NCCI: National Correct Coding Edits The Centers for Medicare & Medicaid Services developed the National Correct Coding Initiative (CCI) as a tool for preventing the overpayment of duplicative or overlapping fee schedule services. There are two basic types of code edits: the Correct Coding Initiative (CCI), and the Medically Unlikely Edits (MUE). Each performs a different function. 1) Correct Coding Initiative (CCI) The CCI edits prevent improper payment when incorrect code combinations are reported. Many of the CCI edits are based on the standards of practice. The CCI contains two tables of edits. CMS refers to these as: 1.a) Column One/Column Two Correct Coding Edits Table Services that are integral to another service are component parts of the more comprehensive service. When integral component services have their own HCPCS/CPT codes, CCI edits place the comprehensive service in Column One (payable) and the component service in Column Two (nonpayable). For example, if a patient undergoes a colonoscopy with a biopsy, the codes for the colonoscopy and the biopsy should be bundled together and billed as a single code. 1.b) Mutually Exclusive Edits Table The CCI Mutually Exclusive Code Edits include those codes that cannot reasonably be performed in the same session. For example, if a patient undergoes a knee replacement surgery, the codes for a knee arthroscopy and a knee arthroplasty cannot be billed together because they are mutually exclusive procedures. 2) Medically Unlikely Edits (MUE) Medically Unlikely Edits (MUE) were developed by CMS to reduce its contractors’ error rate on paid Part B claims. An MUE for a CPT code is the maximum units of service that a provider would report — under most circumstances — for a single beneficiary on a single date of service. Unlike the CCI edits, an MUE edit involves only one code — not a combination of two codes. Many of the CCI edits are constructed in a way that they can be overridden by appropriate use of a modifier. Modifier-59 (distinct procedural service) can be used with the edits. An update of the CCI edits is published every quarter. While coding multiple procedures, every coders must have access to the CCI edits tool to ensure coding is appropriate. >>>>Check out my profile to see more updates. #stayconnectedstayupdated #medicalcoding #cci #cciedits #bundledservice #column1column2 #modifier25 #codify
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Senior Manager Operations at RCM Health Care (Specialist in Medical Billing, Coding and process re-engineering). Credentials team head. Coding delivery...
very useful tips
|| Coding Resource Consultant || Multi-Specialty Coding || Revenue Cycle Management (RCM) ||
NCCI: National Correct Coding Edits The Centers for Medicare & Medicaid Services developed the National Correct Coding Initiative (CCI) as a tool for preventing the overpayment of duplicative or overlapping fee schedule services. There are two basic types of code edits: the Correct Coding Initiative (CCI), and the Medically Unlikely Edits (MUE). Each performs a different function. 1) Correct Coding Initiative (CCI) The CCI edits prevent improper payment when incorrect code combinations are reported. Many of the CCI edits are based on the standards of practice. The CCI contains two tables of edits. CMS refers to these as: 1.a) Column One/Column Two Correct Coding Edits Table Services that are integral to another service are component parts of the more comprehensive service. When integral component services have their own HCPCS/CPT codes, CCI edits place the comprehensive service in Column One (payable) and the component service in Column Two (nonpayable). For example, if a patient undergoes a colonoscopy with a biopsy, the codes for the colonoscopy and the biopsy should be bundled together and billed as a single code. 1.b) Mutually Exclusive Edits Table The CCI Mutually Exclusive Code Edits include those codes that cannot reasonably be performed in the same session. For example, if a patient undergoes a knee replacement surgery, the codes for a knee arthroscopy and a knee arthroplasty cannot be billed together because they are mutually exclusive procedures. 2) Medically Unlikely Edits (MUE) Medically Unlikely Edits (MUE) were developed by CMS to reduce its contractors’ error rate on paid Part B claims. An MUE for a CPT code is the maximum units of service that a provider would report — under most circumstances — for a single beneficiary on a single date of service. Unlike the CCI edits, an MUE edit involves only one code — not a combination of two codes. Many of the CCI edits are constructed in a way that they can be overridden by appropriate use of a modifier. Modifier-59 (distinct procedural service) can be used with the edits. An update of the CCI edits is published every quarter. While coding multiple procedures, every coders must have access to the CCI edits tool to ensure coding is appropriate. >>>>Check out my profile to see more updates. #stayconnectedstayupdated #medicalcoding #cci #cciedits #bundledservice #column1column2 #modifier25 #codify
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Overview The article discusses the finalized 2024 Medicare Physician Fee Schedule (PFS) by the Centers for Medicare & Medicaid Services (CMS), highlighting key changes and their impact on optometry. The updates include a reduction in the conversion factor, the introduction of a new add-on code, adjustments to the Merit-based Incentive Payment System (MIPS) reporting, and new quality measures for optometry. The American Optometric Association (AOA) has provided insights and reactions to these changes. Key Takeaways 1. Conversion Factor Reduction: CMS finalized a 3.4% reduction in the PFS conversion factor, from $33.88 to $32.74. 2. G2211 Add-on Code: A new add-on code for primary care, G2211, was finalized despite opposition due to concerns about potential overpayments and subsequent reduction in the Medicare conversion factor. 3. MIPS Performance Threshold: CMS decided to keep the performance threshold at 75 points, avoiding an increase that would have resulted in more penalties for clinicians. 4. Promoting Interoperability Category: The performance period for this MIPS category was increased to a minimum of any continuous 180-day period within 2024. 5. New Quality Measures: New measures were added to the optometry/ophthalmology specialty set, including screening for health-related social needs and appropriate follow-up for specific eye conditions. 6. Revalidation of Enrollment: CMS will allow doctors a stay of enrollment rather than deactivation during revalidation challenges, enabling resubmission and payment of claims. 7. Delay of eCQM Adoption: Mandatory adoption of electronic Clinical Quality Measures (eCQM) by Medicare Shared Savings Program participants was delayed. 8. Public Reporting of Cost Measures: CMS opted against requiring public reporting of cost measures for CY 2024, continuing to consider this policy for the future. Conclusion This article is beneficial for medical billing and revenue of medical practices as it provides critical updates on Medicare policies, helping practitioners stay informed and compliant. By understanding these changes, practices can better navigate billing and optimize revenue. How Peak Medical Solutions Can Help Peak Medical Solutions can assist you in understanding and adapting to the new Medicare PFS changes, ensuring compliance and optimizing your revenue cycle management. Our expertise in medical billing will help you navigate these updates smoothly, maintaining efficient and profitable practice operations.
