Medical Practice

Medical Practice

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:

CPT/HCPCS selection

Documentation of services including modifiers

ICD-10-CM

National Correct Coding Edits (NCCI)

Medicare Physician Fee Schedule Database (MPFSDB)

Medicare Patients over Paperwork

Medicare Beneficiary Identifiers (MBIs)

Medicare Telehealth

Medicaid Telehealth

Medicare Advisory Group

Medicaid Advisory Council and Committees

 

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 AnthemAetna Better HealthHumana CareSourceWellCare 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.

Medicare and Medicaid Compliance Plans

Medicare and Medicaid Healthcare fraud and Abuse