By Jo-Anne Sheehan, CPC, CPB, CPPM, COC, CPC-I Advance Care Planning is about having the provider do what he or she can to guarantee that the health care treatment a patient receives is consistent with the patient’s wishes should he become unable to make his own decisions or speak for himself.
About JoAnne SheehanJoAnne Sheehan has been successfully providing medical billing, coding and practice management services in the New England area for over thirty-three years. She has witnessed the evolution of healthcare and the increased complexities of medical billing and coding regulations, creating a need for education in this field. JoAnne has been featured in numerous medical publications and has acted as a medical billing expert in highly profiled Medicare and Medicaid fraud cases in Boston and has trained others on both a local and national level in medical billing and coding. She is a certified medical coding instructor, practice management consultant, and an AAPC approved ICD-10-CM instructor. Her hands-on experience is an asset for the CCO students she coaches. She is President and Founder of Lomar Associates, Inc., a practice management company established in 1981.
Q: “I would like for you to go over TCM leveling for the physician’s office. My understanding is that it is based on the medical decision making only, but I would like to learn more about it. Could you possibly discuss this in the next monthly Q&A webinar?” A: Tonight that’s
Copayments, coinsurance and deductibles Q: Why is it so important to collect the copayment at the time of service? A: For the most part, the OIG Special Fraud Alerts have been reserved for national trends in health care fraud and have addressed potential violations of the Medicare and State healthcare programs'
Q: Timely Filing for Claims and Appeals — “Please explain filing limits with insurance claim processing” for the initial claim as well as the appeal process. A: Basically, we’ll be covering information about how all insurance companies do enforce filing limits for both initial claim submission, as well as for appealing
Q: “Can we discuss coding osteoarthritis? I often see it diagnosed as osteoarthritis with a specified site but not if it is primary or secondary.” A: This one is pretty simple. A primary osteoarthritis is considered wear and tear, and is the most frequently diagnosed by healthcare providers. Secondary osteoarthritis has
Q: A biller had contacted me saying that: “I can’t seem to get my first claim transmitted without some type of denial coming back. I am checking the CPT and ICD-10-CM codes and it all links together. What is going on?” A: The first thing is, there is an initial step
Q: Review of X Modifiers (EPSU) (modifier 59 alternatives) — “Can you review the X modifiers implemented January 1, 2015?” A: Honestly, there really hasn’t been that much of a change. In fact, CMS Medicare hasn’t given us much feedback or examples that consultants and coders have been looking for. But
Q: Chiropractic Billing vs Medical Billing - “I recently switched from coding & billing with a 97.5% collection rate to billing for a chiropractic group. Now, 50% of my claims are being denied - particularly with Medicare, and I’m not doing anything differently than I did at my prior job.” Jo-Anne — A: