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Seth Flam, DO

Lead Blogger: Seth Flam, DO

Dr. Flam is one of the founders of HealthFusion and serves as the company's CEO and President. He is board certified in Family Practice and is one of the creative forces behind MediTouch EHR.

Will the New Chronic Care Management Code Be Covered Under Medicare Advantage?

Chronic Care Management and Medicare Advantage
As the new Chronic Care Management code program is rolled out, providers have raised multiple questions that have yet to be answered about reimbursement for the code. One of the questions that have arisen in our recent webinars on the new program was whether the Chronic Care Management code would be covered under other programs such as Medicare Advantage. Currently, as we understand it, chronic care management is only covered for fee-for-service Medicare patients. This question has apparently been raised in other venues as well. At a recent educational session, CMS representatives […] Continue Reading

How to Prepare for the ICD 10 Deadline Without Blowing Your Budget

Are you getting started with preparation for the transition to ICD-10 coding, and worried about how to make the transition in time for the ICD 10 deadline? Concerned that just the cost of training will blow your budget? If so, good news: There are a lot of free resources available to help you plan and make sure your practice is ICD-10 ready. Here are a few we recommend: 1.  The Centers for Medicare and Medicaid Services (CMS) offers a variety of resources including videos and planning tools for both small and larger […] Continue Reading

January EHR Newsletter: Chronic Care Management, Long-Term Care Software, & More

Don’t miss the latest issue of our monthly newsletter for articles on the new chronic care management code from CMS and how to draft the Patient Agreement required (with sample agreement), free webinars and infographics, and much more. If you don’t receive the newsletter via email, sign up for the monthly emails now. Free Webinar — How to Get Paid for the New Chronic Care Management Code Thursday, January 22, 2015 – 1:00 PM Eastern /10:00 AM Pacific Under a new chronic care management program authorized by CMS, you can bill for care that […] Continue Reading

Free Infographic – How to Get Paid for the New Chronic Care Management Code

Chronic care management coding
Did you know that you can be paid for care you’re probably already providing under CMS’ new chronic care management program starting in 2015? It’s some long-needed good news for primary care practitioners and others who provide chronic care management, but make sure you understand the parameters of the program so that you receive your reimbursement. It’s especially important to explain the chronic care management program to your patients and get a signed agreement that outlines what you will provide. In our new infographic, you can see at a glance what the […] Continue Reading

RACs Collected Nearly $4B in 2013; Will Your Medical Billing Software Help Protect You?

Can you medical billing software protect you from a RAC audit?
The Medicare Recovery Audit Contractor (RAC) program identified $3.75 billion in improper payments in 2013, according to CMS’ annual RAC report to Congress. That represents an increase over 2012, when the RAC program recovered approximately $2.4 billion. That, in turn, was an increase over 2011, when the RAC program recovered less than $1 billion. You can see the trend here—RACs are aggressively looking for monies to recover. The Recovery Audit Contractor (RAC) program was created through the Medicare Modernization Act of 2003 (MMA) to identify and recover improper Medicare payments paid to healthcare providers under fee-for-service (FFS) Medicare plans. For […] Continue Reading

55% of E/M Claims Incorrectly Coded – What’s Your EMR Software Doing to Help?

According to a report issued in May by the Department of Health and Human Services Office of Inspector General (OIG), fifty-five percent of claims for E/M services were incorrectly coded and/or lacking documentation in 2010, resulting in $6.7 billion in improper Medicare payments. The report, entitled Improper Payments for Evaluation and Management Services Cost Medicare Billions in 2010, said that Medicare paid $32.3 billion for E/M services in 2010, representing nearly 30 percent of Part B payments that year. In 2012, the OIG reported that physicians increased their billing of higher level […] Continue Reading

The Medicare Advantage HCC Program: Why and How to Optimize Your Coding

medicare advantage hcc
Medicare Advantage, an alternative to traditional Medicare, covers 13 million beneficiaries, or 27 percent of the people in the federal health-care program for the elderly. It can be a profitable part of your practice income—but do you know how to optimize payment? Coding correctly for Medicare Advantage (MA) patients can mean an increase in payment of 2-3 times the base amount, but it’s time consuming—and very challenging—to learn and understand all the coding requirements. Let’s take a look at what’s involved and what you can do to optimize payment. Many variables influence the rate paid […] Continue Reading

What’s the difference between ICD, CPT, LOINC, and SNOMED CT?

Most of us come in contact with medical coding at some point in our lives – whether it is as physicians, medical billers, or patients. When we do, it can be helpful to know the specific purpose of each different coding system. Let’s take a look at some of the more common medical coding standards: ICD, CPT, LOINC, and SNOMED CT. ICD – International Classification of Disease The International Classification of Disease (ICD) is a widely recognized international system for recording diagnoses. It is developed, monitored, and copyrighted by the World Health […] Continue Reading