Why Medical Necessity Continues to Be a Top Priority
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Medical necessity is an important issue. Just review the definition of medical necessity: “a legal doctrine, related to activities which may be justified as reasonable, necessary, and/or appropriate, based on evidence-based clinical standards of care.”
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Healthcare Hotbed for Fraud Cases
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While it might surprise some folks that five Modesto doctors are among those facing fraud charges in a $40 million medical billing and kickback case based in Southern California, it shouldn’t surprise anyone that there was yet another medical fraud case.
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When Practices are Too Cautious about HIPAA
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Many providers have the belief that HIPAA should be treated like well-regarded advice from your mom: It's better to be safe than sorry. But that mentality is not always the way to go. Sometimes, practices can be too cautious with HIPAA. There's a difference between ensuring protected health information (PHI) doesn't fall in the wrong hands and preventing patients
from.
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ICD-10 Diagnosis Codes That Identify Weeks Gestation of Pregnancy
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Effective for Dates of Service beginning January 1, 2017, and thereafter, Medicaid required a Weeks Gestation of Pregnancy Diagnosis Code and a birth weight on delivery claims billed on an UB-04 or CMS 1500 Claim Form if a recipient has received any prenatal, delivery or postpartum services.
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OB Coding: Delivering Accurate Coding Remains a Challenge
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Coders are experts at scanning provider documentation and assigning codes. My approach to chart review is to try to piece together what actually happened during the encounter, and then evaluate whether the documentation supports the coding of the story. This two-part series of articles will address encounters that result
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