Billing and Coding
Proper coding of services is critical to ensuring prompt and accurate payment for medical care.
KMA staff includes an expert coder, compliance officer and reimbursement specialist that can provide personalized assistance with:
Documentation of services including modifiers
National Correct Coding Edits (NCCI)
Medicare Physician Fee Schedule Database (MPFSDB)
Medicare Patients over Paperwork
Medicare Beneficiary Identifiers (MBIs)
Insurance and Payment Models
The Kentucky Department of Insurance regulates Kentucky’s insurance market.
The Centers for Medicare and Medicaid Services and contracts with CGS to serve Kentuckians covered by Medicare. The Kentucky Department for Medicaid Services contracts with five managed care organizations to coordinate health care for most Medicaid members across the state. The MCOs in Kentucky are Anthem, Aetna Better Health, Humana Kentucky Medicaid, WellCare of Kentucky and Passport Health Plan.
Payment models for health care coverage are changing rapidly. Medicare and other insurers are moving to pay-for-performance in addition to the traditional fee-for-service.
Compliance
KMA can help provide development of a compliance plan and answer a variety of audit, coding and documentation questions that can assist in the audit appeal.
Lindy Lady, KMA’s Manager of Medical Business Advocacy, is a Certified Professional Compliance Officer with more than 35 years of Medicare operations experience. She can provide assistance with the development of a compliance plan and answer a variety of audit, coding and documentation questions.
