News and Intelligence

December 30, 2019

Practicefirst would like to notify our clients of important changes as outlined by CMS for CY 2020 regarding Medical Record Documentation.

As per CMS MLN Matters MM11560:

Medical Record Documentation:

CMS is finalizing, for CY 2020, a proposal to reduce burden by implementing a broadened general principle beyond teaching physicians that will allow:

  1. All physicians,

  2. Physician Assistants (PA’s),


April 12, 2019

With an understanding of the definition of critical care from Part 1 of this series, What Constitutes Critical Care?below are essential documentation and coding guidelines for Emergency Management physicians to ensure they receive the reimbursement they deserve.

Critical care is a time-based service and must be documented as the time the provider spent evaluating, providing care and managing the...

April 12, 2019

Emergency medicine physicians are trained to assess patients and make split-second, life-saving decisions, but documenting and coding those encounters can be complex, tedious and time-consuming. Because the relative value units (RVUs) for critical care services are high, the financial implications for physicians and their employers are significant. High RVUs also attract increased scrutiny from pa...

February 1, 2019

When aspiring medical professionals dream of their future careers, it’s unlikely that they consider the critical role that documentation plays in the healthcare process. Once in practice, providers quickly realize that documentation has a direct impact on their financial success. In addition to the complexity of documentation rules and requirements, the advent of electronic medical records (EMRs)...

January 31, 2018

No one likes paying for an oil change or tire rotation every few months. And no one likes chart audits. But just like the return on investment for your vehicle, consistent attention and oversight of medical coding is critical to the bottom line for anesthesia practices. Below are the top five reasons why your anesthesia practice should invest in professional, external audits of your charts:

#1. You...

July 3, 2017


MVP Health Care has created reference guidelines that may provide you and your staff with helpful tools that explain HEDIS measures as well as providing the CPT, HCPCS and ICD-10 codes that count towards the completion of these measures.

You will find these coding reference guides by going to, selecting the Provider drop-down, and then selecting the Qua...

June 6, 2017

In June, the OIG reported that Medicare has paid millions of dollars in Electronic Health Record (EHR) Incentive Payments that did not comply with Federal Requirements.

As an incentive for using certified EHR technology, the Federal Government makes payments to Eligible Professionals (EP’s) that attest to “meaningful use” of EHR’s, by self-reporting data to the Centers for Medicare and Medicaid Ser...

May 1, 2017


Excellus has as a new online pre-authorization tool called Clear Coverage. Clear Coverage includes an interactive question-and-answer medical review, based on Excellus BC/BS specific or InterQual evidence based criteria. This tool provides an instant decision regarding approval or pends for medical necessity review. Contact your Provider Relations Representative to set up t...

March 31, 2017

The Centers for Medicare and Medicaid Services (CMS) has recently reminded providers regarding their MLN publication pertaining to HIPAA Basics for Providers: Privacy, Security and Breach Notification Rules.

PF will be utilizing this document as part of our ongoing employee training regarding HIPAA.

Click here to download a copy of this publication.

February 1, 2017

Effective February 1, 2017 coders will begin using the following:

  • For new patients, 8 organ systems is still a comprehensive exam.

  • Established patients: This will be very important on your established level 4’s (Office/ED settings) and subsequent level 3’s (Inpatient/OBS setting).

    • Instead of needing 2-7 body areas/organ systems, you will now need to document 6-7 BODY AREAS/OR...

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