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The Enlighten Newsletter: Medicare Guidance Edition

We hope everyone is having a great summer! This month, we bring to you the new and improved edition of the Advize Health Newsletter. 

As a leader in the coding industry, Advize Health is continually curating the latest and greatest news and trends in the industry. We strive to provide essential information for coders and medical professionals. Our monthly email reflects this goal by bringing you the highlights, in a simple and easy-to-read package.

Scroll down to check out our newsletter and upcoming events.After you finish the reading, be sure to take our quiz to earn 1 free CEU!

To learn more about our medical record review services, please feel free to email practice leader Jeanmarie Loria at - and be sure to follow Advize Health on Twitter and LinkedIn for updates!
Countdown to ICD-10! 

ICD-10 is quickly approaching...October 1st is less than 30 days! Be sure to check out Advize Health's ICD-10 refresher courses below. 

About Advize Health's ICD-10 Training

Advize Health's ICD-10 training is available to all medical and coding professionals, and is an integral component of any ICD-10 readiness campaign.  Read more below in Upcoming Events. 

Medicare Guidance for Mid-Level Providers 

More and more health organizations are hiring midlevel providers to perform services that were formerly thought to be appropriate exclusively for medical physicians.  While it is less costly to hire Physician Assistants, Nurse Practitioners  and Certified Nurse Midwives, it’s imperative that institutions familiarize themselves with the rules regarding billing for these midlevel professionals.  Not only must we follow rules to meet compliance, it’s also important that we understand maximum allowable reimbursement rates for midlevel providers in order to responsibly plan for the financial health of the group.  While Medicare sets the national standards for professional fee-for-service reimbursement, private payers are permitted to set their own fees.  Additionally, most insurance carriers do not recognize Medicare’s “Incident-To” billing option.  Medicare routinely updates their policies, guidelines, and provider fee schedules on a quarterly basis.  This information is accessible from their website  However, private payers may not publicly post their rules.   We recommend that you contact specific carriers to inquire about their reimbursement policies and fees. 
Advize Health is pleased to highlight and summarize Medicare’s rules for your convenience.
Continue Reading

Chiropractic Coding

Many years ago when I first began my career in the health field I worked for a chiropractic office as I was becoming familiar with their computer system, codes, and billing forms I had a lot of questions!  Over 15 years, work on a bachelors degree and multiple coding and billing certifications later, I realize that even seasoned providers and billers alike have much to question in the area of coding and documenting chiropractic services.


Vaccine Administration Counseling 

Vaccine administration coding and documentation is often confused by many providers, billers, coders, and even auditors.  One misunderstanding is what exactly is a toxoid component? And what documentation is necessary to support billing vaccine administration with counseling?  Here’s a quick look at the codes we are talking about.


The Benefits of DRG Validation

DRG validation is a tool that can be used to reduce risk, defend claims, and ensure the accuracy of the coded items.  The purpose of DRG validation is to confirm that diagnostic, procedural information, and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician's description and the information contained in the beneficiary's medical record.


Digestion of Digestive Codes

The digestive system is made up of the gastrointestinal tract.  Digestion begins in the mouth with chewing the food, and ends in the small intestine. Its unique function is to breakdown and process the food we eat, while removing unused products for waste disposal. The body then absorbs these smaller particles through the walls of the small intestine into the bloodstream, which delivers them to the rest of the body in the form of nutrients and energy.


Compliance Corner

Define the principle of “minimum necessary”.

Answer: a covered entity must make reasonable efforts to use, disclose and request only the minimum amount of... 



You be the Coder

What would the correct CPT code assignment be for this scenario?

A male patient, 54 years of age, comes in on May 3, 2014 for a scheduled transurethral resection of the prostate (TURP). The patient had an initial TURP back in August 2012 but is still experiencing difficulty voiding.


Upcoming Events

To reserve your spot contact or 813.569.2352.

Additional Important Dates:


ICD-10 2-Day Course - 
September 29-30, December 5-6

ICD-10 1 Day Refresher Workshop - 
October 9

Medical Coding Certification Prep Course - Non Nurse
September 12, September 19, September 26
October 10, October 17, October 24

Medical Coding Certification Prep Course - Nurse
September 19September 26 
October 10October 17, October 24

About Advize Health's ICD-10 Training

Attendees will also have one week to complete a series of self-directed virtual trainings. Together, the in-person and virtual trainings cover every chapter of the ICD-10 manual.  All attendees will be provided with valuable take-home materials and will leave with the skills needed to prepare for a successful ICD-10 implementation. Attendees who complete all these will earn 24 CEUs. 

Fraud Waste and Abuse Fact

DOJ and HHS Annual Report Highlights $3.3 Billion in Settlements and Judgments in FY 2014. 

“On March 19, 2015, the Department of Justice (DOJ) and Department of Health and Human Services (HHS) issued their annual Health Care Fraud and Abuse Control (HCFAC) Program report highlighting that the HCFAC Program obtained $3.3 billion in health care fraud judgments and settlements in FY 2014.

Of this amount, the Medicare Trust Fund received $1.9 million and private relators received $369 million. The report also noted that more than $27.8 billion has been returned to the Medicare Trust Fund since the 1997 implementation of the HCFAC Program – a joint DOJ/HHS effort to combat health care fraud.” 


About Advize Health

Advize Health LLC is a medical record review and advisory company headquartered in Tampa, Florida and has employees all over the United States. You might remember our cost-effective and efficient medical record review services as those of Sunera Healthcare, however, due to rapid growth and success, we have re-branded and re-defined our company to create Advize Health, moving full steam ahead in 2015. Our Audit practice produces complete and accurate medical record reviews that fully explain how the codes were determined, down to the actual elements within the medical record. Our highly skilled and experienced team of experts performs the reviews in order to identify inconsistent documentation between clinical records and claim payment. As added benefit to becoming Advize Health, we now offer staff augmentation, education for both payers and providers through our Advisory practice. Visit our website here >>

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newsletter test!

Thank you for reading this issue of the The Enlighten Newsletter. Please click the link next to this Newsletter to take the online free test, worth 1 AAPC CEU. A score of 70% or higher is required. CEU opportunity will be available for up to one year from the date of this newsletter. Your CEU certificate will be emailed to you following your successful completion.
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