Category: Coding & Documentation

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Selling your practice? Clean up the coding first.

Selling your practice? Clean up the coding first. Physicians Practice Pearls – March 2019  by Karen Zupko As more and more practices are courted for acquisition, our firm is being engaged by both buyers and sellers to evaluate the accuracy of coding and documentation, and the efficiency of the revenue cycle. The results of these...

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Understand CMS Advanced Billing Practitioner Professional Billing

Understand CMS Advanced Billing Practitioner Professional Billing ICD-10 Monitor – January 2019  by Deb­o­rah Grider Not billing the APP service can result in serious revenue cycle errors. Many providers are still struggling with the non-physician practitioner (NPP) billing rules from the Centers for Medicare & Medicaid Services (CMS). Most facilities are now referring to NPPs as...

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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” AAOSNow – 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 following...

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The Value of Claims ‘Signal’ Data in Orthopaedic Surgery

The Value of Claims ‘Signal’ Data in Orthopaedic Surgery AAOSNow – January 2019  by Michael Marks, MD, MBA In last month’s article, “Scientific Analysis for Medical Liability Claims,” Coverys’ Robert Hanscom, vice president of business analytics, and Lisa Simm, manager of risk management, presented the methodology the insurer utilizes to analyze medical professional liability (MPL) claims....

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Is ‘Insurance Only’ Billing Advisable?

Is ‘Insurance Only’ Billing Advisable? AAOSNow – January 2019  by Cheyenne Brinson and Patricia Hofstra Surgeons instructing billing staff to bill “insurance only” is a scenario that is all too common in orthopaedic practices. In effect, the practice is waiving the patient’s copay, coinsurance, and deductible amounts and accepting whatever amount the insurance company will pay....

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Medicare’s New Documentation Rules Impact Practices

Medicare’s New Documentation Rules Impact Practices AAOSNow – April 2019  by Margaret M. Maley Surgeons instructing billing staff to bill “insurance only” is a scenario that is all too common in orthopaedic practices. In effect, the practice is waiving the patient’s copay, coinsurance, and deductible amounts and accepting whatever amount the insurance company will pay. In...

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