Category: Blog

Key Components of Payer Contracts

Key Terms, Components of Payer Contracts Providers Should Know

Understanding the terms and provisions in a payer contract is key to maximizing reimbursement, preventing denials, and operating a smooth revenue cycle. Providers are in the business of keeping their patients healthy. But confusing payer contracts riddled with “legalese” and other complicated provisions can get in the way of improving patient outcomes. Payer contracts define […]
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Medicare to Cover Glucose Monitoring on Smartphones

Medicare to Cover Glucose Monitoring on Smartphones

The Centers for Medicare & Medicaid Services (CMS) is modifying its Medicare coverage policy for continuous glucose monitors (CGMs) to support their use in conjunction with smartphones, including the data sharing function CGMs provide. Medicare coverage of therapeutic CGMs began in January 2017, but the policy limited their use in conjunction with smartphones. CMS is […]
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Reimbursement for Hospital

CMS Policy To Reduce Hospital-Acquired Infections Has Minimal Impact On Reimbursement

A decade ago, CMS enacted Hospital Inpatient Prospective Payment System (IPPS), a policy that penalizes hospitals for hospital-associated conditions (HAC) not present during admission. Recent research published in Infection Control & Hospital Epidemiology has shown the program has had minimal impact on hospital reimbursement. The researchers also found associated billing codes were “rarely used” by […]
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ICD-11 Codes

News Alert: ICD-11 Codes Released by WHO

A major shift in the reporting of transgender issues is at hand. They’re here, but it won’t be until sometime until after 2022 that the United States is expected to adopt the codes of ICD-11 – the new International Classification of Diseases, Version 11 – released by the World Health Organization (WHO) in Geneva. According […]
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CPT Modifiers 52 and 53 vs. 73 and 74

CPT Modifiers 52 and 53 vs. 73 and 74

Modifier 74 description: Modifier 74 is used in the medical billing and coding field to indicate that a surgical procedure performed in an outpatient setting was terminated due to extenuating circumstances. When this modifier is applied to a billing code, it signifies that the procedure was initiated but discontinued before completion due to reasons beyond […]
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Fight Back Against Denied Insurance Claims

Fight Back Against Denied Insurance Claims: 5 Steps

Appealing a denied insurance claim can be frustrating, but don’t give up! By following these steps and understanding the process, you can increase your chances of getting the coverage you deserve. Here’s a detailed guide: 1. Understand Why Your Claim Was Denied (and Know Your Rights) Review the Denial Letter Carefully: This document should clearly […]
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July Brings Several Physician Service Code Updates

July Brings Several Physician Service Code Updates

Here’s a summary of the changes for the July update to the 2018 Medicare Physician Fee Schedule Database (MPFSDB). Changes are effective for dates of service on and after July 1, 2018. Indicator Change for RHC and FQHC Care Management Codes. For the following two HCPCS Level II codes, the PC/TC indicator is changed to […]
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