State Specific Medical Coding Resources
articles, webinars, tips, links, forms, files and other resources for state specific coding, reimbursement and compliance
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recent articles
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Jan 16th, 2025
Reasons Why Your Attorney Shouldn’t Write a Refund Letter
by David M. Glaser, Esq.
If your lawyer ever writes you a letter/email telling you to refund money, I recommend you get a new lawyer. Now, it is very easy to misconstrue what I just said. I am not suggesting in any shape, way, or form that a lawyer should not recommend that you...
Jan 15th, 2025
New HIPAA Cybersecurity Rules Proposed
by Wyn Staheli, Director of Content - innoviHealth
A Proposed Rule has been issued regarding HIPAA security to strengthen protections for electronic protected health information (ePHI). How will these changes impact your organization?
Nov 6th, 2024
Consumer Health Plan Appeals
As part of the Patient Protection and Affordable Care Act (PPACA) of 2010, expanded appeal rights for patients have been granted in all states. These regulations grant the right to both an internal appeal through the insurance plan, as well as an independent external appeal.
Nov 5th, 2024
Designation of Authorized Representative for Appeals
A Designation of Authorized Representative is a formal document (form) that allows a third party, such as a friend, family member, attorney, or healthcare provider, to act on behalf of the patient/beneficiary in handling specific aspects of an insurance claim or appeal
Oct 31st, 2024
Managed Care Organizations (HMO, PPO, etc.)
Managed care is a type of health insurance system designed to reduce healthcare costs while ensuring high quality care through coordinated, cost-effective, and efficient delivery of services. Learn the characteristics of these types of programs.
Broadly speaking, managed care is a healthcare delivery system designed to control costs, improve quality, and manage how services are provided to enrollees. It integrates healthcare providers, hospitals, and insurers to coordinate patient care in a cost-effective way. Managed care often emphasizes preventive care, streamlined service delivery, and coordinated treatment plans.
Oct 31st, 2024
What Medicaid Information is in Find-A-Code?
Oct 30th, 2024
What are the Different Medicaid Payment Systems?
The Medicaid payment system, which funds healthcare for low-income individuals and families, is complex and varies by state. It generally works through a combination of fee-for-service (FFS) and managed care models, with federal and state governments sharing costs. This article contains information to help explain some of the different ways that Medicaid pays for healthcare services.
The Medicaid Chronic Illness and Disability Payment System (CDPS) is a diagnostic-based risk adjustment model used to calculate payments for Medicaid health plans, particularly for those covering individuals with chronic illnesses and disabilities.
A conversion factor is a dollar amount that is applied to an adjusted Relative Value Unit (RVU) to arrive at a fee. Conversion factors can be based on a geographic location as well as a national level. The article contains information from the Veterans Administration about how they create their geographically-adjusted 80th percentile conversion factors.
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