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Medical Necessity Monopoly: How to Avoid “Chance” and Advanced to “Go”

Medical Necessity Monopoly: How to Avoid “Chance” and Advanced to “Go” ICD-10 Monitor – November 2018 by Karen Zupko and Michael Marks, MD, MBA A three-step medical necessity action plan can help ensure payment Consider the following: A patient presents to your office complaining of symptoms that indicate a possible herniated disk. A history notes symptoms...

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Major Challenges Face Coders in 2019 and Beyond

Major Challenges Face Coders in 2019 and Beyond ICD-10 Monitor – December 10, 2018 by Deb­o­rah Grider CPC, COC, CPC-I, CPC-P, CPMA, CEMC, CCS-P, CDIP ddress documentation and coding issues up front, rather than correct them later. Coders have had many challenges throughout the years.  When I started in the industry, we did not submit...

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Highlights of the Medicare Physician Fee Schedule Final Rule

Highlights of the Medicare Physician Fee Schedule Final Rule RAC Monitor – November 14, 2018 by Deb­o­rah Grider CPC, COC, CPC-I, CPC-P, CPMA, CEMC, CCS-P, CDIP Highlights of the 2019 Medicare Physician Fee Schedule, released on Nov. 1, are provided by the author. There will be no change in E&M payment levels for 2019, as...

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5 Tips for Analyzing if Ancillaries Yield Profits

5 Tips for Analyzing if Ancillaries Yield Profits Physicians Practice – Oct 10, 2018 by Cheyenne Brinson, MBA, CPA Many practices assume their ancillaries are profitable, yet often lack the systems needed to conduct a proper analysis. Here are five tips for analyzing if ancillaries are yielding promised profits. 1. Set up ancillaries as cost centers on...

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Take A Bite Out of the No-Show Rate

Orthopaedics today — November 2018 by Karen Zupko, President More than half of the orthopedic practices that responded to the KarenZupko & Associates Inc. 2018 American Academy of Orthopaedic Surgeons coding and reimbursement workshop pre-course survey (54%) said that no-shows are a “problem” in their offices. That is up from 38% in 2017 and 43%...

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Answers to Five Common Coding Questions

Answers to Five Common Coding Questions AAOS Now – October 2018 by Margaret M. Maley, BSN, MS and Sarah Wiskerchen What orthopaedic surgeons, practice managers, and staff want to know In this article, we discuss five concerns from surgeons and their staff that are currently “trending.” 1. Vendor advice = a flashing yellow light Question: Our orthopaedic...

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Are Online Coding Discussions Putting Your Practice at Risk?

Are Online Coding Discussions Putting Your Practice at Risk? Medical Office Manager – October 2018 by Cheryl Toth, MBA Here’s an email we recently saw while monitoring a specialty coding listserv: Subject: Acromioplasty and hardware removal with total shoulder arthroplasty Hello All, We have a surgeon that says I am not an aggressive coder because I...

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2019 CPT® Coding for Skin Biopsies

2019 CPT® Coding for Skin Biopsies ICD10 Monitor – September 2018 by Deborah Grider, CPC, COC, CPC-I, CPC-P, CPMA, CEMC, CCS-P, CDIP Skin biopsy codes are changing. EDITOR’S NOTE: This is the second installment in a two-part series on the 2019 CPT® codes released recently by the American Medical Association. For many years we have used two...

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AMA Releases 2019 CPT® Code Set

AMA Releases 2019 CPT® Code Set ICD10 Monitor – September 2018 by Deborah Grider, CPC, COC, CPC-I, CPC-P, CPMA, CEMC, CCS-P, CDIP New code changes number 335. The new current procedural terminology (CPT®) codes have been released with 335 code changes in 2019.  There were many code revisions with guideline, description and instructional note changes.   Let’s look...

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