Developing a Hospital Claim Validation Strategy to Prevent Denials

Published: Thu, 10/10/19

The time to strengthen hospital compliance programs through claim validation is now. According to healthcare finance and information management leaders surveyed by HIMSS Media, clinical documentation and coding were the revenue cycle processes most vulnerable to errors...

Hospitals support medical billing changes, opioid payments

Hospitals support the CMS' proposed changes to medical billing coding and new payments for opioid treatment programs, but they're worried that changes to quality measures could hurt providers.

AHA Urges CMS to Abolish Site-Neutral, 340B Payment Cuts in OPPS

The American Hospital Association (AHA) questioned the legality of site-neutral and 340B payment policies in the Outpatient Prospective Payment System (OPPS), arguing the proposals would “have a chilling effect on beneficiary access to care while also increasing regulatory burden.”

The Demand for Medical Coders Is on the Rise. Here’s How to Land a Gig

After two years of following a doctor around the office as a medical assistant, Raina Diaz was ready for a change.

“I wanted to be part of the back end of the medical field,” says Diaz, 47, of St. Petersburg, Florida. She enrolled at her local state college, where she learned that becoming a medical coder could...

Medicare Retires G Codes for Mammograms

October is Breast Cancer Awareness Month. Make sure your practice’s medical coding for preventive screening mammograms is up to date with current guidelines. The Centers for Medicare & Medicaid Services (CMS) has caught up to the industry and now recognizes the...

The Vaping Epidemic Worsens

Confusion persists for the coding of vaping. The issue of vaping continues to generate national and international headlines. On Sept. 18, a teen from London, Ontario in Canada suffered a severe case of pulmonary illness after using e-cigarettes daily. This marked the first reported case in Canada. In the U.S., the numbers have grown to...

Noridian’s Use of Scenarios Questioned

The Noridian iron infusion Local Coverage Determination (LCD) is important for just about everyone since Noridian is the Supplemental Medical Review Contractor (SMRC). Noridian could end up reviewing and denying your claims even if you’re not in Noridian’s Medicare Administrative Contractor (MAC) jurisdiction.

Coding for hospital observation

Q: Is reporting of Current Procedural Terminology (CPT) codes 99218-99220 restricted to a single physician?

A: According to CPT guidelines, only the physician or non-physician practitioner (NPP) placing the patient in observation status (and subsequently discharging the patient) may report the appropriate initial observation code (99218, 99219, 99220)...