Question: Our Medicare contractor is auditing claims with 98942. Do you have any suggestions for a template for documentation to warrant the use of 98942?
Answer: When you submit a claim with code 98942 you are stating that you have determined that it was medically necessary to adjust all 5 of …
Any type of payer review can create some headaches for providers and cause problems for a healthcare office. Even for a practice that has taken administrative steps to try and prevent a prepayment review, it can still happen. A prepayment review means that you must include documentation WITH your claim. …
Medicare creates and maintains the National Correct Coding Initiative (NCCI) edits and NCCI Policy Manual, which identify code pair edits. When performed on the same patient, on the same day, and by the same provider, the secondary code is considered an integral part of the primary code, and payment for …
In Part 1, Dr. Gwilliam shared with you where auditors and claim reviewers get their information from. Now it is your turn. Dr. Gwilliam will guide you through some of the criteria and systems he uses when reviewing charts for attorneys and doctors. Bring your 2018 DeskBook along because Appendix D will be your friend as you figure out how to keep mistakes out of your practice.
In this presentation, Dr. Gwilliam, a widely renowned auditor and coder, will reveal to you the references he and other auditors use when reviewing your claims and documentation. These include coding books, Medicare guidelines, and private payor policies. Buckle up for a wild ride.
As both a chiropractor for 31 years and one who reviews a lot of medical records for the medicolegal arena and has been teaching documentation for many years, the range of motion question comes up frequently. Although we used to get reimbursed very well for a specific range of motion code back in …
Creating effective care plans and using them properly is the solution to most clinic’s documentation issues. Once you make it clear to auditors and reviewers what the game plan is, and you show that you follow it throughout care, communication issues will be eliminated and you will be able to manage the case better. In this presentation, Dr. Gwilliam, Clinical Director for PayDC Software, and former Vice President of ChiroCode, will review fundamental concepts of care plans, as outlined in Chapter 4.4 of the DeskBook, and show how it is done in one chiropractic EHR. You will leave the webinar with a clear path to improve your care plans so that you can be confident that third parties understand your records.
The new year is coming. Are you ready? Do you know which codes have changed? Do you know which issues are the focus of payers and auditors? Have you conducted annual reviews to make sure nothing is falling through the cracks? Join Dr. Gwilliam of PayDC Software, as he helps you prepare for 2018.
As part of a good compliance plan, and just because it is smart, you should be conducting at least annual audits in your office. If done right, you should be able to catch problems before some insurance company comes after you and demands money back. In the new 2018 DeskBook, we have provided you with self audit forms that you can copy and place in your Compliance Manual as evidence of your efforts to improve. Solutions for identified deficiencies are also right at your fingertips. In this presentation, Dr. Gwilliam will teach you how to audit yourself and keep the external auditors away.
Question: Our claims are being rejected. We think it is related to our diagnosis codes. What is the reason for this?
