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GroupOne Health Source Practice Management Blog

      

The GroupOne Health Source Blog

 Answers and Insights Every Healthcare Professional Needs.

 

Toshya Griffin, CPC

Toshya is the Coding Resource Manager at GroupOne Health Source. Toshya has years of experience as a Certified Professional Coder for GroupOne's RCM customers. Her role as a Coding Resource Manager helps her share her coding knowledge with RCM teams and customers to help minimize denials and improve the reimbursement process.

Email: [email protected]

Author's Posts

New Year, New Codes: 2017 CPT Code Changes Now Available

by Toshya Griffin, CPC on December 20, 2016

2017 is just around the corner and with it comes a number of new CPT codes, deleted codes, and code revisions. The updates made enable providers to get paid for some work that is already being done while other updates remove barriers to providing certain services such as Chronic Care Management.

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Topics: Revenue Cycle Management, Coding

Last Minute Steps You Can Take to Prepare for the End of the ICD-10 Grace Period

by Toshya Griffin, CPC on September 14, 2016

Although the ICD-10 transition officially went into effect last year on October 1st, 2015, a grace period was put into place by the Centers for Medicare & Medicaid Services (CMS). October 1, 2016, will mark the end of a one-year “grace period” that allowed unspecified ICD-10-CM codes on certain physician Medicare claims as well as the end of a three-year partial code freeze. Here's what your practice can do now to prepare.

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Topics: ICD-10

The Basics of Medical Code Bundling and CPT Modifiers

by Toshya Griffin, CPC on August 30, 2016

Managing a healthcare practice comes with a long list of complex challenges that need to be solved on a daily basis. Anyone who is involved in the operational aspects of a medical office or healthcare facility understands that there are many situations that require making educated and rule-based decisions based on a variety of factors. Medical code bundling and the use of modifiers is one of them.

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Topics: Revenue Cycle Management, Coding

What are the Elements of a Highly Efficient Claims Process?

by Toshya Griffin, CPC on August 16, 2016

Because there are typically multiple parties involved in a medical care claim, the process quickly becomes quite complex, which lends itself to a variety of errors caused by both humans and technology. Developing an efficient claims process is crucial to the success of your medical practice, and the process begins before any claims are even submitted.

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Topics: Revenue Cycle Management, Denial Management

Is Your Documentation Ready for the End of the ICD-10 Grace Period?

by Toshya Griffin, CPC on May 31, 2016

Clinical documentation is at the heart of every patient encounter. It needs to be meaningful, and to be meaningful, it needs to be clear, accurate and timely. Clinical documentation isn't just critical for patient care, it is also used to share critical information with other providers while optimizing the claims process. However, with implementation of ICD-10 from October 2015, provider clinical documentation became much more complex: There are now nearly 70,000 codes, up from nearly 14,000 in the ICD-9.

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Topics: Revenue Cycle Management, ICD-10, Coding

How to Prepare for Thousands of New ICD-10 Codes

by Toshya Griffin, CPC on April 19, 2016

The shift from ICD-9 to ICD-10 brought some big challenges to healthcare. To help relieve some of these transition difficulties, the CDC and CMS instituted a freeze on updates to the codes prior to the October 1, 2015 implementation date, according to the American Hospital Association. But now, CMS has lifted the freeze and announced they will be adding a host of new diagnostic and hospital inpatient procedure codes (5,000+ new codes) to ICD-10 for fiscal year 2017.

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Topics: Revenue Cycle Management, ICD-10

Tips for Monitoring and Managing Your Practice's A/R

by Toshya Griffin, CPC on March 7, 2016

Managing accounts receivable (AR) is challenging, and will be even more complicated as more people obtain coverage under high-deductible healthcare plans. Outstanding balances are growing, and collecting these balances is essential when it comes to increasing your practice's cash flow

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Topics: Practice Management, Denial Management

Are You Undercoding Out of Fear of an Audit?

by Toshya Griffin, CPC on February 16, 2016

Declining reimbursement is one of the biggest challenges physicians face today. Ask any physician and they will tell you about the daily struggle of getting paid for their services. However, many physicians are leaving a significant amount of money on the table by undercoding.

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Topics: Revenue Cycle Management, Coding

6 New Medicare Codes Primary Care Doctors Can Use to Increase Payments

by Toshya Griffin, CPC on December 30, 2015

What if we told you there was a way to potentially earn tens of thousands of dollars more from Medicare all while improving patient care? It isn't tied to pay to performance measures or linked to alternative payment models either. 

