Click here for more sample CPC practice exam questions with Full Rationale Answers

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Click here for more sample CPC practice exam questions and answers with full rationale

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What makes a good CPC Practice Exam? Questions and Answers with Full Rationale

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2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

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Click here for more sample CPC practice exam questions and answers with full rationale

Substance Abuse Intensive Out Patient H0015 billing provider?

The situation is that there is a substance abuse facility that performs the three hour intensive outpatient treatment service that is billed under one code H0015. The three hour segments of the service are performed by three different therapists. They are all therapists, no one is an MD. There is no Incident To situation going on. There is no supervising therapist. The MD oversees ongoing care generally, with regular visits but is not present at the time of these services.

How is the billing provider determined?

​My knee jerk reaction is to draw straws and pick someone of the three to bill under, and after spending many hours now reading on this, I still don’t have a better answer. Anyone have direction to an official answer on this, please let me know. ​

Medical Billing and Coding Forum

SAMHSA: Patient consent now required for substance abuse records

 Appropriate sharing of records for patients with substance abuse disorders should be easier under a second final rule issued January 3 by HHS and its Substance Abuse and Mental Health Services Administration (SAMHSA). But in some cases, the new rule adds considerations that might mitigate the advantage.

HCPro.com – Briefings on Accreditation and Quality

Residential Substance Abuse Billing – MN

Hello! Question in regards to billing for residential substance abuse billing in Minnesota. We bill the H2036 for the treatment plan which includes all the clients groups for the day. I’m told the client has to attend 30 hours of groups per week and our clients do this between Monday-Friday. There are no groups on the weekend so there are no progress notes for the weekend dates (only if the HST updates something in their record). Are we allowed to bill for Saturday and Sunday dates when there are no groups? Room and board is a separate line.

Medical Billing and Coding Forum

Fraud and Abuse: Texas Doc Fleeces and Hides

In what reads like a cheesy TV script, a McAllen-area, Texas physician is being charged of healthcare fraud and abuse by abusing patients and money laundering by the Department of Justice (DOJ) to the tune of $ 240 million. Jorge Zamora-Quesada faces a seven-count Grand Jury indictment alleging he and his co-conspirators “orchestrated a massive fraud scheme that jeopardized […]
AAPC Knowledge Center

Report from the Department of Justice Fraud & Abuse Control for 2017 sheds light upon the importance of compliance

In April, the Government released last year’s accomplishments for their work in Healthcare Fraud and Abuse. In 2017 $ 2.6 billion was returned to the Federal Government or paid to private persons. Specifically; $ 1.4 billion was returned to the Medicare Trust Funds and $ 406.7 million was returned to Medicaid programs. Yes, that means that over $ 1 million dollars was paid to Qui Tam relators or put into resources to continue to fight fraud and abuse.

A staggering 967 investigations were opened in 2017 resulting in criminal charges filed for 439 cases involving 720 defendants. This resulted in 639 convictions which is an impressive 88.7% conviction rate. In addition 818 civil actions were filed.

Another interesting statistic was the high number of healthcare exclusions that were published. There were a total of 1,281 healthcare exclusions. They stated that 309 of those exclusions were related to patient abuse or neglect and 972 were a result of licensure revocations.

The post Report from the Department of Justice Fraud & Abuse Control for 2017 sheds light upon the importance of compliance appeared first on The Coding Network.

The Coding Network

SAMHSA: Patient consent now required for substance abuse records

 Appropriate sharing of records for patients with substance abuse disorders should be easier under a second final rule issued January 3 by HHS and its Substance Abuse and Mental Health Services Administration (SAMHSA). But in some cases, the new rule adds considerations that might mitigate the advantage.

HCPro.com – Briefings on Accreditation and Quality

failure to address substance abuse, leading to fines

Hi
Some of my providers read this article:

http://c-hit.org/2018/03/20/med-boar…haven-doctors/

And they are wondering What is meant when the article states that the "board reprimanded and fined a West Haven doctor $ 1,000 for failing to address a patient’s weight loss and substance abuse in 2016." They are wondering what exactly he “failed to address” or document in his notes that led to this. In particular, "his failure to address substance abuse in 2016”.

How exactly do you address that in your providers’ documentation? For patients with known active history of IV drug/heroin abuse, aside from documenting that the provider encouraged the patient to go to rehab, is there anything else that needs to be done to prevent being hit with a similar fine?

thanks!

Medical Billing and Coding Forum

Anthem Denials for Substance Abuse

Beginning March 1, 2018 our California facility began receiving denials for our institutional claims and are now requesting medical records. We are aware that the codes do change twice a year but this is more than that. We are looking for advice from fellow substance abuse billers. Has anyone else been experiencing this?? I would love to discuss codes being used, states that are experiencing this, and all of the above. :confused:

Medical Billing and Coding Forum

Group- Substance/Alcohol Abuse

I am in Arizona and bill for a counselors office. I am wondering which code to use for a group therapy that is for substance and/or alcohol abuse. It is an intensive outpatient therapy but not all of the patients attending the group sessions meet the HCPCS requirement for the group (H0015; which requires 3hours a day at least 3 times a week). My question is, what would you code these patients? H0004-HQ..But that is for behavioral health (Can we consider substance abuse as behavioral health) or the CPT code 90853 (Group psychotherapy- Again, can we classify substance and/or alcohol abuse into this?). I am feeling very confused and would love input on what you would code for these services! Thank you!

Medical Billing and Coding Forum

Coding E&M for substance abuse Facility

Should a pre-admission assessment (99202-05) for a substance abuse facility be coded solely based on the time spent doing the assessment? Please advise. I am referring to section 4 in the attachment.

Evaluation and Management coding score sheet 2.12.2018.pdf

Medical Billing and Coding Forum