The Current Procedural Terminology ® (CPT) definition of Modifier 25 is that it is used to report an evaluation and management (E&M) service on a day when another service was provided to the patient by the same physician or other qualified healthcare professional. Think of Modifier 25 as a “protective” modifier when minor procedures or services are performed on the same date as an E&M office visit. If both services are medically necessary, both are paid, if the Modifier 25 has been appen...
Jun 21, 2022•27 min•Season 12Ep. 512
Listen to Mary's Bookclub, where Mary summarizes the books you can find at the MedLearn online bookstore! In today's episode, Mary explains the importance of Coding Essentials for Infusion & Injection Therapy Services . Listen in to find out why this textbook could be a great edition to add to your essential library.
Jun 15, 2022•3 min
Has the U.S. Department of Health and Human Services (HHS) clarified which telehealth services are valid for data submissions for the HHS-operated risk adjustment (RA) program? Moreover, can Hierarchical Condition Category (HCC) ICD-10-codes – the risk-adjustment model designed to estimate future healthcare costs for patients – be used when the services reported are provided under the public health emergency (PHE) telehealth waivers? You need to know. And you will, when you listen to the next li...
Jun 14, 2022•30 min•Season 12Ep. 511
Revenues are trending down. Audits are on the upswing. Experienced revenue cycle professionals are in short supply. And complex coding and documenting issues seem to be an everyday occurrence. With all the evident Sturm und Drang confronting healthcare professionals of late, ICD10monitor and Talk Ten Tuesdays are producing a special 60-minute edition of the famed Internet broadcast that will air Tuesday, June 7 at 10 a.m. EST. A wide range of subjects and subject matter experts promises to provi...
Jun 07, 2022•1 hr 1 min•Season 12Ep. 510
Listen to Mary's Bookclub, where Mary summarizes the books you can find at the MedLearn online bookstore! In today's episode, Mary explains the importance of Coding Essentials for Respiratory Therapy/ Pulmonary Function. Listen in to find out why this textbook could be a great edition to add to your essential library.
Jun 01, 2022•3 min
Behavioral health can be confusing. To screen or not to screen, what are the questions? Joining us this Tuesday for the lead story is a new panelist, Christine Hall. Christine Hall is the CEO and Senior Consultant for Stirling Global Solutions, LLC. She has 30+ years of healthcare administration and information management experience. Christine is a subject matter expert in compliance, specialty coding, auditing, risk adjustment, telehealth and reimbursement. During the next live edition of Talk ...
May 24, 2022•30 min•Season 12Ep. 509
With telehealth usage during the pandemic—up from 2.1 million services in 2019, to 32.5 million services from March 2020-February 2021—the GAO (US Government Accountability Office) realized that Medicaid hasn’t collected or assessed any data on the quality-of-care beneficiaries received from telehealth services. The GAO now recommends that they do so. Given concerns the GAO has raised about the quality of care provided via telehealth, this beneficiary data is crucial. It’s also consistent with h...
May 17, 2022•29 min•Season 12Ep. 508
Billing and collecting patient visits continue to challenge most healthcare providers and a frequent question often heard is “Can we bill a preventative medicine and new patient visit on the same day?” As a point of reference, there are circumstances when a preventative visit and a problem-oriented visit could be billed on the same date. The problem: the uncertainty of what those circumstances are and differing policies among payers, including Medicare. Do they all agree with these rules for pay...
May 10, 2022•32 min•Season 12Ep. 507
The Centers for Medicare & Medicaid Services (CMS) has released the hospital Inpatient Prospective Payment System (IPPS) Proposed Rule for short- and long-term acute-care hospitals. The Proposed Rule not only updates the Medicare approach to Medicare-Severity DRGs (MS-DRGs) reimbursement, but also advocates for the President’s executive orders addressing quality, inequities, and outcomes in healthcare. While there are no new MS-DRGs, minimal changes to the MS-DRG algorithms, and another one-...
May 03, 2022•31 min•Season 12Ep. 506
A tragic milestone is about to be reached, bringing with it the potential to wreak havoc on America’s crumbling mental health infrastructure: the United States is poised to record one million deaths caused by the deadly coronavirus pandemic. Collateral damage created by these deaths could likely be compounded by hundreds of thousands grieving the loss of loved ones and suffering from the new DSM-official condition: prolonged grief disorder. The number of potential grievers could be approximately...
