Month: May 2022

What is the HIPAA Security Rule?

What is the HIPAA Security Rule?

The HIPAA Security Rule requires covered entities and business associates to implement technical, physical, and administrative safeguards. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) required the HHS secretary to develop rules for safeguarding electronic protected health information (ePHI). Out of these requirements, HHS created the HIPAA Privacy Rule and the HIPAA Security […]
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Medicare advantage prior authorizations are often unnecessarily denied

Medicare advantage prior authorizations are often unnecessarily denied

  A report by the Office of Inspector General (OIG) raises concerns about organizations prioritizing profits over patient access to care. Medicare Advantage organizations (MAOs) often delay or deny services for medically necessary care, even when prior authorization requests meet coverage rules, according to a report by the OIG. A concern with the Medicare Advantage […]
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Preventive Medicine Versus E&M Codes

Preventive Medicine Versus E&M Codes

Choosing a proper office visit code can become confusing unless one understands the rules separating preventive medicine and evaluation and management (E&M) coding. Problem-oriented E&M services, office, and other outpatient visit codes 99202-99215 (along with hospital, observation, and consultative encounters) are for patients who present with signs, symptoms, conditions, diagnoses and/or problems that need to […]
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Don’t Overlook These New PLA Codes

Don’t Overlook These New PLA Codes

A quarterly update for the Clinical Laboratory Fee Schedule (CLFS), issued May 4, includes nine new CPT® codes for proprietary laboratory analyses (PLAs). Medical coding and billing staff that process claims for lab testing should be aware of these codes and pricing. 9 New PLA Codes The following PLA (type of service 5) codes are […]
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Bridge the gaps between payer and provider by automating your revenue cycle

Bridge the gaps between payer and provider by automating your revenue cycle

The health care industry is rapidly evolving. COVID-19 has uncovered a litany of flaws in health care systems, leading to massive changes in the way patients, providers, and payers communicate and operate. One of the highest impact changes in the industry is the widespread shift from a traditional fee-for-service reimbursement system to value-based care. Instead […]
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How to Build ICD-10-PCS Codes From Op Reports

How to Build ICD-10-PCS Codes From Op Reports

Arrive at the correct procedure code by breaking down the operative report. Even seasoned coding professionals occasionally find it challenging to assign the appropriate ICD-10-PCS codes from the operative report. Mastering the procedural coding system used in the inpatient hospital setting takes practice. Medical coders reporting inpatient services should start by reading the operative report, […]
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