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

Practice Exam

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Practice Exam

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

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Practice Exam

2016 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

Practice Exam

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

AMGA: 60% of Medicare Rev. Tied to Risk in ’19

Medical groups and health systems that are members of the American Medical Group Association (AMGA) estimate that 60 percent of their Medicare revenues will be risk-based in 2019, pointing to a greater need for risk-assessment coders. Fierce Healthcare reports respondents to the organization’s annual risk survey said they expect revenues from Medicare Advantage to equal […]
AAPC Knowledge Center

Incident to Medicare Part C and TriCare

Does anyone know how to obtain documentation to show Medicare Part C does NOT apply incident to guidelines? It shows Part B follows incident to, but could not find anything about Part C. Also if anyone has clarity if TriCare follows incident to or not. I could not find documentation for TriCare that says yes or no to follow incident to guidelines. Thank you for any help!

Medical Billing and Coding Forum

Aenta Medicare Reimbursement for Physical Therapy Code

Is anyone having any issues with Aetna Medicare reimbursing for G0283. We keep getting denials and they are stating that it is due to the LCD 35222 stating that the DX is not covered and we have used several DX that should be covered. When we look up LCD 35222 it doesn’t give us much information.

Medical Billing and Coding Forum

Trauma pain epidurals with medicare

We have some anesthesiologists that due pain blocks/epidurals for acute pain due to trauma. These patients are not having surgery, so post op pain is out the door. When Medicare updated their LCD with the new epidural codes they did not include an "acute pain due to trauma code" that was previously listed. They updated 10/1/17 to include this but any epidurals done for trauma pain over the last year and being denied for medical necessity. Has anyone else encountered this issue? If so, were you able to appeal and get reprocessed? Thank you!

Medical Billing and Coding Forum


90785 Psytx complex interactive
90791 Psych diagnostic evaluation
90792 Psych diag eval w/med srvcs
90832 Psytx pt&/family 30 minutes
90833 Psytx pt&/fam w/e&m 30 min
90834 Psytx pt&/family 45 minutes
90836 Psytx pt&/fam w/e&m 45 min
90837 Psytx pt&/family 60 minutes
90838 Psytx pt&/fam w/e&m 60 min
90839 Psytx crisis initial 60 min
90840 Psytx crisis ea addl 30 min
90845 Psychoanalysis
90846 Family psytx w/o patient
90847 Family psytx w/patient
90951 Esrd serv 4 visits p mo <2yr
90952 Esrd serv 2-3 vsts p mo <2yr
90954 Esrd serv 4 vsts p mo 2-11
90955 Esrd srv 2-3 vsts p mo 2-11
90957 Esrd srv 4 vsts p mo 12-19
90958 Esrd srv 2-3 vsts p mo 12-19
90960 Esrd srv 4 visits p mo 20+
90961 Esrd srv 2-3 vsts p mo 20+
90963 Esrd home pt serv p mo <2yrs
90964 Esrd home pt serv p mo 2-11
90965 Esrd home pt serv p mo 12-19
90966 Esrd home pt serv p mo 20+
90967 Esrd home pt serv p day <2
90968 Esrd home pt serv p day 2-11
90969 Esrd home pt serv p day 12-19
90970 Esrd home pt serv p day 20+
96116 Neurobehavioral status exam
96150 Assess hlth/behave init
96151 Assess hlth/behave subseq
96152 Intervene hlth/behave indiv
96153 Intervene hlth/behave group
96154 Interv hlth/behav fam w/pt
96160 Pt-focused hlth risk assmt
96161 Caregiver health risk assmt
97802 Medical nutrition indiv in
97803 Med nutrition indiv subseq
97804 Medical nutrition group
99201 Office/outpatient visit new
99202 Office/outpatient visit new
99203 Office/outpatient visit new
99204 Office/outpatient visit new
99205 Office/outpatient visit new
99211 Office/outpatient visit est
99212 Office/outpatient visit est
99213 Office/outpatient visit est
99214 Office/outpatient visit est
99215 Office/outpatient visit est
99231 Subsequent hospital care
99232 Subsequent hospital care
99233 Subsequent hospital care
99307 Nursing fac care subseq
99308 Nursing fac care subseq
99309 Nursing fac care subseq
99310 Nursing fac care subseq
99354 Prolonged service office
99355 Prolonged service office
99356 Prolonged service inpatient
99357 Prolonged service inpatient
99406 Behav chng smoking 3-10 min
99407 Behav chng smoking > 10 min
99495 Trans care mgmt 14 day disch
99496 Trans care mgmt 7 day disch
99497 Advncd care plan 30 min
99498 Advncd are plan addl 30 min
G0108 Diab manage trn  per indiv
G0109 Diab manage trn ind/group
G0270 Mnt subs tx for change dx
G0296 Visit to determ ldct elig
G0396 Alcohol/subs interv 15-30mn
G0397 Alcohol/subs interv >30 min
G0406 Inpt/tele follow up 15
G0407 Inpt/tele follow up 25
G0408 Inpt/tele follow up 35
G0420 Ed svc ckd ind per session
G0421 Ed svc ckd grp per session
G0425 Inpt/ed teleconsult30
G0426 Inpt/ed teleconsult50
G0427 Inpt/ed teleconsult70
G0436 Tobacco-use counsel 3-10 min
G0437 Tobacco-use counsel>10min
G0438 “Ppps, initial visit”
G0439 “Ppps, subseq visit”
G0442 Annual alcohol screen 15 min
G0443 Brief alcohol misuse counsel
G0444 Depression screen annual
G0445 High inten beh couns std 30m
G0446 Intens behave ther cardio dx
G0447 Behavior counsel obesity 15m
G0459 Telehealth inpt pharm mgmt
G0506 Comp asses care plan ccm svc
G0508 Crit care telehea consult 60
G0509 Crit care telehea consult 50

