American Medical Association
The AMA hasan online outreach for Practice Management called the Practice Management Center.
The Center offers a variety of tools to assist providers navigate the the roadmap of today's practice. Be sure to sign up for the free Practice Management Alerts.
An example of the resources offered is a nice pocket guide to preventive service without patient cost share. The guide provides the CPT codes and the USPSTF Grade that insurance companies should pay under the Affordable Care Act.
Coverage Determinations issued by the Centers for Medicare and Medicaid are the best starting point for knowing what diagnoses will support medicial necessity for a specific procedure. Private insurance is not mandated to follow the same guidelines, but in most cases it does. CMS's National Coverage Determinations will apply in all states. Local Coverage Determinations are listed here alphabetically. Check to ensure the carrier listed on the right is your carrier. CMS also offers an invaluable search feature that allows you to customize a search through both national and local coverage documents.
National Correct Coding Edits is CMS's current standards on what can and cannot be billed together. The documents (which require an "unzipping" program and program that can read either recent Microsoft Excel or "txt" files), list code sets. In the far right column, there will be a code 0, 1 or 9. A "0" means that a modifier is never allowed so the two codes will NEVER be paid together. A "1" indicates that if properly modified, the codes can be paid together. "9" means no modifier is needed. A word of caution here: never use modifiers just to get a claim paid. Always ensure that the services performed AND the supporting documentation support the use of the modifier.
Quick Reference to Medicare Preventive Services: Issued in January, 2010, this publication is a little out of date. It does not include Annual Wellness Exams. Nor does it address the changes in tobacco counseling that allows counseling under a plan to be offered to any smoking Medicare patient. This is an area that KLA tries to update in our Blog. Visit it for up to date posts on the Annual Wellness Exams and the new rules about Tobacco Cessation Counseling.
Or for more detail on Medicare Preventive Services: The Third Edition of The Guide to Medicare Preventive Services. This is a good place to start. However, being even older than the Quick Reference Guide listed above, it excludes even more services.
The ABC's of the Initial Preventive Physical Exam (The Welcome to Medicare Exam)
The Affordable Care Act mandates that new policies include coverage for Group A and B services as determined by the U.S. Preventive Services Task Force. This list is subject to change. For the latest USPST list, visit: http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm.
Practice Management Institute offers many online courses to make better coders of your staff. Many of these courses are geared for speciality practices. Others, such as the online Certified Medical Coder class, can help your staff obtain a certification that is looked on favorably by auditors. Coding training is one area where you are likely to see a significant return on investment.