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

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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

Flu Vaccine Codes and Payments Effective Aug. 1

Is your billing office ready for the 2022-2023 influenza season? For the 2022-2023 influenza season, the Centers for Disease Control and Prevention (CDC) recommends everyone 6 months of age and older be vaccinated against the flu “ideally by the end of October.” This advice has not changed from previous years, but the Medicare Part B […]

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AAPC Knowledge Center

MA Plans Wrongly Deny Needed Care, Physician Payments

Medicare Advantage Organization denials raise concerns that private insurers are maximizing profits at the expense of patients. Every year, tens of thousands of people enrolled in private Medicare Advantage (MA) plans are denied necessary care that should be covered under the program, federal investigators concluded in a report published on April 27. The Department of […]

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AAPC Knowledge Center

Relative Value Units: The Basis of Medicare Payments

There’s more than one way to determine your physician’s payment. Medicare fee-for-service payments are calculated based on relative value units (RVUs) assigned to each covered CPT®/HCPCS Level II code. As defined in Medicare’s National Physician Fee Schedule Relative Value File, there are three RVU categories that, when totaled, determine payment. 1. Work RVUs account for […]

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AAPC Knowledge Center

PHE Accelerated and Advance Payments Come Due

If you received government loans during the public health emergency, they may already be due. On March 28, 2020, the Centers for Medicare & Medicaid Services (CMS) expanded the COVID-19 Accelerated and Advance Payments (CAAP) Program to a wider group of Medicare Part A providers and Part B suppliers in response to the shutdown brought […]

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AAPC Knowledge Center

Provider Relief Fund to Dole Out Add-On Payments

Billions more available to beleaguered providers. Add-on payments are available for healthcare providers “on the frontlines” of the coronavirus (COVID-19) pandemic. The Department of Health and Human Services (HHS) announced Oct. 1 an additional $ 20 billion under a Phase 3 General Distribution allocation of the Provider Relief Fund (PRF). Who Qualifies for Add-On Payments? The […]

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AAPC Knowledge Center

Medicare Uncompensated Care Payments

CMS distributes a prospectively determined amount of uncompensated care payments to “Medicare disproportionate share hospitals” based on their relative share of uncompensated care nationally. 

As required under law, this amount is equal to an estimate of 75 percent of what otherwise would have been paid as Medicare disproportionate share hospital payments, adjusted for the change in the rate of uninsured people. 

In this rule, CMS proposes distributing roughly $ 7.8 billion in uncompensated care payments in FY 2021, a decrease of approximately $ 0.5 billion from FY 2020.

For FY 2021, CMS proposes to use a single year of data on uncompensated care costs from Worksheet S-10 of the FY 2017 cost report to distribute these funds, in part because we have conducted audits of this data. Mindful of the unique challenges facing Indian Health Service and Tribal hospitals and Puerto Rico hospitals, 

CMS proposes to continue to use data regarding low-income insured days (Medicaid days for FY 2013 and FY 2018 SSI days) to determine the amount of uncompensated care payments for Puerto Rico hospitals and Indian Health Service and Tribal hospitals for one more year (FY 2021), similar to the FY 2020 methodology.

In addition, CMS is proposing for all eligible hospitals, except Indian Health Service and Tribal hospitals, to use the most recent available single year of audited Worksheet S-10 data to distribute uncompensated care payments for all subsequent fiscal years. 

We expect there to be an increasing number of hospitals audited for Worksheet S-10 with future cost reporting years. 

As a result, we have confidence that the best available data in future years will be the Worksheet S-10 data for cost reporting years for which audits have been conducted.

Source: MCR – Uncompensated Care Payments


Coding Ahead

GAO Scrutinizes Insufficient Documentation as Cause for Improper Medicare and Medicaid Payments

For quite a long time, Medicare and Medicaid have been included on a Government Accountability Office (GAO) rundown of government programs that are at an expanded danger of misrepresentation, waste, misuse, and bungle. GAO’s investigations of FY 2017 program activities that gauges $ 27.5 billion in inappropriate installments implies it will probably make the rundown again in one year from now’s report.

The GAO is an autonomous, neutral organization that works for Congress. Frequently called the “congressional guard dog,” GAO inspects how citizen dollars are spent and furnishes Congress and government organizations with reports to help survey the administrative government’s execution. As indicated by the report, the GAO appraises that Medicare expense for-administration made $ 23.2 billion in inappropriate installments while Medicaid made $ 4.3 billion.

To build up these assessments, CMS utilizes temporary workers to review an example size of cases. The reviews incorporate medicinal documentation audits to approve restorative need and adherence to CMS charging approaches. The contractual workers extrapolate patterns from the examples to extend the by and large ill-advised installment rate.

The report characterizes lacking documentation as “ill-advised installments in which suppliers submit documentation that is inadequate to decide if a case was legitimate, for example, when there is deficient documentation to decide whether administrations were medicinally important, or when a particular, required documentation component, for example, a mark, is absent.”

As per the GAO, inadequate documentation was referred to as the reason for 64 percent of Medicare and 57 percent of Medicaid inappropriate installments. Information from CMS uncovered that the general rate of deficient documentation over all administrations in FY 2017 was 6.1 percent for Medicare versus 1.3 percent in Medicaid. The report concentrated on this difference.

The GAO report likewise incorporates suggestions to CMS for improving the therapeutic audit procedure to all the more likely comprehend the ill-advised installment rate.

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The Coding Network

Focus on Documentation to Improve Proper Payments for Lenses

Insufficient documentation accounted for more than 77 percent of the 85.2 percent improper payment rate for lenses during last year’s reporting period, according to the 2018 Medicare Fee-for-Service (FFS) Supplemental Improper Payment Data. You can help reduce this staggering error rate by being aware of the national and local coverage policies physicians and non-physician practitioners […]

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AAPC Knowledge Center

Most Hospitals Will See Positive Payments in 2019

U.S. hospitals that are putting quality over quantity will fare well next year for their efforts. Out of  approximately 2,800 hospitals across the country, more than 1,550 will see an increase in their 2019 Medicare payments. For the rest? Well, the news isn’t so good. Where Does the Money Come From? The Centers for Medicare […]

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AAPC Knowledge Center