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Healthcare Disrupter | Innovation for Healthcare Revenue Cycle| AI in Health Tech | #HFMA Chapter #pastpresident #CAT | Board Member | Advisor | Healthcare Change Leader
Heading to the American Society of Anesthesiologists® Advanced 2024National Conference this week. Take a look at the Becker's article about declining Medicare Reimbursement rates and stop by the Aideo Booth #818 and lets talk about how #ai the #aideoway will reduce your total coding costs. #healthcareit #rcmservices #medicalcoding #advance24
Anesthesia reimbursements continue to sink
beckersasc.com
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In proposed updates to 2025 #Medicare policies, #surgerycenters would see a 2.6% average rate update. CMS proposed to add 20 codes to the #ASC Covered #Procedures List, including 16 dental codes. Read ASCA’s initial analysis.
CMS Releases 2025 Proposed Medicare Payment Rule
ascfocus.org
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Bridging Comprehensive Dental Care to PACE and Medicare Advantage: Enable Dental’s Value-Based Care Model At Enable Dental, our mission transcends beyond conventional dental care. Our Value-Based Care (VBC) model, tailored for the Program of All-Inclusive Care for the Elderly (PACE) and Medicare Advantage segments, underscores our commitment to quality over quantity, a paradigm shift from the traditional Fee-for-Service (FFS) model. Key Highlights of our VBC model over FFS: 🍎 Preventive Focus - Early interventions and preventive care are our forte, significantly curtailing the need for extensive treatments later on, especially crucial for managing chronic conditions. 🤝 Collaborative Care - Our model fosters a symbiotic relationship between dental and medical care providers, ensuring a well-rounded care approach, vital for holistic health outcomes. 👩⚕️ Incentivized Quality - With rewards pegged to the quality of care, our providers are incentivized to deliver precise, effective treatments. 🎯 Data-Led Population Health - Continuous assessment and data analytics enable us to refine care protocols, ensuring cost-effectiveness alongside superior health outcomes. The interplay between diabetes and periodontal health serves as a quintessential example of the importance of our integrated approach. Early management of periodontal issues is pivotal for optimal diabetes control, showcasing the potential of our VBC model in orchestrating improved health outcomes and cost savings. Here is a recent study from JADA showing how the cost of diabetic care decreased for those members that received periodontal care. That would mean a regular cleaning or deep cleaning as needed by the patient. https://lnkd.in/gbhr2_bE Enable Dental is steadfast in its vision to redefine the benchmarks of care within PACE and Medicare Advantage through our innovative VBC model. #ValueBasedCare #CollaborativeCare #DiabetesManagement #ElderlyCare #PACE #MedicareAdvantage #InnovativeHealthcare #diabetes #dentistry #dentalinsurance #CMS National PACE® Association American Dental Association NADP Centers for Medicare & Medicaid Services CalPACE
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Vice President, Physician Advisory Solutions at R1 RCM, Advisory Board of American College of Physician Advisors and National Association of Healthcare Revenue Integrity, differentiator between acronyms and initialisms
2025 OPPS Propsed Rule is out and the utilization review headline is "OPPS is a big nothingburger" No changes to Two Midnight Rule 3 procedures added to IOL- related to liver transplants- 0894T -0896T; no removals ASC approved list has a few additions, allowing leadless pacemaker placement and removal 0795T and 0801T but mostly dental. Now what surprises will PFS bring? https://lnkd.in/gFMKHwYD
Public Inspection: Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs, including the Hospital Inpatient Quality Reporting Program; Health and Safety Standards for Obstetrical Services in Hospitals and Critical Access Hospitals; Prior Authorization; Requests for Information; etc.
