Understanding and Navigating Medicare MUE, PTP Edits
The Medicare National Correct Coding Initiative (NCCI) (also known as CCI) was installed to promote national correct coding methodologies and to control improper coding leading to payment. NCCI Procedure-to-Procedure (PTP) code pair edits are automated prepayment...
Pitfalls to Avoid When Using Diagnosis Z-Codes
By: Tami Shaw, Client Manager, Lighthouse RCM Solutions Lighthouse billing and coding specialists have recently observed a rising trend of claim denials for laboratory services involving the Z00.00 diagnosis code. This code, which is used for general adult medical...
Key Billing Considerations for Toxicology Labs: Documentation and Medical Necessity
By: Liset Sanchez, Client Manager, Lighthouse RCM Solutions A recent publication from Palmetto GBA highlights the fact that laboratory services are among the top service types found to make the highest number of billing errors. They categorize those billing errors...
New Novitas Process Set to Impact Pathology and Laboratory Claims
By: Billie Mildenberger, Director of Audit Services Note: Novitas announced this change will not take effect until Sept. 19, 2024. Starting Aug. 18th, 2024, Novitas will implement a process impacting newly effective molecular pathology and Proprietary Lab Analysis...