Apr 26, 2022•28 min•Season 12Ep. 505
The Public Health Emergency (PHE) was extended, as expected, April 16. But here’s the caveat when it comes to PHE waivers: not all waivers were created equal. For example, does a PHE declaration waive or preempt state licensing requirements for healthcare providers? Are HIPAA protections for virtual care removed? Reporting this developing story during the next live edition of Talk Ten Tuesdays will be nationally recognized professional auditor, coder, educator and author Terry Fletcher. Listen a...
Apr 19, 2022•29 min•Season 12Ep. 504
The World Health Organization (WHO) has released the official version of ICD-11, and the National Committee on Vital Health Statistics (NCVHS), is calling for research to evaluate its use in the U.S. Reporting the lead story during the next live edition of Talk Ten Tuesdays will be the ICD-11 national correspondent for ICD10monitor, Mary Stanfill, vice president of consulting services for United Audit Systems, Inc. Stanfill will report on promising published research comparing ICD-11 with ICD-10...
Apr 12, 2022•30 min•Season 12Ep. 503
Thursday, April 7, 2022, is designated as World Health Day by the World Health Organization (WHO). And in a fitting preamble to this annual event, ICD10monitor and Talk Ten Tuesdays will feature a special guest: International Health Information Association (IFMA) President Lorraine Fernandes, who will release an official statement by her organization in support of the implementation of ICD-11. In her prepared remarks, Fernandes will discuss the importance of ICD-11 relative to an estimated 25,00...
Apr 05, 2022•33 min•Season 12Ep. 502
“Clinical Validation Denials: Queries and Strategies for Defending Claims,” and “Critical Care Services: 2022 Coding Update and Major Policy Changes” are discussed by Dr. John Zelem and Chuck Buck who analyze these two essential webcasts produced by ICD10monitor. Use code FRONTANDCENTER for 15% off your ICD10monitor webcast purchase.
Apr 04, 2022•7 min
Artificial intelligence (AI) is omnipresent — in self-driving cars, manufacturing, and healthcare management. Now, AI is even being deployed in the physician query process. Yet engineering AI to be programmed for physician queries requires understanding the physician’s thought process. And that’s always a challenge, on any level — especially for AI computer scientists. For the latest update on automated physician queries, we have invited Gerasimos “Gerry” Petratos, CEO for HiTeks, a company that...
Mar 29, 2022•31 min•Season 12Ep. 501
Welcome to the 500th live broadcast of Talk Ten Tuesdays. Ten nationally recognized thought leaders are scheduled to appear during the landmark production. As part of the full 60-minute broadcast, you will hear updates on topics ranging from the deadly coronavirus to the latest healthcare regulatory news, along with updates on ICD-10 coding, clinical documentation integrity (CDI), mental health, and the revenue cycle. Invited panelists include the following: Matthew Albright Rose Dunn, MBA, RHIA...
Mar 22, 2022•1 hr 1 min•Season 12Ep. 500
Two years ago this week, the World Health Organization (WHO) described COVID-19 as a pandemic — about the same time a cruise ship was held at sea off the California coast, with 3,500 people on board ultimately testing positive for the coronavirus. Today, masks are required. Social distancing is practiced. Countries close and open their borders, schools and public facilities shutter and open, and the embers of burnout explode as the Ides of March arrive. ICD10monitor and Talk Ten Tuesdays continu...
Mar 15, 2022•28 min•Season 12Ep. 499
Only here on Talk Ten Tuesdays will you learn the whole story behind the latest request from the Centers for Medicare & Medicaid Services (CMS). The agency is asking for feedback on four cost-efficiency models as part of the Merit-Based Incentive Payment System (MIPS) program. The deadline is fast approaching: March 25, 2022. The proposed cost-efficiency models for the CY 2023 MIPS cover positions including emergency physician, psychiatrist, and cardiologist/hospitalist. During the next live...
Mar 08, 2022•30 min•Season 12Ep. 498
“Clinical Validation Denials: Queries and Strategies for Defending Claims,” and “Critical Care Services: 2022 Coding Update and Major Policy Changes” are discussed by Dr. John Zelem and Chuck Buck who analyze these two essential webcasts produced by ICD10monitor. Use the code FRONTANDCENTER at checkout for 15% off your ICD10monitor webcasts! https://icd10monitor.com/product-category/webcasts/
Mar 03, 2022•7 min
With Medicare audits looming and U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) Work Plan items now relating to telehealth services performed during the COVID-19 public health emergency (PHE), it is time to make certain that your organization is accurately reporting services and claims within the requirements of the 1135 waivers relevant to the Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020. Remember, too, that in the world of healthcare ...
