, the agency needs a way to identify... -
Pay-per-view: CMS proposes massive APC reconfiguration, updates 2-midnight rule
The 2016 OPPS proposed rule released July 2 is deceptively short, but packs a punch. CMS is... -
Trivia
Francis Scott Key was inspired to write “The Star-Spangled Banner” after seeing the... -
The week in Medicare updates
The week in Medicare updates
Issue 33, September 4, 2015
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Providers appear ready for ICD-10 according to latest end-to-end testing results
With less than one month until implementation, CMS says it’s ready for ICD-10, and so are... -
Q&A: Did CMS add any pass-through drugs for October?
Q: Will CMS be adding any new drugs or biologicals to its pass-through list in its next OPPS... -
Tip: CMS proposes extensive APC reconfiguration in 2016 OPPS proposed
For 2015, CMS finalized changes to reconfigure and consolidate ophthalmology and gynecology APCs... -
Pay-per-view: CMS proposes 2% reduction in 2016 conversion factor due to laboratory overestimation
OPPS costs rose approximately $1 billion more than expected in 2014 due to a CMS overestimation... -
Trivia
The tuxedo got its name from which of the following? -
The week in Medicare updates
The week in Medicare updates
Issue 32, August 28, 2015
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Panel recommends hospital payment for advance care planning at summer meeting
Many healthcare industry stakeholders, including providers, technology vendors, and payers, are... -
Q&A: Authentication is key to establishing medical necessity
Q: We received a denial for services based on medical necessity. A Comprehensive Error Rate... -
Tip: CMS reverses decision on device offset
Providers may want to review claims containing HCPCS code C2623 (catheter, transluminal... -
Pay-per-view: Coding Clinic defines ICD-10-CM seventh character
Coders and clinical documentation improvement specialists need a clear understanding of how... -
Trivia
Johnny Cash once suffered severe injuries due to which of the following? -
The week in Medicare updates
The week in Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 31, August 21, 2015
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WEDI survey shows hospitals nearly ready for ICD-10
Despite implementation efforts taking place in fits and starts for years, hospitals are largely... -
Q&A: Can we still use modifier -JF?
Q: What happened to modifier –JF (compounded drug)? CMS added it in April, but... -
Tip: CMS adds new CPT codes in July quarterly I/OCE update
CMS implemented two new CPT® Category III codes originally introduced by the AMA in... -
Pay-per-view: A physician offers his perspective on ICD-10 implementation
Physician groups have led much of the resistance against ICD-10 implementation. At its June... -
Trivia
Castoreum is a substance used in perfumes and food additives extracted from the castor sacs of... -
The week in Medicare updates
The week in Medicare updates
Issue 30, August 14, 2015
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CMS extends 2-midnight rule enforcement delay, proposes 2016 changes
CMS announced this week an expected extension of the enforcement delay for Recovery Auditor reviews... -
Q&A: How do we report alemtuzumab?
Q: Our physicians want to administer a drug that’s new to us called alemtuzumab, with the... -
Tip: Reporting aftercare codes in ICD-10-CM
Aftercare, or Z codes, should not be used for conditions found in Chapter 19 of the ICD-10-CM... -
Pay-per-view: CMS adds code pairs for complexity adjustment in July quarterly I/OCE update
CMS continues to update payment logic for comprehensive APCs (C-APC) with additional changes in... -
Trivia
In North America, two short soundings of a train whistle indicates what? -
The week in Medicare updates
The week in Medicare updates
Issue 29, August 7, 2015
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CMS' billion dollar projection error will cost hospitals in 2016
Anyone who has looked at an OPPS proposed or final rule is aware the rules contain a... -
Q&A: Should we hard code modifier -PO?
Q: Our business office wants us to start using modifier -PO (services, procedures, and/or... -
Tip: Calculating time for hyperbaric oxygen treatment
CMS deleted HCPCS code C1300 (hyperbaric oxygen [HBO] under pressure, full body chamber, per 30... -
Pay-per-view: Coding Clinic defines ICD-10-CM seventh character
We're less than two months away from the implementation of ICD-10-CM/PCS, and the AHA Coding... -
Trivia
Which symbol was at one point considered part of the English alphabet? -
The week in Medicare updates
The week in Medicare updates
Issue 28, July 31, 2015
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Take the time to comment on 2016 OPPS proposed rule
If healthcare workers lack one thing right now, it’s probably free time. Dealing with... -
Q&A: Which revenue code is used for IV fluid given in ED?
