- Helping you with HIPAA Security Solutions.
News
HIPAA
TriZetto Provider Solutions Cybersecurity Breach
TriZetto Provider Solutions is a healthcare IT subsidiary of Cognizant Technology Solutions that provides revenue cycle management and claims processing services to physicians, hospitals, and health systems. Trizetto has experienced a significant data breach of patient information.
Read More
Coding
E/M Coding Office Debate
“A new patient was seen with heel pain. X-rays were taken at an outside facility, and I independently interpreted these and reviewed the labs. Based on medical decision making, I believe I should be coding E/M code 99204. The patient had one new, acute problem (previously undiagnosed) and I independently interpreted tests. To me this is a no brainer, but my office staff argues that they believe it should be E/M code 99203.”
Read More
FDA Recalls
Coding
Wound Care Coding - Debridement in the Postop Period
“The patient initially had a gastroc recession at the right lower extremity. Our surgeon performed a debridement procedure for the right foot ulceration. It was performed in the clinic, and we planned to code it as CPT 11042. However, the patient is in the 90-day post op period from initial surgery that was performed 4 weeks ago. Is a modifier necessary to submit for payment? Is it 79?”
Read More
MIPS
2026 is here – Are you ready for MIPS?
2026 is here – Are you ready for MIPS? This year brings a lot of changes for Podiatry in MIPS including: A Podiatry MIPS Value Pathway.
Read More
Coding
Qlarant Review UPIC Audit
“We received a request for medical records from Qlarant, who apparently is contracted with Medicare to review records for medical (and, of course, payment) necessity. In this case, they’ve asked for chart notes for ten different patients, one date of service for each patient. We’ve never been subjected to this type of review previously and want to do everything possible to make sure that we submit the appropriate and sufficient records and that we submit them in the appropriate manner. Obviously, we’re also concerned that this inquiry is a fishing expedition that could trigger some larger audit. Is there any advice that you can provide that might help us through this process? In our review of the records that were requested we did notice a few minor billing errors, but we believe that the records substantiate payment for all treatment that was performed.”
Read More