Mar 01, 2022•31 min•Season 12Ep. 497
The recent announcement from the Pan American Health Organization (PAHO) that the World Health Organization’s (WHO’s) ICD-11 coding system went online as of Feb. 11 might have been met with measured enthusiasm globally, but not here in the United States. The much-vaunted coding set isn’t expected to reach America’s shores for perhaps as much as a decade. Nonetheless, ICD-11 continues to be a topic generating interest among America’s coding community. And that is why we have asked Mary Stanfill, ...
Feb 22, 2022•31 min•Season 12Ep. 496
Brain disorders and the accurate selection of the principal diagnosis are two crucially important ICD10monitor webcast topics analyzed by Dr. John Zelem during his conversation with Chuck Buck. Great topics. Great analysis. More great educational opportunities now await you. So now get everyone on your team Front and Center.
Feb 21, 2022•6 min
These complimentary special edition podcast from ICD10monitor features Chuck Buck and John Zelem, MD as they review on-demand webcasts as well as preview upcoming webcasts. Dr. Zelem offers a unique physician perspective as he explains to listeners key learning objectives from these educational webcasts.
Feb 16, 2022•10 min
The billing rules for shared/split evaluation and management (E&M) visits are changing, as they will again in 2023. But although the Centers for Medicare & Medicaid Services (CMS) considers 2022 a transition year, controversy surrounding the 2022 Medicare Physician Fee Schedule (MPFS) is creating contagious confusion. If you and your team are suffering from such chronic consternation, relief will be within reach when you log on next Tuesday for another live edition of the Talk Ten Tuesda...
Feb 15, 2022•31 min•Season 12Ep. 495
To improve care and create transparency, Medicare mandated a pay-for-quality reporting program for hospital outpatient services in 2009. The measures can impact hospital payment if not met, thus creating financial incentives for hospitals to achieve them. The measures are intended to evaluate the regularity of outpatient treatments known to provide the best results for the most patients with a particular condition. During the next live edition of Talk-Ten-Tuesdays, Colleen Deighan, senior consul...
Feb 08, 2022•28 min•Season 12Ep. 494
Principal care management is a service that focuses on the medical and/or psychological needs manifested by a single, complex chronic condition that is expected to last at least three months in duration. During the next live edition of Talk Ten Tuesdays, Colleen Deighan, senior healthcare consultant for 3M HIS Consulting Services, will return to the weekly Internet radio broadcast to report on principal care management and the new CPT® codes for 2022. The live broadcast will also feature these o...
Feb 01, 2022•30 min•Season 12Ep. 493
In today’s supercharged general lexicon, words have enhanced meaning. So as more and more hospitals admit patients, the words “for” and “with” are garnering great significance. With hospitals filling up with patients who have a COVID-19 diagnosis linked to their stay, what is the actual admission for? During next week's Talk Ten Tuesdays broadcast, we have asked nationally recognized professional coding expert, educator, and author Terry A. Fletcher to report on the ever-evolving COVID-19 diagno...
Jan 25, 2022•30 min•Ep. 492
ICD10monitor and Talk Ten Tuesdays continue reporting on the social determinants of health (SDoH), as they relate to health equity. On Tuesday, Jan. 18, the day after the national observance of the life of slain civil rights leader Rev. Martin Luther King, Jr., Sharon Easterling, an African-American senior healthcare consultant, will return to the broadcast to report on this timely and crucially important subject. Many Americans no doubt recall seeing the grainy black-and-white TV news footage o...
Jan 18, 2022•32 min•Season 12Ep. 491
The health of all Americans is on the line – particularly among the nation’s communities of color, where maternal health issues, behavioral health issues, diabetes, and cardiovascular conditions have a disproportionate impact. Recognizing this national concern, the Blue Cross Blue Shield Association has devised a national health equity strategy to confront such health disparities. All this follows the release by the National Center for Health Statistics of 2022 ICD-10-CM codes, both new and upda...
Jan 11, 2022•30 min•Season 12Ep. 490
There’s never enough time to keep up with the myriad of changes confronting clinical documentation integrity specialists (CDISs). And that is why Talk Ten Tuesdays will reveal important content about a new white paper developed by the American Health Information Management Association (AHIMA) and the Association of Clinical Documentation Integrity Specialist (ACDIS), as part of a featured segment during the next edition of the weekly Internet radio broadcast. “Compliant Clinical Documentation In...
Dec 14, 2021•30 min•Season 11Ep. 489