Coding Ahead

Medicare Pays for Prolonged Preventive Services

Effective for claims with dates of service on or after January 1, 2018, prolonged preventive services will be payable by Medicare when billed as an add-on to an applicable preventive service that is payable from the Medicare Physician Fee Schedule, and both deductible and coinsurance do not apply. HCPCS Codes G0513 and G0514 for prolonged preventive services will be added as part of January1, 2018, HCPCS update and the coinsurance and deductible will be waived. 

Coding Ahead

Billing extended EEG read to Medicare

I am need of assistance as to how to bill extended EEG’s to Medicare. We are running into an MUE issue when billing EEG’s that are lasting more than 24 hours. I am wondering how others do this? Since Medicare guidelines state you have to bill by read date I am wondering if (depending on the length of the eeg) you would bill example 95951,26 and then 95951,26,59? or 95951,26 and 95951,26,76?

Medical Billing and Coding Forum

Accepting payments from Medicare patients

We are a billing company and collect payments on behalf of our clients for the patient responsibility portion of the Medicare claim. The payment is processed through our bank as an aggregate. The question was asked if this is proper to accept these payments in our account on behalf of the client for Medicare patients? I cannot find anything that says that this cannot be done but I am looking for any feedback.

The money is allocated back to the clients at invoicing, every 30 days.

Medical Billing and Coding Forum

Medicare Payments Higher at HOPDs than ASCs, Doc Offices

Health Leaders Media

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Medicare Payments Higher at HOPDs than ASCs, Doc Offices

Rene Letourneau, Senior Editor for HealthLeaders Media

Cardiac imaging payments are more than triple when a patient receives care at a hospital outpatient department instead of a physician office, roughly $ 2,100 versus $ 655, respectively, research shows, but quality was not studied. >>>


Editor’s Picks

8 Things Providers Don’t Know About Debt Collection and Cell Phones

Now that the FCC has clarified rules for contacting patients about payments, hospitals and health systems are risking multi-million dollar settlements by failing to take the law seriously. >>>

Two-Midnight Rule War’s Payment Cut Battle May be its Last

CMS says a 0.2% Medicare payment cut for hospitals is needed to offset the estimated costs of implementing the two-midnight rule. Hospitals contend it is "an arbitrary standard." But an analysis of the financial impact of the rule will likely take years and another round in federal court. >>>

Medicare Sparks Site-Neutral Payment Showdown

There is likely no clear winner in the fight between hospital and physician groups who are weighing in on Medicare’s new site-neutral payment policy that goes into effect next year. >>>

The Side Effects of a Better-Informed Patient

While shared decision-making for elective procedures could negatively affect volumes, leaders need to consider that, like value-based reimbursement, it’s coming. So is it better to get ahead? >>>

Changing Patient Behavior Through Technology

Software and hardware developments are opening new ways to get patients more involved in their own care. >>>

Addressing People, Practice, and Profession

At the first HealthLeaders Media CNO Exchange, healthcare executives focused on solutions and innovations to address changes in the industry and the nursing profession. >>>

Sepsis, Septic Shock Redefined in Consensus Statement

Several studies have made it clear that requiring two or more systemic inflammatory response syndrome criteria to define sepsis does not identify the sickest patients with a greater risk for death, one researcher noted. From Medpage Today. >>>

News Headlines

Humana stock rises on proposed hikes in Medicare reimbursements

Louisville Business First, February 24, 2016

HHS failed to heed many warnings that was in trouble

The Washington Post, February 24, 2016

Christians find their own way to replace Obamacare

U.S. News & World Report, February 24, 2016

FDA reform, privacy law standards needed in next healthcare overhaul, group says

Healthcare IT News, February 23, 2016

UPMC says insurer should cover its tentative $ 12.5M settlement in antitrust case

Pittsburgh Business Times, February 23, 2016

CA Legislature to advance health-plan tax

The News & Observer / Associated Press, February 23, 2016

Health startup Oscar shifts course in million-customer plan

Bloomberg, February 22, 2016

Blue Cross complaints top 1,400 as software problems continue

News & Observer, February 22, 2016

Why a CA hospital paid a $ 17,000 ransom in bitcoin

The Christian Science Monitor, February 19, 2016

IBM buys Truven, adding to growing trove of patient data at Watson Health

The New York Times, February 19, 2016

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Webcast: The Evolution and Obstacles of Telemedicine

Date: March 23, 2016, 1:00–2:00 p.m. ET
In this expert webcast, join leaders from Banner Health as they discuss best practices for operating a large telemedicine organization and current telehealth challenges.
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From HealthLeaders Magazine

Changing Patient Behavior Through Technology

Software and hardware developments are opening new ways to get patients more involved in their own care. >>>


Cancer: Aligning Costs and Care


The Healthcare Partnership Midrange

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