federalregister.gov
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Pioneering the Mouth Mind Connection | Founder, Toothsome | Oral & Maxillofacial Surgeon, Niva Dental Specialists
🦷 Why the Discovery Process in Full Mouth Dental Implant Treatment is So Challenging To say that navigating the patient journey to find full mouth dental implant treatment is overwhelming, is an understatement. Here are a few reasons why: 1.) Lack of Transparency: Prices vary widely, and it’s often unclear what’s included. Patients struggle to get straightforward answers about costs and included components and stages of their treatment. 2.) Provider Credentials & Experience: The level of training and expertise varies greatly among providers. Some only offer local anesthesia, while others are trained in advanced techniques and use IV anesthesia or third-party anesthesiologists. 3.) Patient-Provider Match Variability: Not all providers can handle complex cases. Matching the right provider to the patient's specific needs is crucial, but not always a match. This leads to patients seeking multiple 2nd, 3rd, and oftentimes even 4th opinions. 4.) Multiple Hoops to Jump Through: Getting clear answers often requires navigating through a series of consultations and biased information. Clinics are focused on marketing themselves as the best, making it hard to get unbiased information. What patients need is a third-party, independent advocate that allows them to search, discover, learn, and book consultations with the ease of swiping through an iPhone app. 📊 According to a McKinsey survey, over 89% of patients expressed interest in shopping for healthcare services if given the option. 📊 Truven Health Analytics reports US Healthcare prices can vary an astounding 40-50% within a given US metropolitan. It’s time for a change. Patients deserve transparency, ease of access, and trustworthy information to make informed decisions about their oral health. Toothsome #dentalimplants #oralhealth #transparency #patientadvocate #dentalcare #smilemore #toothsome #selfcare #healthandwellness #fullarch #allonx #mouthmindconnection #selfcare #healthcareinnovation Indika Tantrigoda Sunthar Premakumar Ram Bhakta Greg Essenmacher Jason M. Auerbach, DDS Jonathan Mendia Samer Shaltoni Tyler Rushing Greg Essenmacher Margaret McGuckin, MBA Traci Nervo Sophia Dunkley Genevieve Poppe Kyle Stanley Lucy M Barone, M.A. Kayne Bosma Becky Kopecky Dave Roehr
How price transparency could affect US healthcare markets
mckinsey.com
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the medical delivery system can improve access to care for underserved populations. The integration of the dental delivery system into the medical delivery system is a crucial aspect of comprehensive healthcare. This integration is necessary to ensure that patients receive holistic and coordinated care, addressing not only their medical needs but also their dental health. In this essay, we will explore the importance of integrating the dental delivery system into the medical delivery system when needed, the challenges and barriers to integration, and potential solutions to facilitate this integration. Section 1: Importance of Integrating Dental and Medical Delivery Systems The integration of the dental and medical delivery systems is essential for several reasons. First and foremost, oral health is integral to overall health and well-being. Poor oral health has been linked to various systemic conditions, including cardiovascular diseases, diabetes, and adverse pregnancy outcomes. By integrating dental care into the medical delivery system, healthcare providers can ensure that patients receive comprehensive care that addresses both their medical and dental needs. Furthermore, integrating the dental delivery system intos. Many individuals face barriers to accessing dental care, including financial constraints, lack of insurance coverage, and shortage of dental providers, particularly in rural and underserved areas. By integrating dental services into existing medical facilities, patients can receive comprehensive care in a familiar and accessible setting, reducing disparities in oral health outcomes. Section 2: Challenges and Barriers to Integration Despite the clear benefits of integrating dental and medical delivery systems, several challenges and barriers hinder seamless integration. O ne of the primary challenges is the historical separation between medical and dental care.
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Dental Public Health Executive/Consultant, Value-based Care/ FQHC Dental Practice Expert Advisor, and Adjunct Assistant Professor U of Iowa College of Dentistry
VBC in Dentistry, Part 5 If Value-based Payments attempt to force cost savings from the beginning, it is possible to lower costs artificially but not improve patient care. A change in dental culture and practice must arise that focuses on minimally invasive treatment, emphasis on prevention, and medicinal dental therapeutics. "Even though metrics were in place for preventive measures, a capitation design without a link to a diverse set of quality measures (preventive, restorative, referral, access, health outcomes) can create incentives to lower costs but not to improve the overall quality of care. Successful APMs require that providers embrace a value-based, prevention-focused mindset in care delivery. Additionally, providers must be supported with education, tools, and workflows to match the payment model. This modification of dental operations will require a lot of time, but near-term investments are vital to accomplish the long-term impact on health outcomes." https://lnkd.in/gV3HSXN7
Value-based payment alignment: A case study for oral health
dentaleconomics.com
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Your guide to maintaining comprehensive patient records is here! Understand the checklist and audit processes that keep your dental practice compliant and efficient. #PatientCare #RecordKeeping #MedicaidCompliance #NewArticle https://buff.ly/3QKzMSO
Avoiding Common Medicaid Compliance Mistakes in Dentistry
dentalcompliance.com
