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GroupOne Health Source Practice Management Blog

      

The GroupOne Health Source Blog

 Answers and Insights Every Healthcare Professional Needs.

 

A Review of the 2018 CPT Code Set Updates

by Kaitlyn Houseman on December 14, 2017

The new year is almost here meaning it is time for new Current Procedural Terminology (CPT) code changes! The 2018 CPT code set comes with a number of changes that may affect claims processing so it's time to start reviewing which codes affect your practice in order to prevent revenue cycle management disruptions. 

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Topics: Coding

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

by Kaitlyn Houseman 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

The Basics of Medical Code Bundling and CPT Modifiers

by Kaitlyn Houseman 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

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

by Kaitlyn Houseman 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

Are You Undercoding Out of Fear of an Audit?

by Kaitlyn Houseman 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 Kaitlyn Houseman 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

Most Commonly Unexpected Denied Procedures

by Kaitlyn Houseman on December 23, 2015

Claim denials are an unpleasant fact of life, and too many of them can dramatically impact your practice's cash flow. Not only do coders have to cope with murky and complicated rules for coding and documentation but at the same time they have the threat of an audit hanging over them, and it's not easy.
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Topics: Revenue Cycle Management, Coding, Denial Management

Why Finding a Qualified Medical Coder is Difficult

by Kaitlyn Houseman 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

Post ICD-10: What to Expect After October 1st

by Keith Lage on September 30, 2015

Tomorrow ICD-10 will replace the current classification system, ICD-9. Whether you're ready or not, ICD-9 codes will no longer be accepted on claims. Claims with ICD-9 codes after October 1 will be denied without payment. While surveys indicating readiness for the ICD-10 transition vary, one thing is for sure: ICD-10 will dramatically impact medical billing and cash flow. 

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Topics: Revenue Cycle Management, ICD-10, Coding

Be Wary of the ICD-10 Grace Period

by Kaitlyn Houseman 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

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

by Kaitlyn Houseman 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

10 Quick Tips to Prepare for ICD-10

by Kaitlyn Houseman on December 23, 2014

Whether you're just starting out with an ICD-10 plan of action (hopefully not) or you have been preparing for years, it is easy to become overwhelmed and forget everything that a good ICD-10 plan entails.

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Topics: Revenue Cycle Management, ICD-10, Coding

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

by Kaitlyn Houseman 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

4 Steps to Help You Trump ICD-10

by Kaitlyn Houseman on April 29, 2014

If you have not heard by now, CMS has delayed ICD-10 implementation until October 2015. The delay either has you annoyed, doing a happy dance, or perhaps both.  Already start your ICD-10 implementation phase?  If so, it is crucial not to lose the ICD-10 momentum.  If you have not implemented a plan yet, you are in luck!  However the luck will run out so it is important that you take steps to prepare for the ICD-10 implementation.  The thought of the switch alone is stressful but procrastination will only make the transition more difficult.

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Topics: ICD-10, Coding

Senate Approves ICD-10 Delay and SGR Patch

by Kaitlyn Houseman on April 1, 2014

By a vote of 64 to 35, the U.S. Senate on March 31 approved legislation that includes a provision to delay the ICD-10 implementation deadline by one year to Oct. 1, 2015. The US Senate has joined the House of Representatives and passed legislation to prevent a 24% cut in physician fee schedule payments from occurring as previously scheduled. Instead, Medicare physician fee schedule payments will continue to be paid as they have been for the past 3 months.
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Topics: Practice Management, ICD-10, Coding

Now Available: "Road to 10" Resource to Help with ICD-10 Transition

by Kaitlyn Houseman on February 26, 2014

The transition to ICD-10 is going to change how you do business from registration and referrals to superbills and software upgrades.  However CMS has the following resources to help your practice prepare for the transition.

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Topics: Revenue Cycle Management, Practice Management, CMS, ICD-10, Coding

Less Than 10% of Physician Practices Ready for ICD-10

by Kaitlyn Houseman on February 10, 2014

Englewood, Colo., Feb. 4, 2014 – As the Oct. 1 compliance date to transition to the International Classification of Diseases, Tenth Revision (ICD-10) approaches for physician practices, MGMA research released today indicates that overall readiness for implementation continues to lag. Less than 10 percent of responding practices reported that they had made significant progress when rating their overall readiness for ICD-10 implementation, up only slightly (from 4.7 percent) since June 2013, when MGMA previously conducted research to assess readiness levels. The new research includes responses from more than 570 medical groups where more than 21,000 physicians practice.

“The critical coordination that must take place between practices and their software vendor, clearinghouse and health plan partners is simply not happening at the pace required for a seamless implementation. Very simply, ICD-10 is behind schedule,” said Susan L. Turney, MD, MS, FACP, FACMPE, MGMA president and chief executive officer. “MGMA continues to advocate on behalf of members and provides tools and resources to help practice executives make the transition to ICD-10 more cost effective and less disruptive to their organizations.”

MGMA urges the Centers for Medicare & Medicaid Services (CMS) to immediately take action to help ensure that physician practices can successfully undertake such a massive transition, including:

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Topics: Revenue Cycle Management, EHR, Practice Management, CMS, ICD-10, Coding

WEDI Survey a Snapshot of ICD-10 Implementation Status

by Kaitlyn Houseman on January 7, 2014

 “When compared to a similar WEDI survey given in February 2013, the healthcare industry has slipped further behind key ICD-10 compliance milestones suggested in the WEDI/NCHICA timeline,” the Workgroup for Electronic Data Interchange (WEDI) explained in a prepared statement.

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Topics: Revenue Cycle Management, Practice Management, ICD-10, Coding

CMS Phase 2 Denial Edits Will Begin January 6, 2014

by Kaitlyn Houseman on November 14, 2013

Several years ago, CMS mandated that payment for referral services would only be paid if the referring provider were properly enrolled in Medicare.  Due to industry pressure, the effective date for this policy was continually delayed to allow providers sufficient time to meet the enrollment criteria.  According to the following announcement, CMS intends to instruct their Contractors to turn on the ordering and referring edits on January 6, 2014.  

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Topics: Revenue Cycle Management, Medical Business, Practice Management, CMS, Coding, Denial Management

4 Major Risks with ICD-10

by Kaitlyn Houseman on November 13, 2013

According to CMS, 1 in 5 physician practices will see their Medicare denials double for up to 6 months after October 1, 2014, the deadline for ICD-10. Your practice does not have to be one of them. Get started early with planning for ICD-10.

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Topics: Revenue Cycle Management, Medical Business, Practice Management, CMS, ICD-10, Coding