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Assess Whether Acquisition Makes Sense for Your Practice

Assess Whether Acquisition Makes Sense for Your Practice Physicians Practice – February 2019  by Karen Zupko “We said yes because the hospital offered us a ‘sweet deal.'” This was said by a senior surgeon and long-time client who called to report that operational integration had taken a nosedive just a few short months after his practice...

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2019 Billing and Coding Changes for Peripherally Inserted Venous Catheters

2019 Billing and Coding Changes for Peripherally Inserted Venous Catheters SCCM Critical Connections – February 2019  by  Deb­o­rah Grider Central venous access procedures, commonly performed in critical care, have undergone a change in CPT 2019. To qualify as a central venous catheter or device, the tip of the catheter or device must terminate in the...

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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” 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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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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Consider These Questions About Mergers Before You Jump

Consider These Questions About Mergers Before You Jump Orthopaedics Today – January 2019  by Wathen Strong The shift toward hospital or health system ownership of physician group practice has been on a steady pace of growth for several decades. From July 2012 to July 2016, the number of physician practices employed by hospitals increased an astounding...

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