Q: If IV fluid such as sodium chloride is given in the ED, should the revenue code be 250... -
Tip: Steps to account for appropriate modifier -25 usage
Providers should look at their existing procedure charges and make sure they have built some... -
Pay-per-view: Use caution when applying modifier -59 for drug administration services
With drug administration services, providers likely find themselves prompted to use modifier -59... -
Trivia
Which of the following is not the nickname of a player enshrined in the National Baseball Hall of... -
The week in Medicare updates
The week in Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 27, July 24, 2015
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CMS proposes C-APC for observation services in 2016
CMS did not propose making any radical changes to comprehensive APCs (C-APC) methodology, such as... -
Q&A: Reporting modifiers with infusions in the ED
Q: I have been told by our billers that infusion codes reported in the ED along with an E/M... -
Tip: Using modifier -59 to bypass drug administration edits
Use modifier -59 (distinct procedural service) only when appropriate to bypass medically unlikely... -
Pay-per-view: Overhauled 2015 CPT drug test codes bring changes for coders and providers
In an effort to accommodate the latest advances in technology and make the code set easier to... -
Trivia
Although both states are considering legislation to change the laws, New Jersey and which other... -
The week in Medicare updates
The week in Medicare updates
Issue 26, July 17, 2015
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What does AMA and CMS ICD-10 agreement mean for hospitals?
Providers got an unexpected surprise following the Fourth of July holiday when CMS and the American... -
Q&A: Reporting magnetic band implantations to treat GERD
Q: Our physicians want to start implanting a magnetic band around the distal esophagus to treat... -
Tip: Pay attention to CMS rules for reporting drug testing codes
In addition to extensive drug testing code changes in the CPT® Manual, facility reporting for... -
Pay-per-view: Use caution when applying modifier -59 for drug administration services
Most coding professionals have heard modifier -59 (distinct procedural service) referred to as a... -
Trivia
A British historian researching his country’s history found that of approximately 200... -
The week in Medicare updates
The week in Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 25, July 10, 2015
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2016 OPPS proposed rule: CMS looks to extensively reconfigure and consolidate APCs
CMS appeared to give providers a break with this year’s OPPS proposed rule, released July... -
Q&A: New codes receive pass-through status
Q: Did CMS add any new codes for drugs that have pass-through status this month? -
Tip: Reporting definitive drugs tests in 2015
Coders will find 59 new codes in the 2015 CPT® Manual for reporting definitive drug tests... -
Pay-per-view: Providers continue to grapple with reporting modifier -25
Lately I've received a lot of questions from hospitals about how to determine when and if it's... -
Trivia
Scooby Doo was originally named Too Much, but a vocal improvisation in a 1967 song by this singer... -
The week in Medicare updates
The week in Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 24, June 26, 2015
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AMA clarifies its intent with ICD-10 grace period
The bill from Congress calling for a two-year grace period during which providers are not... -
Q&A: Claims for hyperbaric oxygen therapy rejected
Q: We have been receiving rejections of our claims with HCPCS code C1300 (hyperbaric oxygen under... -
Tip: CMS added two new modifiers effective April 1
As part of the April quarterly OPPS update, CMS added two new modifiers valid April 1... -
Pay-per-view: Refresh your knowledge of taxonomy codes
Taxonomy codes play a very important role in medical billing and credentialing for... -
Trivia
What is the most expensive spice in the world? -
The week in Medicare updates
The week in Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 23, June 19, 2015
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MedPAC report could serve as preview of OPPS proposed rule
CMS deferred making any updates to the 2-midnight rule in its 2016 IPPS proposed rule, but the... -
Q&A: Did CMS update pass-through devices in July’s quarterly update?
