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The Coding Corner: Reporting EM services with time as the controlling factor

CPR’s “Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billing. This month’s tip comes from G. John Verhovshek, the managing editor for AAPC, a training and credentialing association for the business side of health care.   Occasionally, a health care provider’s discussions with a patient about his or her medical condition(s) may consume a greater portion of the provider/patient encounter than the time devoted to performing a relevant history, exam and medical decision-making (MDM). In such cases, CPT® guidelines allow you to consider time as “the ...

UnitedHealthcare implements Smart Edits into the EDI claim process

In the April 2018 UnitedHealthcare (UHC) network bulletin, UHC notified physicians that it would implement Smart Edits, a new functionality introduced into the EDI workflow, allowing the payor to autodetect claims with potential errors in the claims pre-adjudication phase. Once a potential error has been identified, UHC will notify the physician (via the 277CA report) within 24 hours, returning the claim to the provider along with a suggested modification to overcome the problem. Providers will have five calendar days to correct the claim and resubmit it, reducing the potential ...

CMA urges Health Net to rescind recently announced payment policies

Since Health Net first notified physicians in March of planned changes to its modifier 25 and emergency services payment policies for Medicare and Medi-Cal lines of business, the California Medical Association (CMA) has been working to educate the payor about physician concerns with the new policies.   Last month, at CMA’s urging, Health Net agreed to delay implementation of the new policies until July 1, 2018, to allow time to review provider concerns with the new policies and to continue discussions with CMA and other stakeholders.   CMA recently wrote to Health Net ...
Award Honors To 10 Deserving Physicians and Community Leaders

Award Honors To 10 Deserving Physicians and Community Leaders

The Santa Clara County Medical Association hosted nearly 200 members and their families for our Annual Awards Banquet where we awarded top honors in nine categories as well welcomed our new 2018-19 President, Kenneth Blumenfeld, MD. 2018 Award Winners: Outstanding Contribution to the Medical Association Thomas Dailey MD Outstanding Contribution in Medical Education John Tatman, MD Outstanding Achievement in Medicine Ruma Kumar, MD Outstanding Contribution in Community Service Suchada Nopachai, MD William C. Parrish Jr. Leadership in Healthcare Award William Parrish Jr. Citizen's Award John and Gini Mitchem Special Recognition Award SCCMA Alliance Foundation Accepted by Suzanne Jackson Benjamin Cory, MD Award Sameer Awsare, MD Robert D. Burnett, ...