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The CERT Program
What It Is and What a Practice Needs to Know The Comprehensive Error Rate Testing (CERT) program is a crucial component of the Medicare program that helps ensure the government is paying only for the services and care that beneficiaries actually receive. The program is designed to identify improper
Comparative Billing Reports (CBRs)
What Are They, and What Do We Do With Them? CMS (Centers for Medicare and Medicaid) is always implementing various programs and initiatives aimed at reducing fraud, waste, and abuse. One such initiative is Comparative Billing Reports (CBRs). In this article, an overview of CBRs, their purpose, and how
Telehealth and the OIG Work Plan
The pandemic and the public health emergency (PHE) it brought along with it, have changed how health care is delivered. Commercial payors have been more amenable to paying for telehealth services in prior years. Due to the pandemic, CMS decided to relax its guidelines on telehealth acceptance and payment.
Final Rule for Physician Fee Schedule and Other Medicare Policies Posted
CMS issued a final rule on the Medicare Physician Fee Schedule and some other policies that are slated to start on or after January 1, 2021. The 1,994 page document has a lot of information on many different policies, so a few important ones will be highlighted here, but
2021 E/M Changes: Are You Ready?
The last big change for Evaluation and Management (E/M) coding was in 2010 when Medicare stopped accepting consultations. Not since 1997 have the guidelines gone through such a big adjustment. Due to the pandemic, though, many practices are not prepared for this upcoming change. This article will look at an
Highlight
Coding & Documentation
Principal Care Management Coding
In CPT this year, there are new Category I codes for Principal Care Management (PCM). CPT CODE DESCRIPTION #•99424 Principal care management services, for a single high-risk disease…; first 30 minutes provided personally by a physician or OQHCP, per calendar month #+•99425 each additional 30 minutes provided personally
Q & A
Coding Quandry
Chronicity of the Condition
Question: One point of clarification I’ve wondered about. What defines the chronicity of the condition? Is it if it’s lasted more than one year already for the patient or is it if we know that it’s going to last more than a year even if it’s only lasted a few
Shave Biopsy
Question: When I am performing a shave biopsy, I append diagnosis code D48.5 to the service. My coder is telling me that it is incorrect, and I should use D49.2 instead. Who is correct? Answer: The coder is correct on this one. D48.5 is Neoplasm of Uncertain Behavior of