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Category Archives: Medical coder certification updates

2018 CPT codes for heart failure with higher reimbursement

Good morning,

Has anyone heard of any new CPT codes for 2018 for heart failure treatment. I have some providers who said there are new codes that are coming out in 2018 which would allow higher reimbursement. I haven’t been able to find anything yet. I know that there is a new designation "C7" which specifies the provider specialty which would help with denials. But they are adamant that new CPT codes will also we out there. Has anyone heard anything?

Medical Billing and Coding Forum – Cardiology

Is It Time to Outsource Your Medical Billing?

If you are noticing your medical billing claims are taking longer and longer to be reimbursed or you are having denials, rejections, or only partial reimbursements on your medical billing claims, it may be time to look at outsourcing your medical billing claims. You may feel as though you would be giving up control of your cash flow when actually you will have more control than ever. In fact, outsourcing your medical billing and coding needs through a medical billing partner is one of the smartest business moves you can make.

The best company to handle your medical billing isn’t necessarily located around the corner from your practice or even in the same town. Thanks to the power of the Internet, secure Internet connections, and advances in software and computer networks that allow for secure transmission of sensitive data, the process of finding a medical billing company to handle your needs is just a mouse click away.

This will free up your staff immensely as they will no longer have to spend long hours at the copy machine getting claims ready to send in. Your claims will be transmitted computer to computer via secure network transmissions and you can get real-time information on your patient accounts at anytime. Furthermore, outsourcing your medical billing will insure that all your claims are properly coded and documented properly. Your medical billing partner can devote 100% of their time to handling your coding and claims. That way your cash flow is steady and you can concentrate on growing your practice.

The post Is It Time to Outsource Your Medical Billing? appeared first on Outsource Management Group, LLC..

Outsourcing – Outsource Management Group, LLC.

4 Initiatives Advancing Healthcare Interoperability in 2017

Healthcare interoperability has been a priority for vendors and providers since the advent of health data exchange.

Timely access to accurate health information regardless of health IT system or location improves provider communication and patient care delivery across the care continuum.

This year, healthcare organizations, health IT developers, and federal agencies alike have made a concerted effort to push the industry closer to its goal of true interoperability.

The following are four recent initiatives and forthcoming projects aimed at transforming interoperability in healthcare in 2017…


Continue reading this article


The post 4 Initiatives Advancing Healthcare Interoperability in 2017 appeared first on Outsource Management Group, LLC..

General Info – Outsource Management Group, LLC.

Subsequent Hospital Visits & ECMO Daily Management

I have never coded these daily management codes for the ECMO, so can they be billed with the subsequent hospital visits. If so is there any reference material pertaining to this? Any help would be greatly appreciated! 🙂

Medical Billing and Coding Forum – Cardiovascular Thoracic

Health Plan Data Unlocks Population Health Improvements

Health Leaders Media

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  January 27, 2016 Follow us on FacebookFollow us on TwitterJoin us on LinkedInRSS feed

Health Plan Data Unlocks Population Health Improvements

Rene Letourneau, Senior Editor for HealthLeaders Media

By analyzing claims data, Milwaukee-based Children’s Hospital has measurably increased immunization rates and boosted care delivery and outcomes for some of the city’s most vulnerable citizens. >>>


Editor’s Picks

3 Ways Telemedicine is Changing Healthcare

From increasing access to influencing better patient outcomes, health systems are recognizing the benefits of virtual patient visits and remote monitoring—and finding ways to mitigate the costs. >>>

Population Health Really Does Work

At self-insured Houston Methodist, a population health pilot designed for staff members saw 50% of high-risk participants move into the low-risk pool within the first six months. >>>

Workarounds in Hospitals Raise Ethical Questions

A disconnect between how an organization imagines work is happening and what staff feel they must do puts healthcare workers on potentially ethically shaky ground. >>>

Postacute Strategies Vary Widely, Lack Standards

Two studies point to the need for a more thoughtful approach to postacute care strategies because readmission rates are simply not improving for some patients. >>>