Q: Are there any new pass-through devices or changes for July under the OPPS? -
Tip: Departments need to work together for successful ICD-10 implementation
One of the largest challenges with ICD-10 may be overcoming the perception that transitioning is... -
Pay-per-view: Recent rules and regulations should reduce provider ICD-10 uncertainty
Providers have been plagued by uncertainty regarding ICD-10, with multiple delays pushing out... -
Trivia
What was President Harry S. Truman's middle name? -
The week in Medicare updates
The week in Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 22, June 12, 2015
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Congress foregoes all logic with latest ICD-10 bill proposal
ICD-10 implementation is 110 days away. Coders, HIM professionals, and providers have spent... -
Q&A: Which new HCPCS codes are effective July 1?
Q: You previously wrote about new code Q5101 for Zarxio®. Are there any additional... -
Tip: Modifier ?PO remains voluntary until 2016
As part of the April quarterly OPPS update, CMS revised the Medicare Claims Processing... -
Pay-per-view: ICD-10 implementation requires organizationwide education and awareness
Organizations must continue to educate and train staff throughout the transition to ICD-10... -
Trivia
What was the original name of the Statue of Liberty? -
The week in Medicare updates
The week in Medicare updates
Issue 21, June 5, 2015
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CMS completes another round of successful ICD-10 end-to-end testing
CMS has completed another round of successful ICD-10 end-to-end testing, with the acceptance rate... -
Q&A: What are biosimilar products?
Q: We are receiving requests from our physicians regarding administration of a new drug... -
Tip: Assess payer readiness before ICD-10 implementation
Provider/payer integration is essential for successful ICD-10 implementation. Contracts will need... -
Pay-per-view: IPPS rule: Long outpatient stays with observation services to be discussed in 2016 OPPS rule
The 2016 OPPS proposed rule is likely to continue CMS' trend of expanded packaging and feature... -
Trivia
Which of the following territorial acquisitions did the U.S. pay the least for, in 2015 dollars? -
The week in Medicare updates
The week in Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 20, May 29, 2015
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ICD-10 misinformation campaign continues in university study
While the AMA has focused on scaremongering instead of educating physicians ahead of the rapidly... -
Q&A: Is there a C code for sinus stents?
Q: We are have a debate about reporting sinus stents. Specific HCPCS C codes represent... -
Tip: Determining comprehensive APC reimbursement
Providers need to take multiple steps to determine the reimbursement for a comprehensive APC... -
Pay-per-view: Apply CMS’ new -X{EPSU} modifiers
When CMS introduced the -X{EPSU} modifiers in August 2014 to be used in specific instances to... -
Trivia
A total of 12 astronauts have walked on the moon's surface since the first moon landing in 1969... -
The week in Medicare updates
The week in Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 19, May 22, 2015
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ICD-10 opponents mount last-ditch roadblocks to implementation
Congress appears to have finally acknowledged the inevitability of ICD-10 implementation in 2015... -
Q&A: Why do we receive an edit when reporting fluoroscopy?
Q: We have started receiving an edit for our pain management procedures reported with CPT®... -
Tip: Reporting tobacco use in ICD-10-CM
Tobacco use and dependence can increase a patient's risk of developing respiratory illness... -
Pay-per-view: CMS releases update to correct and clarify comprehensive APC payments
CMS released updated I/OCE specifications in January with several changes that could require... -
Trivia
The first Memorial Day observance was held May 30, 1868, at Arlington National Cemetery. Before... -
The week in Medicare updates
The week in Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 18, May 15, 2015
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The inevitability of ICD-10 is slowly dawning on Congress
As Congress' latest attempt to delay, or permanently derail, ICD-10 languishes in committees with... -
Q&A: We included a procedure on an inpatient claim before the patient was admitted
Q: We erroneously included a surgical inpatient-only procedure on an inpatient Medicare claim and... -
Tip: Apply CMS’ new -X{EPSU} modifiers
Providers have asked many questions about how to use the –X{EPSU} modifiers due to a lack... -
Pay-per-view: Start resolving ICD-10-CM questions
Many coders rely on the AHA's Coding Clinic advice to resolve sticky situations with ICD-9-CM... -
Trivia
Which of the following can be calculated from the frequency of cricket chirps? -
The week in Medicare updates
The week in Medicare updates
Issue 17, May 8, 2015
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Congress continues tone-deaf approach to ICD-10
Several members of Congress showed a fundamental misunderstanding of ICD-10 during a subcommittee... -
