Upcoding HCCs–Diabetes

Upcoding HCCs–Diabetes

What is an HCC? An HCC is a Hierarchical Condition Category which is used to calculate risk scores that may predict the future cost of healthcare for enrollees. HCCs were implemented by the Centers for Medicare and Medicaid (CMS) and have been adopted by Medicare...
Oh, Oh….Ozempic

Oh, Oh….Ozempic

Ever have a commercial jingle stuck in your ahead? If you haven’t heard the Ozempic jingle feel free to listen here. Manufactured by Novo Nordisk, Ozempic is prescribed to patients to treat Type 2 diabetes and to reduce the risk of adverse cardiovascular events. Novo...
Coding Crisis Psychotherapy

Coding Crisis Psychotherapy

What is Crisis Psychotherapy? Crisis Psychotherapy is a session that occurs between the provider and the patient due to a life-threatening or highly complex issue that requires immediate attention.[1] According to the coding guidelines, “Psychotherapy for crisis is an...
Hospital Observation Codes in 2023 – Gone!

Hospital Observation Codes in 2023 – Gone!

Prior to the 2023 Current Procedural Terminology (CPT) code set, there were several codes specifically used for hospital observation services[1]: CPT 99217 (Observation discharge) 99218-99220 (initial observation care) 99224-99226 (subsequent observation care) All of...
The Value of Prepayment Software and Claims Reviews

The Value of Prepayment Software and Claims Reviews

First, let’s introduce you to Healthcare Fraud Shield’s new Director of Prepayment Review, Alexandria Denton. Alex’s work has spanned across industries in healthcare, hospitality, and holistic well-being. The trajectory of humanity and addressing social needs have...