Documentation, Billing & Coding Archives | Page 2 of 7

A Review of Medicare Part B Therapy Maintenance Programs and the Use of the KX Modifier

UncategorizedBy Cassie Friedenberger July 23, 2025

As the months of 2025 pass, the importance of thorough documentation and adherence to regulatory standards has never been greater, particularly for those providing services under Medicare Part B. Recently, there has been an increasing focus on therapy services, especially regarding the application of the KX modifier and the implementation of maintenance therapy programs. These components are vital in ensuring that patients receive the skilled care they need, even when that care extends beyond the…

Ensuring Medically Necessary Physician or QHP Visits in Nursing Homes

UncategorizedBy Kelly Simonelli July 2, 2025

In nursing home settings, ensuring medically necessary visits by physicians or Qualified Healthcare Professionals (QHPs) is critical for providing high-quality care and maintaining compliance with Medicare guidelines. This whitepaper outlines the definition of medical necessity, Medicare’s guidance on billing and documentation, and key considerations for determining the necessity of patient visits. Definition of Medical Necessity Medicare defines medical necessity as: “Services or items reasonable and necessary for the diagnosis or treatment of illness or injury…

Updates on MDS Diagnoses as of October 1, 2024: Important Information, Including Details on Sepsis

UncategorizedBy Cassie Friedenberger June 10, 2025

Starting October 1, 2024, the Centers for Medicare & Medicaid Services (CMS) implemented updates to the Minimum Data Set (MDS) that directly affect how diagnoses are captured and coded in Section I, Active Diagnoses. These updates matter because they impact reimbursement, care planning, and regulatory compliance. If you have not revisited your diagnosis coding process recently, now is the time. Who is Qualified to Diagnose, and Where to Find these Diagnoses? Understanding who can diagnose…