This is the year of many Centers for Medicare & Medicaid Services (CMS) regulatory requirement changes. This includes the Merit-Based Incentive Program (MIPS), the next steps toward mandatory Authorized Use Criteria (AUC) implementation for advanced imaging, defining more explicitly what is and what is not “quality” care, etc.  It is…
November 14, 2016

Déjà Vu All Over Again

With more than a full year under ICD-10, it seems it is reasonable to expect local coverage determinations (LCD) to be current and correct. After all, everyone in the industry knew there were errors and omissions in some national and local policies.Many had already been pointed out. And yes, some…
Before I begin, I would like to take a moment and acknowledge Dr. Robert Gold, who passed away last week. Dr. Gold was a pioneer and leader in our field of clinical documentation improvement (CDI) and coding. He was first my mentor, then my colleague, and then my friend. I…
They were three simple words that surely represented a collective sigh of relief among the several dozen providers to participate in a recent AppRev survey comparing hospital financial metrics of the last quarter that ICD-9 was in use with those of the first quarter of ICD-10.“Mostly good news,” AppRev President…
EDITOR’S NOTE: President Barack Obama is asking Congress for more than $1.8 billion in emergency funding to combat the Zika virus here and abroad it was announced yesterday,  We have a code!
In December, the movie “Concussion” was released.  It tells the intriguing story of an investigation into repetitive concussion injuries and the National Football League (NFL).
Although ICD-10 implementation has gone amazingly well, there are specialty-specific challenges arising for some practices and groups. For example, orthopedics has an incredibly large list of extremely specific codes. That can be very frustrating for physicians who must treat patients when it is not their primary or only specialty, and they may…
Under ICD-10, submitting compliant and accurate claims and minimizing the negative impact to clients’ cash flow were concerns shared by all those in the coding and medical billing community. While the transition has been relatively smooth as it pertains to our internal operations, there have been unanticipated challenges on the…
Claims appear to be moving along the I-10 with little congestion in the early going following implementation of the new code set. This week’s update will cover Wisconsin Physician Services (WPS), First Coast Service Options, and CGS Medicare and its local coverage determination (LCD) issues and resolutions. Overall, it appears…