Category: Blog

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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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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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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CMS, HHS Finalize 2023 Notice of Benefits, Payment Parameters

CMS, HHS Finalize 2023 Notice of Benefits, Payment Parameters

  CMS and the Department of Health and Human Services (HHS) released the 2023 Notice of Benefits and Payment Parameters Final Rule, which includes standardized plan options, changes to network adequacy reviews, refinements to the Affordable Care Act’s essential health benefits nondiscrimination policy, and other changes. “The recent Open Enrollment Period demonstrated the demand for […]
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Barostim Heart Failure Treatment: Coding Training

Barostim Heart Failure Treatment: Coding Training

The Centers for Medicare & Medicaid Services (CMS) has begun covering a portion of the device cost for Barostim Neo, a neuromodulation device for treating chronic heart failure. In late 2020, the Centers for Medicare & Medicaid Services (CMS) announced that it would begin covering a substantial portion of the cost of implantable heart failure […]
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Revenue Cycle Leaders Experience Price Transparency Rule Burden

Revenue Cycle Leaders Experience Price Transparency Rule Burden

Revenue cycle leaders noted that the confusing regulations included in the CMS price transparency rule make it difficult for their organizations to achieve compliance. The majority of revenue cycle leaders were dissatisfied with aspects of the CMS hospital price transparency rule and expressed doubt about the regulation’s efficacy, according to a KLAS report RevCycleIntelligence received […]
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Cms proposes more than 1k new diagnosis codes

Cms proposes more than 1k new diagnosis codes

Brain illness and injury, with a focus on dementia-related diagnoses, occupy a high volume of the 1,495 proposed changes to the ICD-10-CM diagnosis code set by CMS in the fiscal year (FY) 2023 inpatient prospective payment system (IPPS) proposed rule. At the same time, CMS also introduced a minimal amount of new ICD-10-PCS procedure codes, […]
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