Update: Experity Issues New Guidance on Coding for COVID-19 Services

Update: Experity Issues New Guidance on Coding for COVID-19 Services

Our collective understanding of COVID-19 changes several times a day—as do procedures to ensure your urgent care operation receives the proper reimbursement for the indispensable services you provide. Just last week Experity released what was then new information on proper coding procedures; it’s outdated already, so the company has issued an update. Review it on the JUCM website to ensure you’ll be compensated fully and as efficiently as possible.

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Updated: Experity Issues Guidance on Optimal Coding for Services Related to COVID-19

COVID-19 has been officially declared a pandemic, and school districts, sporting events, and cultural traditions like St. Patrick’s Day parades are being canceled  in order to lower the risk of transmission among large throngs of people. One thing that goes on, however, is the day-to-day operation of the urgent care center—the only difference being that your work is more essential than ever. Secondary to that, of course, is the need to be properly reimbursed for …

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What Would Doing  Away with ‘Incident-to’ Billing Mean for NPs and PAs—and Urgent Care?

What Would Doing Away with ‘Incident-to’ Billing Mean for NPs and PAs—and Urgent Care?

The Medicare Payment Advisory Commission’s unanimous recommendation that Congress do away with “incident-to” billing could have a strong effect on physician assistants and nurse practitioners—and therefore, considering the growing role PAs and NPs play in this setting, on urgent care overall. If incident-to billing is eliminated, PAs and NPs will have to bill independently and at a lower reimbursement rate than they do now. Currently, the services of PAs and NPs who are truly assisting …

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Are You Maximizing Claims on Radiology, Pathology, and E/M Services?

Are You Maximizing Claims on Radiology, Pathology, and E/M Services?

Date-of-services rules can be cumbersome on a good day—and can even turn an otherwise good day into a major headache for coders. A Medicare administrator contractor (MAC) put forth a provider outreach and education (POE) recommendation recently aimed at leveling out that “uphill battle” when it comes to complying with date-of-service requirements. An article in published online by DecisionHealth recommends clarifying the specific date-of-service rules your urgent care center follows when reporting common radiology, pathology, …

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Independence Blue Cross Slashes Reimbursements on Modifier 25

Independence Blue Cross Slashes Reimbursements on Modifier 25

Independence Blue Cross has implemented a new policy that cuts reimbursements on procedures billed with modifier 25 (“Significant, separately identifiable E/M service”) by half for care given to Medicare Advantage members and patients covered by private insurance plans. The lower rate does not apply to traditional Medicare claims. Independence covers patients under its own name, but also through QCC Insurance Company, Keystone Health Plan Eastand AmeriHealth. The move sets Independence apart from other payers, including …

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Be Mindful of Dates of Service When Coding for Flu Shots—or Get Claims Denied

Be Mindful of Dates of Service When Coding for Flu Shots—or Get Claims Denied

Among the Centers for Medicare and Medicaid Services’ new codes is one that’s likely to be confusing as patients start coming in for flu shots. A quadrivalent vaccine made and distributed by Sequirus is available for reporting, but if billing staff use the corresponding code, 90756 (Influenza virus vaccine, quadrivalent [ccIIV4], derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use) before January 1, 2018, the claim will be denied. Instead, they’re advised …

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When Coding, Remember: ‘Necessity’ Is in the Eye of the Beholder

When Coding, Remember: ‘Necessity’ Is in the Eye of the Beholder

Providers are employing evaluation and management (E/M) code 99214 more than ever—and seeing fewer denials and higher reimbursements than in the past, ultimately. That doesn’t mean it’s open season on the higher level code (and associated higher reimbursements), however; documenting medical necessity sufficiently is still critical to ensuring the code is valid compared with the reigning most common code (99213). Operators must ensure coders understand that while a level 3 visit requires one to three …

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ICD-10 Update: Transition Hysteria Much Ado About Nothing for Most

ICD-10 Update: Transition Hysteria Much Ado About Nothing for Most

Much like concerns that the Y2K crossover would wreak havoc on civilization as we know it, the transition to ICD-10 codes has been far less disruptive than was feared by many. A new survey by KPMG shows that 79 percent of organizations have made the transition without any major hiccups, with 28 percent calling it “smooth” and 51 percent reporting “a few technical issues, but overall successful.” Just 11 percent called their transition experience a …

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October 1: Out with ICD-9, in with ICD-10

October 1: Out with ICD-9, in with ICD-10

“Urgent care” was in its infancy and electronic medical records were practically the stuff of science fiction when the ICD-9 codes were released in 1979. The Centers for Medicare and Medicaid Services (CMS) takes one giant leap toward catching up with the launch of ICD-10 codes on October 1. As of that date, ICD-9 codes will no longer be accepted. CMS has said the new coding set is expected to “advance public health research and …

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