Now there’s 70,000 Ways to Classify Ailments

Doctors, insurers and hospitals are preparing themselves for possible business disruptions on Oct. 1. This is when ICD-10 hits, a massive new set of codes meant to describe any illness or injury.

Under ICD-10, cardiologists will have over 800 codes for describing angioplasty. Dermatologists will have 8 different types of acne. Gastroenterologists who aren’t sure what’s causing […]

By |September 29th, 2015|ICD-10 Readiness, Medical Coding News and Recent Articles|Comments Off on Now there’s 70,000 Ways to Classify Ailments

Holdup at the doctor’s office? New billing codes could be why.

Starting October 1st, physicians and hospitals will have to be far more specific than ever before when diagnosing problems from visits.

Because of this change to the system, called ICD-10, patients should expect longer than usual times to be billed for their portion. This may even add waits to the doctor’s office when visiting.

To both physicians […]

Medicare Reimbursement Rates Get a Small Increase

California Medical Association (CMA ALERT) – The CMS announced that a 0.5% increase will be made for Medicare reimbursement rates, which are effective starting July 1, 2015 to December 31, 2015.

The increase to Medicare reimbursement rates is an effect of the Medicare Access and CHIP Reauthorization Act, signed in April 2015. CMS has released the […]

CMS will reimburse ICD-10 mistakes for one year after transition deadline

For one year past the Oct. 1, 2015 deadline, the CMS will reimburse for wrongly coded claims as long as that erroneous code is in the same broad family as the right one. There had been concerns among providers that they wouldn’t be paid if they made minor mistakes trying to implement the new complex […]

US Attorney’s Office Recovers Over $20 Million Dollars Against Community Health Network

In another instance of false claims to Medicare and Medicaid programs, Josh J. Minkler, United States Attorney, announced today a $20,324,902.22 civil settlement with Community Health Network (ACHN), a non-profit health system with more than 200 sites of care and affiliates throughout the State of Indiana.

You can read the full article on the website here […]

By |July 2nd, 2015|Medical Coding Audits and Compliance|0 Comments

Medicare Fraud – Taken For a Ride By Ambulance Companies in New Jersey

A four-month Medicare fraud crackdown targeting ambulance service fraud has resulted in 11 New Jersey-based ambulance service providers relinquishing their licenses this year, according to the New Jersey Department of Health. However, as many as 20 to 25 companies reportedly have closed, remaining providers say. The Garden State costs Medicare more than any other state for […]

Government Recovers $3.3 billion in Fiscal 2014 Federal Health Program Fraud

WASHINGTON–The government recovered $3.3 billion in fiscal 2014 from individuals and companies that tried to defraud federal health programs, part of an effort by the Obama administration to improve enforcement and prevent abusive billing practices.

The administration recovered $7.70 for every dollar spent investigating health-care-related fraud and abuse in the past three years, according to a […]

New “X” Modifiers and Impact to UnitedHealthcare Commercial Reimbursement Policies

For information related the the New “X” Modifiers and Impact to UnitedHealthcare Commercial Reimbursement Policies, please see the January UnitedHealthcare Jan 2015 Network Bulletin.

By |January 18th, 2015|Medical Coding Best Practices|0 Comments

Is Physician Fear of ICD-10 Turning Them Off Preparation?

This article by EHR Intelligence points out theat there are a lot of reasons for healthcare professionals to dislike the notion of ICD-10. Further, recent surveys point out that although physicians may be jittery about the unknowns of ICD-10, they aren’t necessarily being proactive about addressing them. ICD-10 will require effort, but the industry has been […]

By |January 18th, 2015|ICD-10 Readiness|0 Comments

Medicare Outreach Article – Modifier -59 Could Impact Reimbursement

This is a “heads-up” notice to please review the details of the recent Medicare Outreach Article from CMS. We suggest that you check with your MACs on the implementation date for the new X modifiers.

STOP – Impact to You
New coding requirements related to Healthcare Common Procedure Coding System
(HCPCS) modifier -59 could impact your reimbursement.


By |January 6th, 2015|Medical Coding Best Practices|0 Comments