Medicare Timed Codes Guidelines

Medicare's guidelines for reporting of timed codes is found in Medicare Claims Processing Manual Chapter 5, Section 20.2. Also known as the '8 minute' rule, it describes how to calculate time for appropriate reporting when more than one timed code is performed at the same time.
It should be noted that while ...

Documentation for Home Health Services (Part A non DRG)

The Medical Learning Network provides coverage guidance, which should be documented, for home health services.

Regarding inadequate physician certification/re-certification

Physicians or Medicare allowed NPPs must certify that:

Telemedicine Billing and Reimbursement

The opportunities for providers who want to provide telemedicine, also known as telehealth, continue to expand in all sectors of the healthcare market. Even the VA, long a symbol of a fossilized, bureaucratic healthcare entity, has begun to embrace this technology. Though most are familiar with what telemedicine is, many still have questions surrounding the billing and reimbursement of these services.

Traumatic Subluxation Coding Controversy

There has been some controversy over the use of the ICD-10-CM subluxation codes commonly referred to as traumatic (S13.1-S23.1-, and S33.1-). Are they appropriate for chiropractors to use? The answer to that question is complicated.

Combined Deskbook Resources

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Provider Documentation Guides (PDGs) Are Excellent Training Tools - Part II

PDGs, when properly used, can be tremendous tools to help providers document key pieces of information pertinent to identifying medical necessity for services ordered, performed, and billed. Using PDGs in provider training sessions can improve documentation habits, making proper code selection easier and medical necessity clear. Schedule and execute a quick, 10-minute provider session in the following manner:


I can count on two consistent issues in coding audits.  Doctors report that their patients are, in general, sicker than patients in other practices.

Medicare Improper Payment Report for Behavioral Health Services

The following information is from the 2014 Medicare Improper Payments Report by the Department of Health and Human Services.

This table shows the Improper Payment Rates by Provider Type and Type of Error for Medicare Part B claims:

    Provider Type

    Improper Payment Rate

Treatment Plan Alert -- Attention Needed


Denials and refund demands due to the failure to have a treatment plan (Care Plan) documented in the chart.

Subjective History

Over the years, Medicare and others have paid claims based on the information that was only on the claim form. Supporting clinical necessity details from the charts were rarely used.

Record Cloning and "Spinners" Attract CMS Gaze"

The Centers for Medicare and Medicaid (CMS) requires that all treatments it pays for be medically necessary. CMS normally reimburses fairly quickly, then audits submitted claims to detect cases where treatment should not have been authorized. Doctors demonstrate the medical necessity of their claims by submitting, when requested, the documentation on cases that the auditors have flagged. If submitted documentation justifies the treatments paid for, the claim will be upheld. If not, then the government asks for its money back, and fines may be imposed.


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