It is important to differentiate between ED professional and ED facility coding, and how levels of service are assigned. EDITOR’S NOTE: Recently, RACmonitor published articles referencing UnitedHealthcare/ Optum’s notice that they were changing the way they process emergency department (ED) claims, beginning April 1, 2020, along with how professional and facility…
Highlights of the 2019 Medicare Physician Fee Schedule, released on Nov. 1, are provided by the author. There will be no change in E&M payment levels for 2019, as was proposed in the Centers for Medicare & Medicaid Services (CMS) proposed, rule, news that comes as a relief to many…
CMS proposes major changes to E&M guidelines. Well, we have heard it for years: evaluation and management (E&M) guidelines need an overhaul. And now we have a proposal on the table. Before we get into the proposed changes, think for a moment: if you had full autonomy, how would you…
Providers must document the complexity of care for each and every patient. There is a standard misunderstanding of the utilization of time-based documentation and billing. Clearly, over time, many opinions and interpretations of ambiguous guidelines have clouded this topic, and it is time that we get back to the basics…