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Topics: Revenue Cycle Management, Coding

Why Finding a Qualified Medical Coder is Difficult

by Toshya Griffin, CPC on November 22, 2015

Whether in a hospital, a physician practice, or a skilled nursing facility, medical coders are the essential connection between the clinicians who care for patients and the insurance companies that reimburse physicians under patient policies. The job of the medical coder is to inform insurers about patient diagnoses and treatments in a format that allows them to calculate reimbursements for medical services.

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Topics: Revenue Cycle Management, Coding

4 Major Insurance Payers Share Policies on Reimbursing ICD-10 Claims

by Toshya Griffin, CPC on October 19, 2015

While the Centers for Medicare and Medicaid Services announced a year's grace period this summer when it comes to claims coded with ICD-10, not all large commercial payers are following suit.

According to the CMS announcement, during the 12 months immediately following the October 1, 2015, date, “Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family.”

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Topics: Revenue Cycle Management, ICD-10

Be Wary of the ICD-10 Grace Period

by Toshya Griffin, CPC on September 28, 2015

With ICD-10 just 3 days away, healthcare providers and practices should be gearing up for the biggest change in healthcare to occur in decades. However, there seems to be a lot of debate and confusion surrounding the CMS announcement of a “grace period” with ICD-10. If you haven’t yet heard of the “grace period” it is intended to alleviate some of the concern surrounding the additional time physicians will need to spend on documenting with the new ICD-10 code set.

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Topics: Revenue Cycle Management, ICD-10, Coding

What Will ICD-10 Do To Your Cash Flow?

by Toshya Griffin, CPC on September 26, 2015

The change from the ICD-9 coding standard to ICD-10 will affect healthcare provider cash flow from several different angles. In fact, you could do everything "right" in the lead-up to ICD-10 and still face problems with revenue cycle management. But knowing where and how ICD-10 will make an impact can help you prepare and do your best to minimize problems.

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Topics: Revenue Cycle Management, ICD-10

Will ICD-10 Make Your Staff Less Productive?

by Toshya Griffin, CPC on August 6, 2015

Change is difficult, even if it is ultimately a positive change. ICD-10 is one of the biggest changes to hit healthcare in decades and the deadline is getting closer and closer. The upcoming transition from the ICD-9 coding standard to ICD-10 will lead to more accurate tracking of individual and population health trends, and will allow much greater specificity in medical coding. But there's no question that the transition will be challenging.

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Topics: Revenue Cycle Management, ICD-10

5 Things You Must Know About Denied and Rejected Claims

by Toshya Griffin, CPC on July 1, 2015

As the ICD-10 deadline approaches, you might be wondering how your practice is following up on denied and rejected claims. According to CMS, 1 in 5 practices will see Medicare denials double for 6 months after October 1, 2015. Understanding how your practice is following up on denied and rejected claims now is critical to the success of your revenue cycle. Investing time into your denial management strategy can minimize the impact of ICD-10 on your practice.

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Topics: Revenue Cycle Management, Denial Management

5 Hidden Ways Your Medical Practice is Losing Revenue

by Toshya Griffin, CPC on June 17, 2015

According to recent studies, approximately 25%-30% of all medical practice income is lost due to incorrect coding, underpricing, missed or never submitted charges, and nonexistent or improper follow-up. Physician practices have to have a comprehensive and strategic approach to medical billing that involves a skilled personnel mix, from those who schedule appointments to those who follow up with insurers about denied claims. Many practices have switched or are switching to electronic health record (EHR) systems, expecting them to solve medical billing problems.
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Topics: Revenue Cycle Management, Practice Management

Changes to CPT Coding in 2015: Profit or Pain for Physicians?

by Toshya Griffin, CPC on January 6, 2015

2015 is here and with it comes 550 changes to CPT coding. Every year brings updates, additions, and deletions of CPT codes. How you handle the changes can make your start to 2015 profitable or painful.

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Topics: Revenue Cycle Management, Coding

CMS Expands Telehealth Physician Reimbursement in 2015

by Toshya Griffin, CPC on December 3, 2014

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Topics: CMS, Telehealth

EHR Templates, Cloning, and Upcoding: Should You Worry?

by Toshya Griffin, CPC on June 27, 2014

Electronic Health Records are designed to help practice’s save time, improve the quality of documentation, and ultimately provide better patient care.  However, some features of electronic health records could endanger your business and lead to False Claims Act violations.

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Topics: Revenue Cycle Management, EHR, Coding

ICD-10 Documentation and Coding Concepts Webcast: Orthopedics

by Toshya Griffin, CPC on June 18, 2014

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Topics: ICD-10