How Public / Private Accelerators are Fostering eHealth Innovation

It is no surprise that a growing number of healthcare institutions are seeking partnerships to fund and nourish innovative startups. Massachusetts and New York are at the forefront of fostering such relationships. >>>

Readmission-reducing RED Protocol Adoption Lagging

The creators of the 12-step Re-Engineered Discharge protocol say it saves money, but hasn’t yet been widely or fully adopted. Follow-up studies have shown that problems arise when RED is diluted. >>>

Bringing the Healthcare Quality Message to the Masses

A documentary film honoring the AHRQ and the late John Eisenberg, a health systems research pioneer, also aims to promote health policy and patient safety, says his son, the filmmaker. From MedPage Today. >>>

Intelligence Report

Intelligence Report: The Outpatient Opportunity—Expanding Access, Relationships, and Revenue

In this HealthLeaders Media research report, the reasons behind ambulatory and outpatient care expansion may originate from different strategic points of view, but the tactics and objectives have much in common.
Order Today >>>

News Headlines

Trump calls for Medicare to negotiate drug prices

The Hill, January 27, 2016

Has Obamacare’s Medicaid expansion reached a tipping point?

CNBC, January 27, 2016

Medica, Blue Cross notch big growth in public insurance

Star Tribune, January 27, 2016

Health insurer Centene missing data drives with client information

Reuters, January 26, 2016

CBO lowers estimated Obamacare sign-ups by 40%

The Hill, January 26, 2016

Fidelity moves deeper into healthcare space with new exchange

Boston Business Journal, January 26, 2016

Deficiencies found at Theranos lab

The Wall Street Journal, January 25, 2016

Drug shortages in American ERs have increased more than 400%

Chicago Tribune, January 25, 2016

Law keeps ID health insurance CEO’s salaries secret / Associated Press, January 25, 2016

Broward Health CEO kills himself, sheriff’s office says

Sun Sentinel, January 25, 2016

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Our award-winning Daily News & Analysis e-newsletter can keep your leadership team abreast of relevant breaking news, and with in-depth industry coverage through 10 weekly e-newsletters that hit every pillar of healthcare, we’ve got your whole leadership team covered. Subscribe to any — or all — of our e-newsletters.


Webcast: Building Reputation, Managing Risk—ProMedica’s Model

Date: February 9, 2016, 1:00–2:00 p.m. ET
In this expert webcast, learn how establishing a proactive program to build reputation capital, manage reputational risk, and create a collaborative connection will better prepare providers for dealing with crises in the future.
Register Today >>>

From HealthLeaders Magazine

Big Ideas

What big ideas have you enacted? What big opportunities await your organization? >>>


Ups and Downs of High Volume


Remaking the Board

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When is Diagnostic Vats 32601 Separately Billable?

Hello, I am trying to determine when a diagnostic throracoscpy can be billed separately with modifier 59, when converted to open? The NCCI manual goes back and forth and I’m not sure when we can bill cpt 32601-59.

I have a provider who wants to bill CPT 32601-59 when converted to open once it it is realized the procedure cannot be done safely or for other reasons via vats, converts to open.

Any advise would be apprecaited, example –
Decision for Vats for decortication in ER day prior, on insertion of thoracoscope, it was noted that there were significant adhesions with purulence throughout the chest cavity and a trapped right lower lobe and right middle lobe. Based on this, it proved to be difficult to do a decortication through a VATS approach. It was decided to perform a posterolateral thoracotomy. A posterolateral thoracotomy was performed. The provider wants to bill the Vats in addition to the open procedure. Refers to chapter 5 NCCI " However, a diagnostic thoracoscopy is separately reportable with an open thoracotomy, thoracostomy, or mediastinal procedure if the findings of the diagnostic thoracoscopy lead to the decision to perform an open thoracotomy, thoracostomy, or mediastinal procedure, …with modifier 58".

