Barbara’s News – Page 9 – CRN Healthcare Solutions

New Jersey’s New Law Aimed Eliminates “Surprise” Medical Bills

July 9, 2018August 28, 2018Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

The New Jersey (NJ) governor signed a new law designed to curb the impact of costly “surprise” medical bills when a patient sees a non-participating provider during an admission. The bill is quite complex but tries to balance the needs of patients, … For more, read here: AAPC Blog

Anthem Investigator Charged with Fraud

July 9, 2018August 28, 2018Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

A former fraud investigator for Anthem, Inc. is one of five people indicted on federal healthcare fraud charges. Those indicted participated in a multi-year scheme to commit fraud against at least eight health insurance companies. The fraud investigat… For more, read here: AAPC Blog

How to Document E/M with Counseling and Coordinating Care

July 2, 2018August 28, 2018Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

The only case when time may be used as the overriding factor in determining an evaluation and management (E/M) level is when counseling and/or coordinating care dominates the encounter, which means that the time expended on counseling and/or coordinat… For more, read here: AAPC Blog

Understand Clearing Houses

June 25, 2018August 28, 2018Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

Clearing houses affect revenue flow through denials. Understanding them and their processes helps you speed your re-submissions. After a claim file is sent to the clearinghouse, an edit report is sent back to the practice, indicating claims and charg… For more, read here: AAPC Blog

Modifiers 52 and 53 vs. 73 and 74

June 13, 2018August 28, 2018Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

Modifier 52, Reduced Services and Modifier 53, Discontinued Procedure apply to physician services while Modifiers 73 and 74, Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia and Disc… For more, read here: AAPC Blog

E/M Documentation by Med Students Rules Clarified

June 7, 2018August 28, 2018Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

The Centers for Medicare & Medicaid Services (CMS) issued a MLN Matters article ( MM10412 Revised) on May 31 with a retroactive effective date of January 1, 2018 clarifying documentation requirements when performed by Medical Students in a teac… For more, read here: AAPC Blog

Audiology Technician Billing

June 4, 2018August 28, 2018Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

Medicare stipulates precise requirements for billing audiology technicians’ services. As outlined in the Centers for Medicare & Medicaid Services’ (CMS) Transmittal 84 in February 2008, these requirements are distinct from those governing audiolog… For more, read here: AAPC Blog

Coding 3 or 4 Sinuses Using FESS Codes

May 22, 2018August 28, 2018Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

A lot of people have been asking questions about how to code FESS surgeries with the new combination codes when three or four sinuses are operated on. Sinus and FESS We have been expecting an AMA CPT® Assistant article with guidance this year, but no … For more, read here: AAPC Blog

Denials Management for the Medical Coder

May 14, 2018August 28, 2018Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

Managing denials is more difficult in 2018 than it was in 2005, 2000, or 1998. Not because practices are necessarily receiving more denials from payers but because unlike the early to mid-2000s and 1990s, we are now posting payments via auto remit pro… For more, read here: AAPC Blog

Advocacy to Change 31241’s Pay to Outpatient

May 3, 2018August 28, 2018Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

Advocates are seeking to convince the Centers for Medicare & Medicaid Services (CMS) to pay for outpatient care of patients receiving 31241 Nasal/sinus endoscopy, surgical; with ligation of sphenopalatine artery. The new code for 2018 was assigned… For more, read here: AAPC Blog