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Build in workflow, create a tagging system to succeed with CCM payments

09/12/2016

Tip your cap to the many providers who found success in the first year of chronic care management (CCM) but also take a hard look at your CCM potential — you may be leaving money on the table for services you already provide.

New claims suggest 99214 becoming ‘new normal’ — but mind necessity when you code

09/12/2016

by: Roy Edroso

More practices are claiming level 4 established patient visits, and they seem to be going through — but make sure that in addition to all the elements you need to claim them, you have sufficient medical necessity to back them up.

Confirm a definitive diagnosis to select first-listed ICD-10 code

09/12/2016

by: Richard Scott

Get up to speed on ICD-10 coding guidelines to select the proper first-listed diagnosis – a nuanced calculation that contains a number of wrinkles in the outpatient setting.

ERISA challenge works on self-funded plans – but only if insurer broke the law

09/12/2016

by: Roy Edroso

Question: It is my understanding that the Employee Retirement Income Security Act of 1974 (ERISA) does not apply when the patient is employed by a company with a self-funded insurance plan. Is that true?

Most specialists performing chronic care management services succeeded

09/12/2016

by: Richard Scott

Dozens of specialties billed chronic care management (CCM) code 99490 in 2015, achieving a cumulative denial rate of 5.7% for the million-plus claims submitted.

2017 CPT changes affect moderate sedation, influenza vaccine, bunionectomy codes

09/08/2016

by: Laura Evans and Julia Kyles

As you page through your newly released 2017 CPT manual, the biggest change you’ll notice may be what’s missing: The list of more than 400 codes that were defined as including moderate sedation has been deleted from Appendix G.

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