Quite often, physicians are unaware that payers outside of Medicare have expectations when it comes to medical necessity, documentation guidelines, clinical indications, and coding policies. Jean Acevedo, LHRM, CPC, CHC, CENTC, AAPC Fellow, reviews some basics to help the coding and billing staff.
Have you ever felt overwhelmed with the state of your practice and although you know that change is necessary, you have no idea where to begin? I often hear, “Our practice is so busy, and we have changes that must be made to report successful results to CMS for MIPS.
This article will discuss some of the ways in which data quality can affect the clinical, administrative, and financial aspects of your practice.
As nonphysician practitioners (NPPs), such as physician assistants (PAs) and advanced registered nurse practitioners (ARNPs), have started to work in rheumatology practices with greater frequency, it has become increasingly important to understand “incident to” requirements.
In contrast to selling or outsourcing self-pay accounts receivable, lending institutions may provide 0% or low-interest rate loans to patients to cover their estimated responsibility. The institution has to have an adequate process and knowledge base to create estimates based on residual responsibility after the insurance payment.
Before we get too excited, let us look at the history of the E&M documentation guidelines, because this may hold a clue as to how CMS will approach revisions to these guidelines. It is worthwhile to note that CMS’ previous attempts to revise the E&M documentation guidelines were met with a lack of consensus and support from stakeholders.
“Incident to” services are defined as services that are furnished incident to physician professional services in the physician’s office. These services are paid at 100% of the physician fee schedule, whereas services reported by nonphysician practitioners are paid at 85%.
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