Q&A: Reporting drug codes with no G code crosswalk
Q: I have a question about reporting drug tests to CMS for CPT® codes that do not have a... -
Tip: CMS updates comprehensive APC logic for add-on codes
A change CMS made to the I/OCE specifications earlier this year corrects the processing for... -
Pay-per-view: HOP Panel discusses site parity, drug administration at latest meeting
The policies that CMS publishes each year in the OPPS proposed rule don't always come as a... -
Trivia
How long is a standard bowling lane from the foul line to the head pin? -
The week in Medicare updates
The week in Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 16, May 1, 2015
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Learn strategies to reduce the burden of Part B rebilling
New regulations allow hospitals to bill Part B services for inpatient cases that are internally... -
Q&A: Requirements for drug panels ordered in the ED
Q: When a patient presents to the ED and the physician there orders a drug panel, we perform the... -
Tip: Classifications changing in ICD-10-CM
Not all classifications remain the same in ICD-10-CM. Hemoptysis (coughing up blood or... -
Pay-per-view: Apply CMS’ new ?X {EPSU} modifiers
When CMS introduced the –X {EPSU} modifiers in August 2014 to be used in specific instances... -
Trivia
Richard II was the first British monarch to demand this title, which comes from the Latin for... -
The week in Medicare updates
The week in Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 15, April 24, 2015
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CMS to address long outpatient stays with observation services in OPPS rule
Since nearly the moment it was announced, CMS' 2-midnight rule—created to help define... -
Q&A: Rejections for codes without internal edits
Q: We are receiving rejections for HCPCS codes J0365 (injection, aprotonin, 10,000 kiu) and J7180... -
Tip: Reporting anxiety disorders in ICD-10-CM
According to the National Institute of Mental Health (NIMH), anxiety disorders affect... -
Pay-per-view: CPT Medicine section updates reflect new products and technologies to report
Each year, the AMA updates the Vaccines, Toxoids section of the Medicine chapter in the CPT®... -
Trivia
Which city's airport is identified with the code PIE? -
The week in Medicare updates
The week in Medicare updates
Issue 14, April 17, 2015
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SGR reform passes with no ICD-10 delay, so what’s next?
Congress finally repealed the Sustainable Growth Rate (SGR) this week. The fix ends more... -
Q&A: We now receive edits on certain skin substitutes
Q: We have been reporting skin substitutes with the appropriate procedure codes (either CPT®... -
Tip: Remember to check AMA website for new vaccine product codes
Each year, the AMA updates the Vaccines, Toxoids section of the Medicine chapter in the CPT®... -
Pay-per-view: Reporting mental disorders in ICD-10-CM
Mental health disorders are common in the United States, with an estimated 19% of Americans 18 or... -
Trivia
The word "senator" is a Roman term derived from the Latin senex, which means what? -
The week in Medicare updates
The week in Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 13, April 10, 2015
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Providers’ greatest obstacle to ICD-10 preparations could soon be removed
If the Senate manages to pass the bipartisan Sustainable Growth Reform (SGR) reform bill... -
Q&A: Drug payments updated for April
Q: Did CMS make any changes to drug payments for April? -
Tip: Reporting vascular dementia in ICD-10-CM
Vascular dementia is caused by impaired blood flow to the brain, which damages the brain's blood... -
Pay-per-view: Majority of industry stakeholders support ICD-10 at House hearing
When Congress delayed ICD-10 implementation in 2014 by inserting language into an unrelated... -
Trivia
Which of the following condiments was originally patented as a medicine and sold as a pill? -
The week in Medicare updates
The week in Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 12, March 27, 2015
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Congress poised to finally fix the SGR
Congress is closing in on a permanent fix to the Sustainable Growth Rate (SGR) formula... -
Q&A: CMS updates pass-through device list
Q: Did CMS grant pass-through status for any new devices in April? -
Tip: Coding kidney stones in ICD-10-CM
Urolithiasis (ICD-10-CM categories N20-N22) is a condition in which hard masses, or calculi... -
Pay-per-view: Analyze the impact of comprehensive APCs
For 2015, CMS identified 219 HCPCS/CPT codes as good candidates for comprehensive APCs (C-APC... -
Trivia
Which of the following animals has the largest eyes (in total size)? -
The week in Medicare updates
The week in Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 11, March 20, 2015
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CMS reverses policy on inpatient-only procedures
This week, CMS released Transmittal 3217, effective April 1, which will allow inpatient-only... -
Q&A: Can we code marker placement for a breast biopsy?
