All posts by Martha Summerlin

Medical Necessity

Medical Necessity and Your Practice: It’s More Than Just ‘Doctor’s Orders’

Here’s how to help physicians document appropriately (hint: no cloned notes!)

A quick Google search for the term “medical necessity” doesn’t turn up anything you don’t already know. In fact, most sites give some version of this definition: “health care services that a physician, exercising prudent clinical judgment, would provide to a patient.” The definition’s vagueness More..

Radiation Exposure

Weigh the Risks & Benefits: FDA & CMS Look to Your Hospital to Manage Radiation Dosages

Patient Care Means Responsible Use of Available Imaging Techniques, Feds Warn

When your entire way of doing something changes, adjusting takes time – especially when that “something” is 41 pages of detailed changes to the already unwieldy hospital Conditions of Participation (CoPs). These extra changes to radiology and nuclear medicine have many hospitals confused, particularly when More..

NPP Billing

NPP Billing: Know When to Use Incident-To Vs. Split/Shared Billing

Optimize your reimbursement and save yourself headaches

It’s no secret that more and more practices are using skilled non-physician practitioners (NPPs) to provide efficient and patient-centered care – and why shouldn’t they? A 2014 Medical Group Management Association (MGMA) analysis reports that 68 percent of highly functioning practices employed NPPs. And with More..

CMS Nursing Home Residents

Beyond Bingo & Board Games: Tailor Nursing Home Activities to Meet Residents’ Real Needs

To comply with CMS, you’ll have to avoid the 3 plagues: loneliness, helplessness & bordeom

“It’s not the years in your life that count, but the life in your years,” goes the saying, one that could very well be the motto for the Centers for Medicare & Medicaid Services (CMS) in their new survey process instituted last November. Using “f-tags” More..

Inpatient and Observation Coding

Coding for Inpatient or Observation Status: More Than Just the Two-Midnight Rule

Hint: Look at physician’s order, not services provided

Incorrectly coding a patient’s hospital status could cost your physicians significantly, even years down the road. The Centers for Medicare & Medicaid Services (CMS) has been aggressively reviewing inpatient and observation claims to reduce the amount of improper payments. When you’re under such scrutiny, thorough More..

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