Excel is a powerful tool for storing data however it can be very difficult to analyze the mass amounts of information stored in an intuitive way. Many individuals and organization find themselves spending countless hours manually producing tables and charts in excel.

The current healthcare environment continues to create regulatory complexities so physicians are forced to reduce patient time and focus on regulatory and administrative issues. Keeping a clinic or health system compliant has become the forefront to avoid government and private payor audits.  As physicians try to create efficiencies with implementation of Electronic Health Records/Electronic Medical Records (EHR/EMR’s), a new vulnerability to government scrutiny begins to evolve.

So you are thinking of adding Social Workers to your practice. But you are thinking- Will the services be covered? What requirements must be met? Is it even worth it? What codes can they bill?

Here are the answers to your questions:

How long has it been since you have read the Centers for Medicare & Medicaid Services (CMS) policy manual on Modifier 25? Or are you like many people individuals who have never looked at the policy on the modifier and were only taught by others? In this hectic world, it is can be difficult to take time to settle in and really look at the guidelines however this is a critical step in the process. In this three part series, modifier 25 is addressed in depth mainly with regards to CMS guidelines and occasionally referenced from individual Medicare Administrative Contractors (MACs).

2013 has marked a significant year for coding changes for psychiatry and psychology.  As with other specialties, the AMA provided a clear division of coding for psychotherapy services as opposed to medical management of patient problems.  CMS has adopted most of the new coding regulations put forth by the AMA yet, many State Medicaid plans have narrowed the scope of coverage within the code series.

Non-physician providers (NPPs) continue to integrate and gain credentials offering collaborative billable services in a hospital setting. Yet to this end, the professional side of coding has several gray areas that MAC guidelines don’t address clearly. For the purposes of billing Medicare Part B, medical record documentation must satisfy a few criteria found in the Internet-Only Manual (IOM).

Observation coding continues to be a vulnerable area when it comes to professional billing and coding. RAC contractors have a keen eye on timing of these services, as the relative value can change significantly based on which services actually are rendered.

Although consolidated payments for the facility portion of SNF care are hot on the RACs’ issue list for 2012, the professional side is also key to beating a Part B audit. In 2011, per HDI, issues for Region D included visits to patients in nursing facilities and visits to patients in swing beds. Payment for Part B SNF care carries a lower RVU value, which, to no one’s surprise, has become a RAC focus being as this area of coding is often misunderstood. Per the fine print provided by HDI, nursing facilities and hospital units providing “swing beds” constitute services often coded as inpatient, thus creating an overpayment for professional services. Another key element to coding these visits properly is reporting the correct POS, which, based on type of facility, also may account for a revenue differential.

Jana presented to over 1000 attendees across the Nation last week at a Wolter's Kluwer MediRegs teleconference educating on Compliance Audits and Evaluation & Management Services.  Wolters Kluwer is offering a Free Trial to the MediRegs Coding Suite and for additional information click here.  The presentation slides are also available. 

As compliance professionals, the conversation about qualifying medical necessity or medical decision-making probably has surfaced at one time or another during education with providers, coders or auditors.  As discussed in the first article of this two-part series, these phrases often are used interchangeably and have caused all of us to think about how to best manage and monitor when it comes to documentation and coding.