Laboratory Question for the Week of October 30, 2017
MedLearn Publishing
October 30, 2017
Do you know what the payment rate would be for CPT® codes 85025 (CBC) and 80061 (lipid panel) under the new proposed CLFS?
Do you know what the payment rate would be for CPT® codes 85025 (CBC) and 80061 (lipid panel) under the new proposed CLFS?
Would modifier 52 be appropriate when the physician orders polysomnography with CPAP titration, and during the phase of the test using the CPAP, the patient is physically unable to complete this portion of the test (e.g., adverse event)?
What code would I use for the second stent if the doctor’s dictation states “MI with culprit lesions in the LAD and RC”? If I can only assign code 92941 one time, what code do I use for the additional artery?
Is it appropriate for a pharmacy to use modifier KX when billing DME MACs for immunosuppressive drugs provided to Medicare beneficiaries who received an organ transplant that was paid for by Medicare?
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CMS has accused Bryan Merrick, MD of wrongful Medicare billings on 10 patients over a span of 20 months. As they would react to a
Should hospitals combine two admissions into one? In the absence of CMS guidance, hospitals are urged to do the right thing. Last week I wrote
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Mental health diagnoses offer possible insight into the mind of suspected Las Vegas mass murdered Stephen Paddock. EDITOR’S NOTE: The following are remarks by nationally
Electronic medical record (EMR) technology offers both advantages and pitfalls, but EMR errors must be investigated nonetheless. EDITOR’S NOTE: In this article Dr. John Irwin,
Complexity of medical decision-making is key, but you can’t bill for something you didn’t do. This article was prompted by a Talk Ten Tuesdays listener’s
CMS CRUSH (Comprehensive Regulations to Uncover Suspicious Healthcare) signals a new era of data-driven program integrity oversight that extends far beyond coding and CDI. As federal scrutiny of claims, documentation, billing practices, provider enrollment, and payment accuracy intensifies, healthcare organizations must be prepared to identify and address vulnerabilities before they result in audits, denials, repayments, or enforcement actions. Join us for this timely webcast to learn what CMS CRUSH could mean for your organization and discover practical strategies to strengthen documentation, claims integrity, compliance readiness, and reimbursement defensibility.
Medicare regulations are complex and even seasoned professionals struggle to apply them consistently. Due to overwhelming demand, Dr. Hirsch returns for Part 2 of Ask Dr. Hirsch: Clarifying Medicare’s Most Misunderstood Rules to answer even more of Medicare’s most misunderstood questions, covering inpatient status, observation, SNF access, Medicare Advantage denials, and more. Join Dr. Hirsch as he provides clear, referenced answers to real-world questions submitted by your peers, helping you navigate Medicare compliance with confidence and clarity.
Traditional utilization management models can no longer keep pace with regulatory shifts, payer scrutiny, and operational pressures. In this webcast, Tiffany Ferguson, LMSW, CMAC, ACM, ACPA-C, introduces an Adaptive Model strategy that modernizes UM through role specialization, technology-driven workflows, and proactive, team-based processes. Attendees will learn how to restructure programs to improve efficiency, strengthen clinical collaboration, and enhance financial performance in a rapidly changing healthcare environment.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
Artificial intelligence is rapidly transforming healthcare revenue cycle operations, from coding and auditing to compliance and denials. Join industry leaders Pam Warren (MaineHealth) and Raemarie Jimenez (AAPC) for a live fireside chat exploring how AI is changing workflows, workforce roles, payer-provider dynamics, and compliance risk—and what organizations should be doing now to prepare.
Prepare for FY 2027 IPPS changes with a comprehensive 3-part masterclass covering ICD-10-CM/PCS updates, MS-DRG shifts, NTAPs, compliance risks, and reimbursement strategies.
Stay ahead of FY 2027 reimbursement changes with expert analysis of MS-DRG shifts, NTAP updates, Medicare Code Edits, and emerging technologies impacting inpatient payment accuracy.
Stay ahead of FY 2027 ICD-10-PCS changes with expert analysis of new procedure codes, revised guidelines, and high-impact updates affecting reimbursement, compliance, and inpatient coding accuracy.
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