Q: An auditor recently told us to code two CPT® codes for a breast biopsy with placement of a... -
Tip: CMS moves skin substitutes from low- to high-cost category
In 2014, CMS added skin substitutes to the list of packaged drugs and biologicals, dividing the... -
Pay-per-view: ICD-10-CM anatomy refresher: Urinary system
The urinary system, also known as the renal system, provides a variety of bodily functions... -
Trivia
Which U.S. president served as an executioner before taking office, earning the nickname... -
The week in Medicare updates
The week in Medicare updates
Issue 10, March 13, 2015
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ICD-10 opponents may have finally run out of time
ICD-10 opponents have been fighting the code set for 20 years, but in approximately two weeks... -
Q&A: When do we report ICD-10-CM category E13 for diabetes?
Q: We see a lot of diabetes diagnoses at our facility, but are confused about when we might... -
Tip: Determine the impact of comprehensive APCs on your facility
Addendum J of the 2015 OPPS final rule is a spreadsheet that includes several tabs providers can... -
Pay-per-view: CMS adds comprehensive APC logic in January quarterly I/OCE update
The implementation of comprehensive APCs (C-APCs) in the 2015 OPPS final rule likely wasn't a... -
Trivia
March 15, the Ides of March, is known as the date Julius Caesar was assassinated. What did the... -
The week in Medicare updates
The week in Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 9, March 6, 2015
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Support for another ICD-10 delay may be dwindling in Congress
Providers and Congress members largely support ICD-10 implementation on October 1, 2015... -
Q&A: Where do we find skin substitute classifications?
Q: We use a lot of skin substitutes. Where do we find a list of the new HCPCS codes and how... -
Tip: Modifier -PO remains optional until 2016
CMS added one modifier for 2015, but will not require its use until January 1, 2016... -
Pay-per-view: Analyze the impact of comprehensive APCs
The implementation of comprehensive APCs (C-APCs) in the 2015 OPPS final rule likely wasn't a... -
Trivia
A panophobe is afraid of what? -
The week in Medicare updates
The week in Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 8, February 27, 2015
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CMS completes successful first round of end-to-end testing
The main concern of some Congress members regarding ICD-10 implementation during the recent House... -
Q&A: Should we report injections during cataract surgery?
Q: Our surgeons have started performing drop-less cataract surgery. Instead of using eye drops... -
Tip: Providers still seeking extension of supervision requirements exemption
Non-enforcement of supervision requirements for certain therapeutic services for critical access... -
Pay-per-view: Musculoskeletal and nervous system sections get new procedure, combination codes
As new and more effective treatment options are created and evaluated, AMA must update... -
Trivia
In America, the most collect calls placed on which day? -
The week in Medicare updates
The week in Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 7, February 20, 2015
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CMS seeking modifier -59 information from providers
The latest guidance from CMS on modifier -59 (distinct procedural service) did little to help... -
Q&A: Why are we receiving denials for so many drug testing codes?
Q: We are receiving denials for many of the new CPT® codes in the laboratory section of... -
Tip: Combination codes in ICD-10-CM provide additional information
ICD-10-CM allows coders to report additional detail for many conditions of the male reproductive... -
Pay-per-view: CMS updates outpatient supervision level documents
In December 2014, CMS posted a document on its Advisory Panel on Hospital Outpatient Payment (HOP... -
Trivia
Which U.S. president once worked as a model, appearing on the cover of Cosmopolitan magazine? -
The week in Medicare updates
The week in Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 6, February 13, 2015
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Arguments for ICD-10 delay see little support at Congressional hearing
Last year's unexpected ICD-10 delay disappointed countless hospitals, payers, physicians... -
Q&A: Why are we seeing so many edits when using modifier -25?
