Rybar Group
Slide background
Slide background

Industry News and Updates

Are you ready for ICD-10 Grace Period to end?

When the industry transitioned from ICD-9 to ICD-10 in October 2015 the payers, led by CMS, decided to observe a “grace period.” This grace period essentially lessened some of the burden of coding to the highest level of specificity in ICD-10. The intent of the grace period was to allow providers the time to improve their documentation to support the level of specificity available with ICD-10 codes, and to adjust to the new code set.  The grace period is scheduled to end September 30. 2016.

Effective October 1, 2016 claims will be required to have diagnosis codes with the highest level of specificity, making payer procedure/test requirements enforced more stringently as defined in the respective policies, such as LCD/NCD.

For example, an injection of Hyaluronan aka Hyalgan or Supartz is only covered by WPS Medicare for eight (8) diagnosis codes from the family of M17. There are eleven (11) total codes in this family. From October 1, 2015 thru September 30, 2016, any code from the M17 family would be covered for this drug.  October 1, 2016 and on only the specified codes from this family will be payable.  So, osteoarthritis of knee, unspecified (M17.9) most probably will result in a rejection.

With over 1,900 ICD-10 code changes for 2017, the bar has been raised to capture a clear clinical picture through specified codes.  Is your clinical documentation ready? Whether you are interested in a quick probe review or a highly detailed audit including one-on-one provider education with an auditor, we are here to meet your needs.  Please give us a call or email Laura Lovett, CPC, CPMA, CPC-I, CANPC, CEMC directly at llovett@therybargroup.com.

Beginning January 1st, 2016 RHCs and FQHCs may receive payment for Chronic Care Management Services (CCM) furnished to Medicare beneficiaries having multiple chronic conditions that are expected to last more than 12 months or death of the patient.

The payment rate for CCM services in RHCs and FQHCs will be $40.82, and could be billed in addition to the RHC visit as long as the required 20 minutes of qualified CCM services is met.

Cash and Point-of-Service Collection Risks:
Although more Americans have health insurance coverage, 25% do not have money or liquid assets to cover their deductible, according to an article in U.S. Money on March 3, 2015. Even if your state has expanded Medicaid, according to the IRS regulation for 2016, HDHP individual policies have out-of-pocket maximums as high as $6,550 and family policies as high as $13,100.  HDHP are also required to have deductibles not less than $1,300 for an individual or $2,600 for a family.

Incident to vs. Split/Shared
There tends to be a lot of confusion surrounding services performed by mid-level providers, such as nurse practitioners and physician assistants….Read More



Steve Sprague – CAH Conference – November 2016


Laura Lovett

Contributions by Laura Lovett CPC, CPMA, CEMC.  Laura can be reached directly at llovett@therybargroup.com or 810-853-6173

Mid‐level Provider Services
Coding and billing for mid‐level providers, NP/PAs, can seem like a daunting task. The reality is it is not
difficult if you take time to understand the guidelines and develop practices to utilize these providers
appropriately.  Read More

What it means to be a medical coder…….
You have to stop and think when someone asks you a question like “how old are you?” but can rattle off the codes for things like DM, HTN, COPD, GERD, etc. without batting an eye.
You find humor in the strangest things “this gentleman presents today after having accidentally introduced a foreign body into his left knee”. (FYI, he shot himself with a nail gun) Read More

Industry Trend: Probe Audits and Data Mining

Nobody wants to be audited. Nobody has time to be audited. Unfortunately that is the reality that
healthcare providers face; external audits can be initiated at any time. Read More