The NCCI manual –

"14. A diagnostic thoracoscopy (CPT codes 32601, 32604, 32606) is not separately reportable with a surgical thoracoscopy on the ipsilateral side of the thorax.
A diagnostic thoracoscopy to assess the surgical field or extent of disease prior to an open thoracotomy, thoracostomy, or mediastinal procedure is not separately reportable. However, a diagnostic thoracoscopy is separately reportable with an open thoracotomy, thoracostomy, or mediastinal procedure if the findings of the diagnostic thoracoscopy lead to the decision to perform an open thoracotomy, thoracostomy, or mediastinal procedure. Modifier 58 may be reported to indicate that the diagnostic thoracoscopy and open procedure were staged or planned.
If a surgical thoracoscopy is converted to an open thoracotomy, thoracostomy, or mediastinal procedure, the surgical thoracoscopy is not separately reportable. Additionally a diagnostic thoracoscopy should not be reported in lieu of the surgical thoracoscopy with the open thoracotomy, thoracostomy, or mediastinal procedure. Neither a surgical thoracoscopy nor diagnostic thoracoscopy code should be reported with the open thoracotomy, thoracostomy, or mediastinal procedure code when a surgical thoracoscopy is converted to an open procedure.

Medical Billing and Coding Forum – Cardiovascular Thoracic

What do you do when the auditor just will not respond?

I work at a Substance Abuse Rehab and Cigna has been doing audits of all of their out of network providers. I have not heard of a single facility that has passed the audit. We recently had our audit completed and predictably failed (even though a retrospective audit from Optum BH came up with 0 problems during the same time span). We now have a no payment flag placed on our facility and we are forced to refer patients that come in with Cigna to other facilities.

I have been trying to contact our auditor since the day we found out the flag was placed on our facility. She sent me one email that was very terse and stated a letter would be sent out later that week……that was 6 weeks ago and we have yet to receive the letter. Since then I have called and or emailed 2 or 3 times per week and I have gotten nothing. I have no idea why we even failed the audit and at this point all we are doing is turning patients away.

Personally I believe ignoring me is purposeful on the auditors part. I also believe that the audit itself is punitive and is meant to drive out of network providers away from accepting Cigna patients rather than to improve care for their patients. Basically, the longer the auditor ignores me, the longer any appeal process will take. I am wondering if I have any legal recourse in this matter. If the auditor will not respond to me, who do I talk to? Almost all of Cignas plans are self funded, so they are under ERISA, which I believe rules out state insurance commissioners. I am completely lost here and any direction will help a great deal.

Medical Billing and Coding Forum – Payer/Health Plan

Prepare for JustCoding’s redesign by downloading quiz certificates, preregistering

The team at JustCoding is proud to announce a revamped and redesigned website launching soon. The new site will include great new features and make it easier than ever to browse our content, track your CEs, and more.

Before the new site launches, we ask all of our Basic and Platinum customers to print out their certificates for quizzes they’ve already taken. We will not be able to transfer quiz history to the new site. To get past CE certificates after the new site launches, you will have to retake the quizzes. Click here to access your current certificates.
Our new site will also require Free users to register to access the weekly free article, mini-poll, free quizzes, and other resources. Don’t worry—it’ll take less than a minute. Please click here and you’ll be all ready when the new site launches. If you are already a JustCoding Basic or Platinum subscriber, you don’t need to do anything—we’ll send you information when it’s time to access the new site!
New on JustCoding Platinum!      
2016 outlook in Special Reports and NewsHIM department focuses for next year
This report from HIM Briefings (formerly Medical Records Briefing) looks at trends that may emerge in 2016 and what your organization may want to focus on. – JustCoding News: Inpatient

MOON requirement delayed in IPPS final rule: What next?

MOON requirement delayed in IPPS final rule: What next?

Hospitals got a last-minute reprieve from the Medicare Outpatient Observation Notice (MOON) notification requirement, which was set to go into effect August 6. Citing the need for additional time to revise the standardized notification form that hospitals will need to use to notify patients about the financial implications of being assigned to observation services, CMS moved back the start date for the requirement in the 2017 IPPS final rule to ‘no later than 90 days,’ after the final version of the form is approved (

CMS released the new draft of the form ( August 1 and accepted public comments for 30 days. The MOON notification form is intended to be used to help hospitals comply with the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act. The Act requires hospitals to provide a verbal and written notice of outpatient status to any patient in observation who has been in the hospital for more than 24 hours, stipulating that hospitals must inform patients within 36 hours from the start of the service about their status. However, without a final version of the form ready for use, it would appear that hospitals cannot comply with the NOTICE Act at this time.