Q: We are seeing an increase in the number of edits we are receiving for modifier -25... -
Tip: AMA adds CPT code to report arthrodesis of the sacroiliac joint
A new CPT® code for arthrodesis, a joint fusion technique to relieve pain, of the sacroiliac... -
Pay-per-view: ICD-10-CM anatomy refresher: Reproductive system
Since portions of the reproductive system use some of the same structures as the urinary system... -
Trivia
A dog is a canine and a cow is bovine, but which of the following animals is ovine? -
The week in Medicare updates
The week in Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 5, February 6, 2015
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CMS’ latest modifier -59 update offers little guidance for providers
After CMS announced four new, more specific replacements for modifier -59 (distinct procedural... -
Q&A: Are we coding and billing Comprehensive APCs correctly?
Q: We don’t quite understand the CMS' new Comprehensive APCs (C-APC) and how to code or... -
Tip: CMS issues no updates for NSEDTS in 2015
Several years ago, CMS defined a list of nonsurgical extended duration therapeutic services... -
Pay-per-view: Musculoskeletal and nervous system sections get new procedure, combination codes
As new and more effective treatment options are created and evaluated, AMA must update the... -
Trivia
Which mammal has the longest gestation period, at approximately 660 days? -
The week in Medicare updates
The week in Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 4, January 30, 2015
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Medicare unveils alternative payment models
Federal officials announced an accelerated effort to use payment reform to shift Medicare and the... -
Q&A: Do we have to report an unlisted code for a laryngoscopy?
Q: We are providing a new service where the ear, note, and throat physician performs a... -
Tip: CMS removes procedures from inpatient-only list in 2015 OPPS final rule
CMS removed two add-on procedure codes from the inpatient-only list in the 2015 OPPS final rule... -
Pay-per-view: Taking a three-dimensional look at CMS’ finalized policies
As CMS pushes the OPPS from a fee-for-service program toward more of a true prospective payment... -
Trivia
The record for most snowfall in a 24-hour period occurred in Silver Lake, Colorado, beginning... -
The week in Medicare updates
The week in Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 3, January 23, 2015
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Congress begins work on latest SGR fix
Congress' Subcommittee on Health met this week to begin discussing legislation that could... -
Q&A: Does CMS have a code for new wireless heart sensors?
Q: Our physicians want us to purchase a new wireless sensor to monitor pulmonary artery pressure... -
Tip: CMS finalizes quality program changes in 2015 OPPS final rule
CMS finalized several changes to the Hospital Outpatient Quality Reporting (OQR) program in order... -
Pay-per-view: CMS finalizes comprehensive APCs with complexity adjustments for 2015
In a concerted effort to move healthcare payments to a system of "quality over... -
Trivia
In 1804, Napoleon became king of which country? -
The week in Medicare updates
The week in Medicare updates
Issue 2, January 16, 2015
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CMS extends deadline to volunteer for ICD-10 end-to-end testing
CMS is giving providers additional time to volunteer for its second wave of ICD-10 end-to-end... -
Q&A: Can we report CPT therapy codes for services by non-therapists?
Q: Can we report new CPT® codes 97607 (negative pressure wound therapy, utilizing disposable... -
Tip: CMS expands packaging in 2015
CMS finalized changes for conditional packaging of ancillary services in the 2015 OPPS final... -
Pay-per-view: CMS adds data collection for services in off-campus, provider-based departments
CMS proposed that a new HCPCS modifier be appended to every code for a service furnished in a... -
Trivia
Before Dutch carrot growers began to cultivate orange carrots in the 17th century, the vegetable... -
The week in Medicare updates
The week in Medicare updates
Issue 1, January 9, 2015
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Does your facility struggle with injection and infusion coding and billing?
We consistently receive questions about coding for injections and infusions, even though the... -
Q&A: Should we be reimbursed for corneal tissue for transplants?
Q: Why are we not receiving anything from Medicare to cover the cost of corneal tissue? We... -
Tip: CMS makes changes to device edits in 2015
CMS will no longer implement specific procedure-to-device or device-to-procedure edits for any... -
Pay-per-view: Taking a three-dimensional look at CMS’ finalized OPPS policies
As CMS pushes the OPPS from a fee-for-service program toward more of a true prospective payment... -
Trivia
The coldest recorded temperature in America occurred January 23, 1971, in Prospect Creek, Alaska... -
The week in Medicare updates
The week in Medicare updates
Issue 11, March 20, 2015
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Upcoming CMS events
Upcoming CMS events
Issue 9, October 9, 2015
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Upcoming CMS events
Upcoming CMS events