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Observation & Medical Necessity — NAHRI Forums

WEBWas on a conference call with my CDM Coordinators within my health system and involved in a lively discussion. If there's no medical necessity for …

Actived: 9 days ago

URL: https://forums.nahri.org/discussion/142/observation-medical-necessity

Medicare and Medicare MA Inpatient denials

WEBI am trying to show the need for placing in observation first preventing these low case mix admissions that are denied since regulations below state when you have a …

Category:  Health Go Health

Services included in Inpatient Room and Board

WEBWe have recently been receiving defense audits from commercial payors. There have been several services that they are disallowing, stating that these services …

Category:  Health Go Health

Billing for Planning MRI's — NAHRI Forums

WEBI am new to my role so please bear with me Our health system has been billing for planning MRI's prior to sterotactic brain procedures using CPT Code 76498 …

Category:  Health Go Health

Charge TPN in Observation status — NAHRI Forums

WEBMy Nurse Audit team is having an internal discussion related to the ability to charge TPN (Total Parenteral Nutrition) as an IV Infusion with cpt 96365 and 96366.

Category:  Nutrition Go Health

Condition code 42 — NAHRI Forums

WEBSeptember 2017. You would only report condition code (CC) 42 when the home health care is unrelated to the hospital stay in general. Using CC42 is not about matching the …

Category:  Health Go Health

Observation 2023 — NAHRI Forums

WEBObservation 2023. [email protected]. December 2022 in CODING & DOCUMENTATION. Good afternoon-. As you know CPT 99218 is being deleted as of …

Category:  Health Go Health

Telehealth Facility Fee Coding and Billing under CMS COVID-19

WEB1 . Telehealth Facility Fee Coding and Billing under CMS COVID-19 March 26, 2020 – Caroline Znaniec, Mid- Atlantic NAHRI Chapter Leader . The COVID-19 pandemic has …

Category:  Health Go Health

New Revenue Integrity Dept. — NAHRI Forums

WEBWithin our health system, we have several different RI Depts/Teams. Here are a few of the positions that seem consistent throughout. Manager. Chart Auditor. …

Category:  Health Go Health

Overview of Public Health Service (PHS) Act Provider and …

WEBProvider and facility requirements that apply starting January 1, 2022 • No balance billing for out-of-network emergency services (PHSA 2799B-1; 45

Category:  Health Go Health

Surprise Medical Bills Fact Sheet

WEBSurprise Medical Bills Here are some examples of when consumers have received surprise medical bills: • A consumer had a surgery at an in-network hospital or outpatient surgery …

Category:  Medical Go Health

Unacceptable Principal Diagnosis

WEBWe recently began getting edits for Unacceptable Principal diagnoses lately on Outpatient claims; however, I thought this edit was only a MCE for Inpatient claims.

Category:  Health Go Health

Northern Plains Regional Chapter

WEBHello, The Northern Plains Regional Chapter has formed! This chapter will encompass NAHRI members from the states of South Dakota, North Dakota, Montana, …

Category:  Health Go Health

Hospital ED Coding and Payment Reference Guide

WEBUpdated March 2022. Following are the results of an independent third-party coding analysis performed in January 2022 by MCRA Reimbursement and whose coder is …

Category:  Health Go Health

Industry Approach to auditing after updates to your EMR specific …

WEBWe are in the process of developing a new position for an auditor on the Revenue Integrity team that would perform audits quarterly after our EMR system …

Category:  Health Go Health

Standard Notice and Consent Documents Under the No …

WEBOMB Control Number: 0938 -1401 Expiration Date: 03/31/2022 . Standard Notice and Consent Document s Under the No Surprises Act (For use by nonparticipating providers …

Category:  Health Go Health

Can Declotting 36593 be coded separately from Chemo 96413

WEBIf the documentation in the health record supports the presence of a clot, CPT code 36593 may be reported for the declotting of an implanted device or catheter …

Category:  Health Go Health

Revenue Code for PICC Line Insertion (36568 or 36569)

WEBIf the nurse does the PICC in one of the designated treatment rooms rather than at the bedside, the charge is under revenue code 761. PICC placements by nursing …

Category:  Health Go Health

Model Disclosure Notice Regarding Patient Protections …

WEBIf a state develop s model language for its disclosure notice that is consistent with section 9820(c) of the Code, section 720(c) of ERISA, and section 2799A-5(c) of the PHS Act, …

Category:  Health Go Health

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