Billing & Coding

CMS has noted that several high volume procedure codes are typically reported with a modifier that unbundles payment for visits from the procedure, even though the modifier should only be used for reporting services beyond those usually provided. Therefore, CMS believes the services may be misvalued. As a result, CMS is proposing to prioritize 83 services for review as potentially misvalued. Fact sheet

The final version of the 2017 ICD-10- PCS codes has been released by the Center for Medicare and Medicaid Services. Beginning on October 1, 2016, the first day of the federal fiscal year, the use of these codes will become mandatory for hospital inpatient services.

CNN reported an astounding number of individuals charged with false billing. There was about $900 million in false billing that involved Medicare and Medicaid fraud. Along with the $900 in false billing, $36 million in Detroit involved a front for a narcotics diversion scheme. There were 301 defendants charged in the United States involving 61 medical professionals’ 36 Federal Judicial districts and 28 doctors were charged.

To help the understanding of what is covered under Dental and what may be covered under Medical, review Regence's coverage criteria:  

Coverage under medical or dental benefits is determined by the condition that is being diagnosed and treated, regardless of whether the service is provided by a dentist or a medical doctor.


Note: Member contracts for covered services vary. Member contract language takes precedent over medical policy.

I. Dental Services

NAMAS Weekly Auditing and Compliance Tips


Combined Deskbook Resources

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What is an Other Qualified Healthcare Professional?

To begin to answer this question, let's review the exact wording in the CPT codebook:

Our interactive course lets all participants have fun while learning. We teach to all

learning styles through games, computer teaching, lecture and interactivity. All

participants will understand how and why medical billing can be a profit center in

the dental practice.

After a very successful first course in Las Vegas, Laurie Owens will be teaching with Christine Taxin. As a

former student who has done an outstanding job working with a large Implant &

Periodontal Associates in Seattle Washington. She has contributed to the growth

The AMBA is the largest association in the nation that provides education, resources and credentials for independent, third party medical billers and doctor's office billers. The AMBA provides their services to medical billers that work from their home, office, or in physician offices. Billers can become certified through the AMBA by passing the Certified Medical Reimbursement Specialist (CMRS) exam which is the highest standard certification for medical billers, period.


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