medical coding training

Every year, the Centers for Medicare & Medicaid Services (CMS), and the American Medical Association (AMA) release updated coding and reporting guidelines that make additions, deletions, and revisions to the ICD-10 and HCPCS code sets, and CPT codes, respectively. During Public Health Emergencies (PHE), such as the COVID-19 pandemic, CMS and AMA will release updates more frequently. By offering ongoing medical coding training to cover these quarterly and annual updates, your coding team upholds an accuracy standard and stays compliant with these revised guidelines. YES Education offers a robust catalog of medical coding updates that refreshes as the code set revisions are released, including quarterly and annual updates for ICD-10-CM/PCS and CPT.

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PCI CPT codes

The Refresh With YES: CPT PCI Procedures Webinar provides an overview of the CPT codes for Percutaneous Coronary Intervention (PCI) procedures divided into 14-19-minute modules. During this four-part series on PCI CPT codes, learners will receive information on various PCI procedures, including a review of the heart’s anatomy and pathophysiology of conditions that may necessitate a PCI procedure. The coding guidelines and codes for PCI are thoroughly examined, and case examples of PCI are presented. The modules offered within this course include: Anatomy and Disease Process Review, CPT Guidelines and Coding (Parts 1 and 2), and Review of Case Studies.

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screening for COVID-19

This article offers guidelines on how to code screening tests for suspected COVID-19 infection. There are two different kinds of tests for COVID-19: a viral test to detect a current Coronavirus infection, and an antibody test to confirm is the patient previously had COVID-19 (CDC, 2020). The CDC has issued guidance on conducting screening tests for COVID-19 and other recommendations for viral testing (2020).

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CMS guidelines for telehealth

The Centers for Medicare & Medicaid Services (CMS) has decided to update the CMS billing and coding guidelines for telehealth or in-home provider services due to the urgency of the current 2019-Novel Coronavirus (COVID-19) pandemic (CMS, 2020). CMS has broadened the scope for reimbursement for virtual check-ins and other digital communications with patients to safely and effectively respond to this Public Health Emergency (PHE). In the interim, telehealth services will not be limited by program restrictions put in place by Medicare (Federal Register, 2020). Evaluation and management (E/M) service codes cover these remote and communication technology-based services performed by a physician or non-physician practitioner (NPP).

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DNFB

One of the biggest revenue-killers for healthcare providers is DNFB accounts. DNFB (DNFB meaning “discharged, not final billed”) – defines unbilled accounts where the patient has been discharged from the healthcare facility, but the final bill from the encounter has not been submitted. The cost effects of outstanding DNFB accounts and claims denials are staggering, and can negatively impact the providers’ cash flow and potential net revenue. So, what are the best practices to reduce DNFB days and claims denials?

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telemedicine reimbursement guidelines

CMS released the Medicare telemedicine coding and reimbursement guidelines for healthcare providers to use during the COVID-19 pandemic (CMS, 2020). According to the CMS Medicare Telemedicine Health Care Provider Fact Sheet, reimbursement for these visits are considered the same as in-person visits and are paid at the same rate (CMS, 2020). The U.S. Department of Health & Human Services Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs (CMS, 2020).

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Telehealth and Covid-19

CMS clarified on April 10, 2020, that the submission of ICD-10-CM diagnoses codes for Risk Adjustment are permitted from coding telehealth services as long as it meets the set criteria (i.e. inpatient, outpatient, or professional service and from a face-to-face encounter) (CMS, 2020). CMS is stating that telehealth services can meet the face-to-face requirement “when the services are provided using an interactive audio and video telecommunications system that permits real-time interactive communication” (2020). From a medical coding and billing standpoint, the change in the telehealth services criteria for risk adjustment is causing updates to how these services are billed.

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Perhaps the most important upcoming development in the fight against COVID-19 is detecting antibodies to the infection, and new tests for this purpose are being developed. As these are new tests, existing codes do not reflect these antibody studies. To assist, the CPT Editorial Board has fast-tracked the approval of two new CPT codes for the COVID-19 antibody blood testing (AMA, 2020). The new codes were published April 10, 2020, and are effective immediately. Use of the codes will allow for tracking and reporting of antibody tests specifically for COVID-19.

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The establishment of a coding compliance program remains a significant effort by the Office of the Inspector General (OIG) in its attempt to engage the healthcare community in combating fraud and abuse. The OIG developed a Compliance Resource Portal with materials and guidelines for healthcare professionals. A fundamental element to an effective compliance program is conducting internal monitoring and auditing. Coding audits have the added value of ensuring you are running an efficient and profitable, not to mention minimized liability, operation. Earlier detection of any potential coding issues will pay off financially and will reduce risks for additional external audits.

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Healthcare facilities and independent practices face unique challenges when merging or being acquired. As an HIM and Coding consulting company, YES has encountered several opportunities to implement auditing, coding, and education improvement plans in similar scenarios. This case study provides a thorough analysis on the unique challenges a medical facility faces when merging with independent practices, as well as solutions for a successful facility acquisition process. Challenges impact overall medical coding quality, turnover rate, productivity and the bottom line. The analysis covers the solutions implemented, and an overview of the impact these presented to a facility, practiced over a 33-month period.

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