HCC Blog by Caridad

Medicare offers participants an Annual Wellness Visit (AWV) which is not an appointment for a "physical", although it is easy to see why some may think it is. It should be thought of more like a "getting to know you" or "interview" visit.  It can be thought of setting a base line of information. Beneficiaries can qualify for this if they: ■ Are not within the first 12 months of their first Medicare Part B coverage period; and ■ Have not received an Initial Preventive Physical Examination (IPPE) or AWV within the past 12 months.   Translated that means : if they have not had one of these done already AND that they haven't had a IPPE either, in the last year.  It is possible to check a data base to see if they have already had any of these services.  Inquiry with your employer. This document is divided into two sections: the first explains the elements of a beneficiary’s initial AWV; the second explains the elements of all subsequent AWVs....

The purpose of the NCD Manual is to describes whether specific medical items, services, treatment procedures, or technologies can be paid for under Medicare.  On this website you will find Coverage Determinations divided by Chapter 1 and four Parts. Part 1 Sections 10 - 80 Part 2 Sections 90-160.26 Part 3 Sections 170-190.34 Part 4 Sections 200-310.1 There is also a Crosswalk from NCD Manual to Coverage Issues Manual and a Crosswalk from Coverage Issues Manual to NCD                                                                                    ...

you can find guidance about coverage and billing for preventive and screening serves in Chapter 18 of the Medicare Claims Processing Manual Chapter 18 - Preventive and Screening Services https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c18.pdf Major Category IV: Excluded Preventive and Screening Services Preventive and screening services are excluded from the Part A payment made under the SNF PPS, but are subject to SNF CB. As such, they are separately payable under Medicare Part B, but only to the SNF. The SNF must bill the services listed on the next page for beneficiaries in a Part A stay with Part B eligibility on TOB 22X. ===== The first two files list codes that physicians, nonphysician practitioners, and suppliers (other than ambulance suppliers) can bill separately to the Part B MAC . If neither file lists the code for the service, the service is subject to SNF consolidated billing and the physician, nonphysician practitioner, or s...

The Office of Inspector General (OIG) report “The Hospital of Central Connecticut Incorrectly Billed Medicare Inpatient Claims With Kwashiorkor” dated June 2015.    The OIG was looking to determine if the Hospital was complying with Medicare billing requirements for Kwashiorkor.   Kwashiorkor is a type of severe protein malnutrition. It generally is found in children living in parts of the world without and adequate food supply or due to a famine. Since Medicare is primarily covering people 65 years or older, it is doubtful this condition would be prominent. The following link leads to the finds of their investigation.   http://oig.hhs.gov/oas/reports/region9/91402036.pdf

This is a great website that offers the opportunity to learn many different subjects.  It is one of my favorites and it's free! http://www.gcflearnfree.org/ #HCC #ICD10 #CMS #ICD9 #RiskAdjustment #ICD10questions   #Career #MedicalCoding #Coding       Disclaimer : This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations.   The information presented herein is for general informational purposes only and is accurate as of the date of

The Office of Inspector General (OIG) on behalf of the Department of Health & Human Services (HHS) programs is in charge of identifying waste, fraud and abuse in Medicare, Medicaid and more than 100 other HHS programs. They oversee Medicare and Medicaid.  They do audits and investigations in an effort to find fraud, waste and abuse; as well as educating the public about schemes so they are aware of how to identify it. Each year they lay out their plan for the coming year. The plan for 2016 can be found at: Office of Inspector General Work plan for 2016 In case the above link isn't working, it is located at: http://oig.hhs.gov/reports-and-publications/archives/workplan/2016/oig-work-plan-2016.pdf OIG Home page #HCC #ICD10 #CMS #ICD9 #RiskAdjustment #ICD10questions #Career  #MedicalCoding       Disclaimer : This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guideli...

Review 2017 CPT code changes Review all changes to guidelines, notes, and instruction in the book Highlight changes in the book’s index pertinent to your specialty, and review those changes Highlight changes in the tabular section pertinent to your specialty Create a documentation “cheat sheet” of 2017 updates that must be documented differently for coders to capture the needed information and distribut it to clinicians Review and update superbills, chargmasters, etc. Upload software chanes Train coding and billing staff on changes Review PQRS changes from CMS Communicate with payer/provider reps regarding reimbursement and overage issues Archive last year’s books