Category Archives: iMAX Medical Billing Insights

Drug courts key in opioid fight

In the big, complex world of Ohio’s opioid problems, drug courts may only be a small part of the solution. But they are an important component, nonetheless, and Hancock County is fortunate to have one in place in common pleas court. The need has never been greater for a program that provides certain low-level, nonviolent drug offenders the tools they need to become functioning citizens instead of convicted felons. The first drug court here began in 2014 under the oversight of Judge Reg Routson, and the second is now run by Judge Jonathan Starn. The first two graduates from Starn’s

Recent spike in overdoses in Montgomery County

MONTGOMERY COUNTY, Ohio (WDTN) – The Montgomery County Alcohol, Drug Addiction and Mental Health Services (ADAMHS) released a statement today that said while deaths are down from last year, recently there has been a dramatic spike in overdoses. Montgomery County is one of seven counties in Ohio that the Ohio Department of Health has seen an increase in drug overdose patients in emergency departments. The Montgomery County coroner’s office said that while heroin is the dominant drug they are seeing in these overdoses, methamphetamine is making a resurgence, and they want to remind everyone the dangers of opioids or meth being laced with

A New Wave Of Meth Overloads Communities Struggling With Opioids

Principal Mary Ann Hale dreads weekends. By the time Fridays roll around, 74-year-old Hale, a principal at West Elementary School in McArthur, Ohio, is overcome with worry, wondering whether her students will survive the couple of days away from school. Too many children in this part of Ohio’s Appalachian country live in unstable homes with a parent facing addiction. For years, the community has struggled with opioids. Ohio had the second-highest number of drug overdose deaths per capita in 2016, according to the Centers for Disease Control and Prevention. But in McArthur, a close-knit village of about 2,000 in rural

Mahoning county awarded $146,000 in federal funding to fight the opioid epidemic

The Mahoning County Alcohol, Drug and Mental Health board was awarded $146,000 in federal funding to fight the opioid epidemic, U.S. Sen. Rob Portman announced today. “This is terrific news for Mahoning County, and these new funds will help the community’s efforts to combat the heroin and prescription drug epidemic gripping our state,” said Portman, a Cincinnati-area Republican. “I was proud to help secure the opioid funding” and “I have seen firsthand how this law is making a difference across our state. This is another positive step forward, but we must do more, and that’s why I continue to push

Butler County gets $830K to fight opioid epidemic

U.S. Senator Rob Portman, R-Cincinnati, announced today that Butler County will received more than $830,000 in federal opioid funding through the 21st Century CURES law. The Ohio Department of Mental Health and Addiction Services disbursed $26 million through local Alcohol, Drug, and Mental Health boards and statewide initiatives. This is the second consecutive year Ohio has received opioid funding that Portman helped secure in the CURES law Congress enacted in 2016. The Butler County Mental Health and Addiction Recovery Services Board will receive $833,882. “These new funds will help the community’s efforts to combat the heroin and prescription drug epidemic

Key Terms, Components of Payer Contracts Providers Should Know

Understanding the terms and provisions in a payer contract is key to maximizing reimbursement, preventing denials, and operating a smooth revenue cycle. Providers are in the business of keeping their patients healthy. But confusing payer contracts riddled with “legalese” and other complicated provisions can get in the way of improving patient outcomes. Payer contracts define and explain a provider’s reimbursement arrangement for delivering healthcare services to patients covered by a specific health plan. The contracts cover everything from reimbursement rates and provider networks to medical necessity and provider credentialing. Understanding complex payer contracts is key to ensuring timely, correct reimbursement

Chief Complaint Is a Must Have

Each time you meet with a patient, you should document a chief complaint (CC). CPT defines the CC as “A concise statement describing the symptom, problem, condition, diagnosis, or other factor that is the reason for the encounter, usually stated in the patient’s words.” Simply stated, the chief complaint is a description of why the patient is presenting for healthcare services. An easily identifiable chief complaint is the first step in establishing medical necessity for services rendered. The 1995 and 1997 Documentation Guidelinesfor Evaluation and Management (E/M) Services specifically require, “The medical record should clearly reflect the chief complaint.” If the patient

Essential Tips for Successful Appeals

Successful appeals are often a result of how you present appeals to your carrier. Here are vital tips to achieve successful appeals. Be Prepared: Anyone speaking with the carrier regarding an appeal—be it a coder, biller, office manager, or provider—should have the knowledge and detailed information necessary to discuss that appeal. The individual should be able to review the operative note with the payer, to explain the rationale for the coding/billing, and to demonstrate why the claim should have been treated differently. Write an Appeal Letter: Don’t just send an explanation of benefits (EOB) with a balance bill. Instead, spell out

Presumptive Drug Testing

Presumptive drug testing services may be performed prior to definitive drug screen testing (80320-80377), when a provider wants to rule out illicit drug uses or to confirm the presence of a particular drug class without identifying individual drugs; or, to distinguish between structural isomers. For example, a patient using prescription opioids for pain management may receive a randomized drug screen service to test for the presence of opioids and illicit drugs, or other prescription drugs that may cause risk when combined with opioids (e.g., benzodiazepines). Presumptive Drug Testing CPT Codes Medicare and private payers require the same codes to report presumptive drug

Warning Signs of Heroin Use for Parents   KNOW THE SIGNS What are the signs of Heroin use? A neatly folded receipt resembling an envelope. A Q-Tip with the cotton bud plucked off. And who doesn’t have some dirt smudges on their doors or light switches? Unless you are aware, many of these seemingly innocent items go unnoticed. Knowing signs of opiate and heroin abuse could save a life. It could keep a family together. It could be the first step in getting someone, whom you care about, off of a dangerous, deadly course. Experts suggest that addicts will almost never be far from their drugs. They