‘Hospitals should review the IPPS final rule that contains significant clarification on things like when and how the notice is delivered and finalize their own policies for delivering the notice pending the final version of the MOON being available,’ says Kimberly Anderwood Hoy Baker, JD, CPC, director of Medicare and compliance for HCPro in Middleton, Massachusetts.

CMS stated in the 2017 IPPS final rule:

We expect the final [Paperwork Reduction Act] PRA approval of the MOON around the time the implementing regulations are effective. Therefore, the implementation period for hospitals and CAHs will begin sometime after the effective date of this final rule and will be announced on the CMS Beneficiary Notices Initiative Website at: and in an HPMS memorandum to MA plans. During this implementation period, hospitals and CAHs will have time to prepare for implementation, consistent with past implementation practices for beneficiary notices. Hospitals and CAHs will be required to deliver the MOON to applicable patients who begin receiving observation services as outpatients on or after the notice implementation date.


‘Hospitals should watch the Beneficiary Notice Initiative page, where CMS said they would announce implementation information, for more information on the finalization of the MOON and implementation time frames,’ says Baker.

Hospitals will likely not be required to provide the MOON notification form to patients until 90 days after PRA approval, which could mean compliance with the MOON and NOTICE Act is at least 120 days out from the final rule release date given that there is also a 30-day comment period on the revised form, according to Baker.

‘When the final version of the notice form is ready for use, hospitals should use the 90-day implementation period to develop a mechanism for the form to be in their EHR with a trigger to print the notice when the patient is registered as or has a status change to observation. This will allow for the form to be delivered by the designated individual to the patient immediately rather than attempting to do it at discharge,’ says Rose T. Dunn, MBA, RHIA, CPA, FACHE, chief operating officer for First Class Solutions, Inc.

The message should be delivered by hospital staff who are well versed in the purpose of the notice and how patient status may financially impact the patient. Dunn recommends that hospitals choose patient access staff, financial counselors, or utilization review/case management staff to deliver the MOON rather than patient care staff.

The role of HIM in MOON compliance

While many facilities plan to task departments outside of HIM with delivering the verbal and written notice to observation patients, that does not mean there isn’t a seat at the table for HIM when it comes to operationalizing this regulation.

At Via Christi Health in Wichita, Kansas, Sam Antonios, MD, FACP, FHM, CCDS, medical director of medical information and ICD-10 physician advisor, and his colleagues are working to ensure they understand the nuances of the MOON.

Antonios’ facility is currently building a daily report to help track patients who have been in observation 24 hours.

The report will help the facility ensure compliance with the NOTICE Act and MOON, but this may be a challenge for facilities that do not have the capability to create such a document in their electronic systems. But even with the right systems and alerts in place, relying on just one report may present challenges. ‘For example, you may have patients who don’t have the right trigger from the initiation of observation services,’ Antonios says. Remember, the MOON must be delivered 24?36 hours after the initiation of observation services, which is not always the time when the patient entered the hospital, especially for those in the emergency department, he says.

In general, HIM should aid in the creation of reports listing any admission for Medicare beneficiaries in observation. Records for patients who have been in observation for more than 24 hours should be flagged when the report is run, which should ideally be done twice daily and be sent to the team tasked with delivering the MOON, Antonios says.

HIM must play a role in deciding what to do with the MOON when it is completed and how to track verbal notification of observation status, Antonios says. Should HIM scan the MOON forms immediately for inclusion in the patient’s medical record, or should scanning be completed at the end of the patient’s hospital stay? Deciding which option is best may depend on the needs of your facility and staffing patterns.

