CCM Under the Microscope: Are Your Providers Documentation-Ready? Written by: Christine Hall, CHC, CPC , CDEO, CPB, CPMA, CRC, CEMC, CPC-I Chronic Care Management (CCM) services are getting extra attention from Medicare Administrative Contractors (MACs) as part of their Target, Probe, and Educate (TPE) program. They are closely reviewing CCM claims for possible misuse, which…
Before You Bill Incident To—Is the Treatment Plan Really There? Scott Kraft, CPC, CPMA, CEMC, CPA-RA Whenever you perform an audit under Medicare’s Incident to billing rules, you’re really auditing two different things. First, did the visit note support the code assigned and whether it included any documented changes to the patient’s treatment plan. Second,…
Prescription Drug Management Requires More Than a Medication List Written by: Jill Young What documentation is required to show a provider is performing prescription drug management? It has been a question since the changes to the Office or Other Outpatient Services codes was announced by the American Medical Association (AMA) in 2021. The table Elements of Medical Decision…
Non-Medically Necessary vs. Statutorily Excluded Services: Understanding the Differences Written by: Jennifer McNamara “That’s not covered.” It’s a phrase we hear all the time—but what does it really mean? There’s a definite distinction between non-medically necessary services and those that are statutorily excluded. Understanding the difference between non-medically necessary and statutorily excluded services is essential…
Prevention of Patient Complaints and Payer Denials: Covered vs Non-Covered Preventive Services Written by: Pam Vanderbilt “I just got a bill for my free annual visit!! Sound familiar? Calls from patients who are upset because they got a bill for services they thought were covered. When I research these complaints, the issue causing the services…