Coding Is a Team Sport 05/14/2012
While the physician is ultimately responsible, it takes the entire ophthalmic team to stay current with coding changes, implement the updates into the practice, submit the claim and then process (or resubmit) the explanation of benefits correctly. I often joke that if we saw only one or two patients a day, we’d get it right 100 percent of the time. Obviously, we see substantially more patients with a plethora of insurance coverage — all of which may vary. How do you keep up? One solution is to dedicate a part of each staff meeting to coding updates or a coding quiz to make sure the team is on the same playing field.
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Nine Key Coding Lessons: Your Colleagues’ Favorite CODEquest Insights 04/16/2012
Nothing is as constant as change. That phrase was not written to describe the rules and regulations of documentation and coding, but it certainly fits. Ask any of the ophthalmologists of every subspecialty who attended CODEquest Coding College in 2011. The following are a few of the learning gaps in their coding knowledge identified in course evaluations.
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Acquiring a Detailed Patient History for Common Eye Emergency Cases 03/12/2012
“I need to see the doctor right away — and I don't have an appointment.” Staff is often on the receiving end of this request, either by phone or in person, and they need to decide quickly which patients should see a physician and when. Front-desk staff may not be trained for this sort of evaluation, but physicians should be able to help triage ocular emergencies and schedule patients accordingly. Your practice can simplify the choices by dividing clinical presentation into four tiers.
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To Charge or Not to Charge Interest: Medicare Billing Fees Explained 02/13/2012
One question on everyone’s mind lately seems to revolve around the appropriateness of charging Medicare patients interest on past-due amounts. Here's the bottom line from CMS regarding charging interest, etc., to Medicare beneficiaries.
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Update on Recovery Audit Contractors 01/18/2012
In addition to focused medical review, comprehensive error-rate testing (CERT), and Office of Inspector General and Medicare Advantage plan audits, ophthalmology can add recovery audit contractors (RAC) to the list of growing types of mandated audits.
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What’s in a Name? Defining and Understanding Local Coverage Determinations 12/05/2011
Though it’s a far cry from the infamous feud between the Montagues and Capulets, there can be an occasional conflict on exact coverage policy between physicians and Medicare Part B payers. To help you avoid becoming part of such conflicts, here’s a quick guide to local coverage determinations (LCDs).
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Solving Eight of Your Coding Concerns 10/11/2011
When it comes to CPT codes, it can be confusing at best and downright costly at worst. Here are eight common situations and the (usually) quick solution.
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Interpreting the Remittance Advice 08/15/2011
“Look at the amount we billed. Look at what the insurance company allowed. Write off the difference and bill the patient or the second insurance the difference.” Those words were the only training I received when I started processing the explanations of medical benefits now referred to as remittance advice (RA). The reality is there is so much more to know.
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Accuracy or Abuse? Appropriately Applying the ABN 06/13/2011
More paperwork. Just what the patient and the office needs. Yet the Advance Beneficiary Notice (ABN) is a crucial safety net for payment when used correctly. This article is designed to set the record straight on instances where it is appropriate to use the ABN and when it is not.
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Inside Information on Successful Coding 05/16/2011
These coding tips will help you achieve documentation compliance, which will result in proper payment of claims the first time.
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Avoiding an Audit: History-Taking and the Components of the Chief Complaint 04/18/2011
Simply hearing the word “audit” can cause anxiety in any physician…and with good reason! Yet, there are simple steps you can take to protect yourself. For example, did you know that the number one reason physicians don’t do well in a third-party payer audit is due to an inadequate history to support the level of documentation billed — particularly in a new patient exam? Let’s review the chief complaint and the three components of history-taking in E&M (evaluation and management) coding.
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Ophthalmic Abbreviations 101 03/14/2011
Have you noticed how the ophthalmic community seems to talk in code? PT w/? IOP f/u VF OU. And sometimes we even make-up our own abbreviations system. To avoid confusion or even embarrassing mistakes, here are some of the most commonly used appropriate abbreviations. Use them for standardize documentation in the medical record.
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Coding Tips for the Young Ophthalmologist 02/14/2011
One way of attracting unwanted audit attention is duplicate claim submissions. A duplicate claim is defined as a claim submitted to Medicare from the same provider, for the same beneficiary, for the same item or service, for the same date of service.
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Misuse of Modifier -79 12/06/2010
The Office of the Inspector General (OIG) recently issued a Management Implication Report on the misuses of the modifier -79.
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Ophthalmology Coding, Pt. 2: Keratoplasty to YAG Capsulotomy 06/14/2010
Last month, we began highlighting key points in coding the services most frequently performed in ophthalmology, from A-scan ultrasound for intraocular lens calculations through foreign body. This month, we’ll pick up with keratoplasty.
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Ophthalmology Coding, Pt. 1: A-Scans to Foreign Body 05/26/2010
Remember the pirate’s often-lost wooden eye in Pirates of the Caribbean? Or Tom Cruise’s eye transplant in Minority Report? Movies showing eye injuries intrigue us. Although it is a challenge to code these incidents, an even greater challenge lies in correctly coding the ophthalmic procedures we see daily. Our focus is to begin highlighting key points in coding the services most frequently performed in ophthalmology.
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CMS Signature Requirements for Medical Review 04/12/2010
Auditors of recent chart reviews have reported an increase in the number of records reviewed that have unacceptable signatures. Medicare contractors require a legible identifier for services provided or ordered. The signature may be handwritten or an electronic signature may be used. Stamped signatures are not acceptable to sign an order or any other part of the medical record. CMS has clarified what entail acceptable methods of signing records and/or tests.
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Three Tips for Fraud Avoidance When Altering Medical Records 03/15/2010
Chart audits have revealed that some providers are altering medical records inappropriately. CMS reminds physicians not to alter the documentation after a request for records has been received. Improper altering often fails into two categories.
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Claim Submission: Getting It Right the First Time 02/08/2010
For those of you who process explanation of benefits (EOBs), what is more frustrating and time-consuming than to have a claim denied, which then requires reprocessing? The truth is, there are mistakes common to all practices that, if avoided, can lead to membership in the “clean claim club.”
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Medicare Update: Reporting Simplified for 2010 E-Prescribing Incentive 01/11/2010
For successful reporting under the 2010 e-prescribing incentive program, a single quality-data code (e-prescribing G-code) should be reported, according to the following coding and reporting principle: |
