Author Archive | Cheryl Nash

BACK TO BASICS – The EOB

The EOB or ERA, EOP, 835, etc. There are many acronyms to describe the payer’s remittance when received. Understanding these is even more challenging. In this article we will try to de-mystify and provide a better understanding of the process.   First the acronyms: The most common are EOB- Explanation of Benefits, EOP- Explanation of […]

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CAN I BILL THE PATIENT FOR THAT?

This is a question commonly asked by many practices, and it is a loaded question! The answer is: It Depends.   Depends on what? There are as many rules surrounding what you can and cannot bill a patient for as there are for sending clean claims. I will try to de-mystify the most common scenarios […]

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NEW YEAR AND NEW CODES

Everyone is excited for the 2018 coding changes.  Some of the hottest new technologies have been assigned codes by the AMA and these will be effective on 01/01/18.  Just in time for the New Year, APFS is providing coding clarification on these new service codes. 36465 – Non compounded foam sclerosant with ultrasound compression maneuvers […]

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TEMPLATES CAN CONFUSE THE ISSUE

Templates. They are a standard of practice, a requirement for your EHR, a time saver, and the bane of the medical reviewer’s existence.   Errors are common.  Designated templates are used from case to case.  This requires key elements of the form to be updated to match the specific case being documented. Common elements in […]

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A/R BEST PRACTICES

One of the biggest concerns in a practice is their collections.  Getting patients in the door is only half the battle.  Having their claims processed to completion is the natural outcome, but at times this seems to be the portion that gets swept under the rug.   Day-to-day operations gets in the way of a […]

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ACCEPTING THE PATIENT’S WORD…

Conservative Management- that’s the buzz term you need to know in insurance coverage policies. But what does this mean to your practice?  Probably not what you would like to hear.   Management means medically supervised conservative treatment, and while this includes prescription strength compression stockings that have been properly measured and ordered, it also means […]

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SEDATION SERVICES BILLING — PART 2

In the last article I wrote about coding for sedation services.  I briefly touched on the coding and reporting requirements for moderate sedation.  In this article, I will elaborate on that and provide a breakdown of what is needed to report these services.   In 2017 the codes for physician reporting of moderate or conscience […]

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NEW AUDIT BY NORIDIAN

Noridian has released letters informing providers of a new pre-payment review called the TPEE- Targeted Probe and Education with Extrapolation review. This is a pilot program and if successful may become a part of the CMS integrity program.   Noridian states that this review will consist of a prepayment process designed to educate the provider […]

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SEDATION SERVICES BILLING — PART 1

Coding and Billing for sedation services tend to cause confusion for providers that are not accustomed to such billing practices. Services such as tumescent, anoxiolysis, and moderate sedation get mixed up with the codes that are out there for general anesthetic services. For clarity, these services have specific definitions and attendant work requirements and/or certification […]

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NEW LANGUAGE IMPACTING PHLEBOLOGY CPT CODES

It has been a few years since CPT has made any changes of note to the codes most commonly utilized by the phlebology practice.  This has allowed us to stay blissfully unaware of the impact CPT updates can have.  We wanted to bring to your attention the very important information added in this year’s edition. […]

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