Category Archives: iMAX Medical Billing Insights

Summit County residents continue to overdose at lower rates than months ago

(Image courtesy of Summit County Public Health) By Amanda Garrett Beacon Journal/Ohio.com As Christmas approached, the number of Summit County residents seeking hospital help for overdoses continued a recent decline. Hospital emergency rooms reported treating 28 people for overdoses Dec. 15-21. That’s about half the overdoses reported here during weekly periods just months ago. It’s a welcome trend, but it’s unclear what’s driving the decline and whether it will continue. Summit County Public Health officials began tracking the hospital-reported numbers after they soared over a long July Fourth weekend last year. In 2015 and the first half of 2016, two

Local drug deaths: Hundreds die, but ‘it’s a lot less’ than expected

The record number of Montgomery County overdose deaths in 2017 rose so fast that by June the number exceeded the previous year’s total of 349 and health officials braced for up to 800 dead. “It was scary,” said Helen Jones-Kelley, executive director of the Montgomery County Alcohol, Drug Addiction & Mental Health Services (ADAMHS) board. “We’re certainly not celebrating the number of people who did overdose and die, but it’s a lot less than the number anticipated.” Though the very worst fears didn’t come, still, overdoses had taken 558 lives by Dec. 21, or 209 more than in 2016. The

New detox center set to open Jan. 2 in Sandusky, Ohio

A new detox center in Sandusky will open Jan. 2 and will welcome patients from across the region. The new 16-bed facility was built as an extension of the Erie County Health Department, 420 Superior St. While its main focus will be patients from Erie and Ottawa counties, Trey Hardy, chief of behavioral health for the department, said it also will welcome people from Lorain County. “The preference will be for residents of Erie and Ottawa counties because we had some funding provided through our local mental health and recovery board,” Hardy said. “But if we have beds available, we will

$1 Billion Class Action Lawsuit Filed Against eClinicalWorks

A class action lawsuit filed Thursday in the U.S. District Court in the Southern District of New York alleges that electronic health records vendor eClinicalWorks failed “millions of patients by failing to maintain the integrity of patients’ records.” A cover sheet filed with the complaint lists a monetary demand of just under $1 billion, or $999 million. The class action lawsuit comes six months after eClinicalWorks agreed to pay $155 million to resolve a False Claims Act lawsuit and settle allegations that it violated federal law by misrepresenting the capabilities of its software. In the False Claims Act lawsuit, the

Canton getting national award

A national nonprofit organization chose the city for its use of federal funds to support a youth opiate prevention program. CANTON The city will be one of five communities nationwide to receive the Audrey Nelson Award next month in Washington, D.C. The National Community Development Association, a nonprofit comprised of more than 400 local governments, chose Canton for “best community practices of utilizing federal Community Development Block Grant (CDBG) funds,” according to a news release. Canton used $65,000 of its CDBG money, awarded annually to local governments and states, for a one-year youth opiate prevention program, community events hosted by police

Summit County drug courts try new approaches

Turning Point drug court graduate Drew Sherwood takes up residence at Brian’s house, a sober house, in Wooster. Sherwood, who graduated from Summit Countys drug court in August, says the program gave him the tools he needed to finally kick his drug addiction. (Phil Masturzo/Akron Beacon Journal/Ohio.com) Drew Sherwood credits Turning Point with turning around his life. Sherwood, who graduated from Summit County’s drug court in August, says the program gave him the tools he needed to finally kick his drug addiction. “I would say Turning Point helped save my life,” said Sherwood, who has been drug-free for a year

UnitedHealthcare accuses Dallas labs of $100 million fraud involving kickbacks for bogus drug tests

One of the nation’s biggest insurers, UnitedHealthcare, has sued a Dallas-based laboratory network, alleging the owners paid millions in bribes and kickbacks to doctors and other providers between 2011 and 2016 for overpriced and unnecessary drug and genetic tests. Next Health‘s sales consultants gave people $50 gift cards to urinate in cups at Whataburger bathrooms, the lawsuit says. The specimens were sent to the labs for a battery of unnecessary and expensive tests under the guise of a “wellness study,” the lawsuit alleges. UnitedHealthcare says it got stuck with the $100 million tab because of Next Health’s fraudulent activities. Next

MDM: The Driving Force in E/M Assignments

The medical decision-making (MDM) component of evaluation and management (E/M) services is perhaps the most crucial element in determining the correct level of service assignment for patient encounters. The majority of individuals involved in the E/M coding process may not agree on the interpretation of the components, but would agree that the clinical thought process expressed in the MDM components best describes the level of medical necessity, as well as the level of service necessary for that specific problem. Medical Necessity Trumps All Else E/M levels have typically been assigned based on three main components: history, exam, and MDM. Although only

CPT Coding for Laboratory Panels

A laboratory panel is a package of tests that often are ordered together. Each panel code (80047-80076) includes multiple tests. When all the tests included in the panel are ordered, report the panel code. If any test defined as part of the panel is not performed, report the code(s) to describe the individual tests performed. CPT® instructs: …panels were developed for coding purposes only and should not be interpreted as clinical parameters. The test are listed with each panel identify the defined components of the panel. These panel components are not intended to limit the performance of other test. If

Incident to Provider Cannot Change Plan of Care

When a non-physician practitioner (NPP) performs an incident to service, that NPP must follow the plan of care as prescribed. He or she may not independently change the course of treatment. This requirement appears in Chapter 15, Section 60 of the Medicare Benefit Policy Manual, as shown in bold text: … to have …[a] service covered as incident to the services of a physician, it must be performed under the direct supervision of the physician as an integral part of the physician’s personal in-office service. As explained in §60.1, this does not mean that each occasion of an incidental service performed by a nonphysician