‘HIM professionals should ensure that the form is properly signed and scanned into the appropriate section of the medical record where it can be consistently found during an audit,’ says Edward Hu, MD, CHCQM-PHYADV, system executive director of physician advisor services at UNC Health Care system in Chapel Hill, North Carolina, and president of the American College of Physician Advisors. In addition, HIM will also play a role in ensuring the CMS-approved MOON is given to observation patients, Hu says.

In an era when hospitals are increasingly using electronic methods of documentation and communication, it may be tempting to create an electronic version of the MOON for patients to read and sign. However, Hu notes that if this practice is implemented the patient must still receive a paper copy of the form. ‘Hospitals must provide a signed paper copy of the MOON to the beneficiary, even if he or she reviews and signs on an electronic pad,’ he says. ‘The hospital must provide the MOON on paper for the beneficiary’s review if the beneficiary asks to review a paper version.’

Tracking and delivering the MOON is one hurdle to overcome, but so too is ensuring that patients understand the information presented to them. Language barriers can present a challenge when delivering the MOON. While it may be relatively easy to obtain a copy of the notice for patients who speak more common languages like Spanish, it is a bit more difficult at Antonios’ facility where patients speak a variety of languages that the form is not available in. In turn, staff may have a difficult time verbally notifying patients of observation status during off hours when a translator is unavailable, he says.

Hu notes that HIM can play a role in ensuring the Spanish-language version of the MOON is made available to patients and staff when it is approved by CMS. ‘Hospitals also have an obligation to provide the information on the MOON in a language and manner that the patient understands. Although this does not mean the MOON must be translated into every language, it does mean that the hospital has an obligation to ensure understanding by beneficiaries with limited English proficiency,’ he says.


The ups and downs of MOON

Complying with the NOTICE Act and operationalizing MOON has presented a significant challenge for healthcare organizations. Some are unsure of how to deliver the form and little is known about the impact it will have on patient relations and hospital staffing.

The verbal and written notice to observation patients should be given between 24 and 36 hours of the patient being placed in this status, which has many wondering whether they should actually wait 24 hours to deliver the notice since it can be challenging to ensure the notice is given before the 36-hour mark, says Antonios. ‘It leaves you with an open window of only 12 hours of actually being able to deliver before missing the deadline,’ Antonios says. Failure to deliver the notice within the given time frame can result in noncompliance.

While Antonios points out that CMS stated in the 2017 IPPS final rule that facilities can deliver the MOON prior to 24 hours of observation care, this may not always be the best option?especially since CMS noted that it discourages this practice. Delivering it before the 24-hour ma=rk as a proactive measure to ensure observation patients in need of the notice are not overlooked?or even delivering it on time?can present challenges since an observation stay can often become an inpatient stay based on a physician’s finding during the early hours of patient care, Antonios says.

Whether you decide to wait 24 hours or deliver the MOON as soon as observation status is initiated, there will be pros and cons.

Not waiting for the 24-hour mark may mean the verbal and written notice were given but not needed and could result in patients who are confused about their status and the financial implications of it. ‘It’s so early in the process that you may have people switched to inpatient before 24 hours and then you would have wasted the little bit of energy and resources to do a task that you didn’t need to do, because if you switch someone before 24 hours you don’t have to give them anything,’ Antonios says.

Delivering the MOON to all patients when they are first assigned to observation makes it easier to capture these Medicare beneficiaries before the 24?36-hour window passes, he says. It lends a fair amount of standardization and automation to the process of complying with the NOTICE Act and MOON, Antonios says.

However, ensuring that staff who are educated on completing the written notice and verbally explaining observation to patients are available at all times is not an easy task. While emergency departments (ED) are often well staffed during nights and weekends, other areas of hospitals may not have the same coverage, which could result in noncompliance if the MOON delivery window is missed. The ED?be it registration or other staff?may be the ideal setting for delivering the MOON if it is done routinely prior to the 24-hour mark. ‘Staffing on the floor goes down significantly after hours. It goes down significantly during the weekend, but the ED typically still has staff,’ Antonios says. ‘People receive paperwork in the ED anyway. It’s part of the process.’ – HIM Briefings