It's my opinion and experience that any investment you make coding education will yield a significant return on your investment. Various studies have estimated individual physicians can forego tens of thousands of dollars a year by undercoding. Many physicians undercode not only out of fear of … [Read more...]
Medicare non-covered services
Medicare does not cover items and services that are not reasonable and necessary for the diagnosis or treatment of an illness or injury or to improve the functioning of a malformed body member. Section 1862(a)(1) of the Social Security Act is the basis for denying payment for types of care, … [Read more...]
Base Medical Coder Job Description on These Traits
When visiting a client's office, I found out the office manager was in the process of hiring a new full-time medical coder and had been tasked with writing job description for this position. She asked my if I could offer up any tips on how she should go about this task. Well first be sure to consult … [Read more...]
Mind This Advice if Eligibility Denials Are All Too Common
Patients who are ineligible for benefits that you thought they had are a potential headache for every medical practice. In fact, some experts say it's the most common billing mistake that medical practices make that is causing them denials or recouped payments. Eligibility denials are by far the … [Read more...]
Ophthalmology Services: Questionable Billing and Improper Payments
The Office of the Inspector General (OIG) reports that Medicare is vulnerable to fraud, waste, and abuse for wet Age-related Macular Degeneration (wet AMD) and cataracts: Administration of Lucentis injections for wet AMD more than once every 28 days (based on local coverage determinations) … [Read more...]
Ophthalmologists incorrectly reporting HCPCS codes G9890 and G9891 on Medicare claims
CMS (Medicare) recently found that some ophthalmologists are reporting G9890 and G9891 in error for services after 12/31/2017, causing claims to deny. These codes were deleted and reissued 4/1/2018 with a different definition and purpose. G9890: Bridge payment – first session furnished by MDPP … [Read more...]