Category: Blog

HCPCS codes G9037 and G9038

New MCP Model HCPCS Codes G9037 & G9038

Clinicians participating in the Making Care Primary (MCP) model now have access to two new HCPCS Level II codes, HCPCS Codes G9037 and G9038, introduced in fiscal year (FY) 2024. These codes expand the scope of interprofessional consultation services, allowing primary care providers (PCPs) to bill for time spent collaborating with specialists. The MCP Model: […]
Learn More
medical necessity documentation

Medical Necessity Documentation: A Guide to Reducing Claim Denials

Claim denials are a significant headache for healthcare providers, impacting revenue and administrative efficiency. While denials can stem from various issues, a large majority are rooted in documentation errors, particularly those related to demonstrating medical necessity. Defining Medical Necessity: The American Medical Association (AMA) defines medical necessity as healthcare services or products provided to a […]
Learn More
Clinical validation Queries

Enhancing Clinical Validation Queries to Address Rising Denials

The volume of clinical validation denials is increasing, yet clinical validation queries have not kept pace. One key reason for this discrepancy is the complexity involved in constructing clinical validation queries, which require precise and thorough documentation to ensure accurate coding and reimbursement The Unique Challenges of Clinical Validation Queries Unlike traditional queries that request […]
Learn More
AI in Medical Coding

AI in Medical Coding: A New Era of Accuracy and Efficiency

Medical coding is the lifeblood of healthcare operations. It forms the crucial bridge between patient care and financial reimbursement, ensuring that healthcare providers are compensated for the services they render. However, the complexity and sheer volume of medical codes, coupled with the ever-evolving regulatory landscape, make accuracy a persistent challenge. This is where the potential […]
Learn More
AI in Radiology

AI in Radiology: Navigating the Reimbursement Landscape

AI in Radiology is rapidly transforming the field, with new AI tools and algorithms continuously being developed and integrated into clinical practice. However, while AI’s role in medical imaging is expanding, a critical issue remains unresolved—reimbursement. The Reimbursement Challenge Despite the increasing adoption of AI in Radiology, experts highlight a significant gap: the absence of […]
Learn More
Medicare Overpayment Rule

Navigating the 2025 Medicare Overpayment Rule Changes

The Centers for Medicare & Medicaid Services (CMS) has finalized a rule significantly changing how healthcare providers must handle Medicare overpayments. The new Medicare Overpayment Rule, effective January 1, 2025, is part of the 2025 Physician Fee Schedule Final Rule and impacts Medicare Parts A/B (Traditional Medicare) and C/D (Medicare Advantage and Prescription Drug Plans). […]
Learn More
RCM automation

Maximizing A/R Efficiency with RCM Automation

A well-managed A/R process ensures timely cash flow, reduces administrative burdens, and maintains the stability of a healthcare practice. However, many healthcare practices still struggle with outdated, manual A/R management processes that can lead to inefficiencies, errors, and delayed payments. In recent years, Revenue Cycle Management (RCM) automation has emerged as a game-changer in addressing […]
Learn More
Denial Management Process

3 Proactive Strategies for Improving Denial Management

In the ever-evolving field of medical billing, denied claims remain a significant obstacle for healthcare providers. Studies reveal that over 10% of claims face initial rejection by insurers, leading to revenue losses, administrative strain, and frustration for all stakeholders. To mitigate these challenges and ensure financial stability, an effective denial management process is essential. However, […]
Learn More
telehealth billing strategies

Telehealth Billing Strategies: Maximizing Revenue

Telehealth revenue can be a lifeline for many healthcare organizations struggling financially due to cancellations of elective and non-urgent procedures. However, maximizing this revenue stream requires effective Telehealth Billing Strategies. This includes accurate coding, timely claim submissions, and navigating the complexities of payer reimbursement policies for virtual services. Understanding Telehealth Billing: A Few Key Concepts […]
Learn More
x