Category Archives: iMAX Medical Billing Insights

10 Documentation and Coding Principles to Demonstrate Medical Necessity

When preparing medical documentation and coding medical conditions, keep these 10 principles in mind to demonstrate medical necessity for services reported: List the principal diagnosis, condition, problem, or other reason for the medical service or procedure. Be specific when describing the patient’s condition, illness, or disease. Distinguish between acute and chronic conditions, when appropriate. Identify the acute condition of an emergency situation (e.g., coma, hemorrhage, etc.). Identify chronic complaints, or secondary diagnoses, only when treatment is provided or when they affect the overall management of the patient’s care. Identify how injuries occur. Assign diagnosis codes to the highest documented level

CMS Guidance for Date of Service Professional Claims

From specimen collection to maternity packages, inspect coding and billing DOS rules. On Sept. 19, 2017, the Centers for Medicare & Medicaid Services (CMS) released MLN Matters® article SE17023 for physician and non-physician practitioners who submit claims on either the CMS-1500 form or electronically via the X12 837 Professional Claim to Medicare administrative contractors (MACs) for Part B service charges. The MLN Matters article does not offer new guidance, but reiterates how to represent the date of service (DOS) on Part B outpatient provider claims. It also reminds providers, “Expenses are considered to have been incurred on the date the

Officials: Medicaid expansion repeal could halt momentum in opioid fight

CHILLICOTHE – If Medicaid expansion isn’t continued, Chillicothe Mayor Luke Feeney and others are concerned it could derail local efforts to combat opiate addiction. Feeney, Michelle McAllister, coordinator of the Heroin Partnership Project, and Cheryl Beverly, founder of Cheryl’s House of Hope, expressed concerns during a brief press conference on Friday. “Ross County has been one of the hardest hit in the opiate epidemic and we are finally beginning to make headway, but without Medicaid expansion, our efforts will be pushed back tremendously,” McAllister said, referencing in part the decrease in overdose deaths in 2017. “If we don’t have Medicaid expansion,

Drug problem in Ashland shifting from opiates to meth

ASHLAND – These days, Ashland Police and METRICH drug task force detective Brian Evans get more calls about crystal meth than heroin. He estimates Ashland police officers find methamphetamine about three to five times as frequently as they find marijuana during traffic stops. In 2015, just one meth case came across Evans’ desk. In 2016, he saw 17 cases involving the drug. Last year, the number rose to 37. This year alone, the department has had 14 METRICH meth cases, with the drug showing up in more than half the total 22 METRICH cases as of April 11. Meanwhile, the

Medical community avoided discussions about opioid crisis

A paragraph in an Akron Beacon Journal story last fall raised tough questions about the medical industry. The story was about a local hospital successfully managing pain following surgery by prescribing medications other than addictive opioid painkillers. The paragraph said this of the nonopioid experiment: “The patients were easy to convince. It was tough to convince the other surgeons, anesthesiologists and nurses because it challenged their typical teachings.” Opioids are the drugs killing more than 4,000 Ohioans a year, and a study by the state showed that 80 percent of those who died of an overdose were at one time

Enquirer wins Pulitzer Prize for Seven Days of Heroin coverage

In the next seven days of the heroin epidemic, at least 180 people in Greater Cincinnati will overdose and 18 will die. Babies will be born to addicted mothers. Parents will go to jail. Children will end up in foster care. This is normal now.   https://www.cincinnati.com/videos/news/2017/09/10/video-180-ods-18-deaths-1-week;-how-heroin-crisis-normal-now/105408394/     The Cincinnati Enquirer staff has won a Pulitzer Prize in the local reporting category. The story “Seven Days of Heroin” was recognized by the Pulitzer board “for a riveting and insightful narrative and video documenting seven days of greater Cincinnati’s heroin epidemic, revealing how the deadly addiction has ravaged families and communities.” The Enquirer

Perspectives On The Opioid Crisis From Oregon, Ohio, And New York

From prescription painkillers to heroin to powerful synthetics like fentanyl, this country is in the grasp of a serious public health epidemic. And it doesn’t just affect those who are addicted. The opioid crisis is indirectly affecting local government budgets, schools, courts, and neighborhoods. This week ideastream, in partnership with Oregon Public Broadcasting and WXXI in Rochester, is looking at the wide reach of the epidemic in our special series Opioid Crisis: The Ripple Effect. Morning Edition Host Amy Eddings sat down with reporters from each of the three stations to discuss the state of the crisis. The opioid crisis in

Work Through Coding and Reimbursement Challenges

There’s usually a reason and a solution for every denied claim. Claim denials are inevitable. The first step to work through them is understanding the most common denials, such as: bundling; global denials; multiple frequency denials; and no plan coverage denials. Bundling Unbundling occurs when a service is billed using individual codes when a single, all-encompassing code exists. For example, a provider might order a lipid panel; however, instead of billing 80061 Lipid panel, the provider bills each test separately. Another example of a common bundling mistake is reporting 76000 Fluoroscopy (separate procedure), up to 1 hour physician or other

Dangerous Drug Mixture On Ohio’s Streets Is Blamed For Many Recent Opioid Deaths In Ohio Right Now

As opiate deaths continue to climb in Ohio, there’s another deadly trend that’s apparently gaining popularity – drug combinations. The Ohio Health Department’s Dr. Mark Hurst says the “speedball”, the combination of heroin and cocaine, was what led to actor John Belushi’s death in the 1980’s. And he says there’s a similar combination that’s responsible for the recent rash of opioid deaths in Ohio right now but this one involves something more potent than heroin. “The potency of fentanyl is 50 times that of heroin and so it’s even more lethal in a dose than heroin would be,” Hurst says.

Recovery housing helps recovering addicts fight addiction

COLUMBUS (WCMH) — In Franklin County alone, there have been nearly 1,000 emergency room visits because of suspected overdoses so far in 2018 according to Columbus Public Health. For those who want to help, it can be difficult knowing where to start in the face of such an overwhelming problem. There are places for recovering addicts to live to adjust to life before addiction. “You know it’s just normal life,” Jason Schenck who is a recovering addict. “People are doing their laundry and eating dinner.” He is working to get his life back to normal after years of battling addiction. He’s