Category: Blog

Updated Guidance for 340B Modifiers from CMS in 2024 and 2025

Updated Guidance for 340B Modifiers from CMS in 2024 and 2025

The Centers for Medicare and Medicaid Services (CMS) recently updated guidance on the use of 340B modifiers by Medicare providers and reimbursement providers for drugs Part B biologics and the 340B Drug Enforcement Program. Published participation. The purpose of this rulemaking is to inform all provider types about the newly amended 340B requirements for 2024 […]
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CPT® 2024 Update: New Codes and Guidelines

Table of Contents Evaluation and Management Surgery: Musculoskeletal System Surgery: Respiratory System Surgery: Cardiovascular System Surgery: Urinary System Surgery: Female Genital System Surgery: Nervous System Radiology Pathology and Laboratory Medicine Category III Codes 2024 CPT Coding updates:  Take a look at the updates in CPT coding and guidelines for professional services. Every year, on January […]
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Top Strategies to Prevent Medical Billing and Coding Errors

Top Strategies to Prevent Medical Billing and Coding Errors

Medical coding and billing errors are a persistent headache for healthcare providers, costing them time, money, and reputation. Studies show that a staggering percentage of medical bills contain errors, leading to denied claims, delayed payments, and frustrated patients. Focus on Prevention: Top coding and billing Errors to Avoid Non-Covered Charges: Verify insurance coverage before rendering […]
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5 strategies to address Prior Authorization Challenges

5 strategies to address Prior Authorization Challenges

Prior Authorization Challenges are a growing hurdle for medical practices dealing with Medicare Advantage plans. Recent investigations reveal concerning trends: improper denials and a lack of transparency from some insurers. This can significantly delay or even block essential care for patients. The Problem with Prior Authorizations Improper Denials: A government investigation found that Medicare Advantage […]
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Compliant Coding and Billing for Physicians: Expert Tips

Compliant Coding and Billing for Physicians: Expert Tips

The article explores common billing mistakes and offers tips for four healthcare services that can cause payment headaches for physicians. 1. Annual Wellness Visits vs. Physicals: Understanding Medicare Requirements Differentiating between Annual Wellness Visits (AWV) and Initial Preventive Physical Exams (IPPE) is crucial for accurate billing. Both are covered by Medicare for preventive care, but […]
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2024 ICD-10-CM Update Enhances Chronic Migraine

2024 ICD-10-CM Update Enhances Chronic Migraine

The good news for coders is that the 2024 ICD-10-CM update allows for more specific coding of chronic migraine with aura, improving accuracy and potentially helping patients access treatment. Diagnosing Migraine: A Complex Puzzle While the International Headache Society defines chronic migraine, pinpointing the exact type can be challenging. Migraines come in various forms, and […]
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How Intelligent Automation Can Address 3 Revenue Cycle Challenges

How Intelligent Automation Can Address 3 Revenue Cycle Challenges

The healthcare industry has long buzzed about the potential of Artificial Intelligence (AI) to revolutionize financial operations and internal workflows. However, for practical solutions tackling the complexities of RCM, intelligent automation offers a more realistic path forward. Why Intelligent Automation Over AI? True AI strives to mimic human cognition, but it remains in its early […]
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Master Telehealth Coding: A Guide to Reimbursement and Avoiding Denials

Master Telehealth Coding: A Guide to Reimbursement and Avoiding Denials

Navigating the complexities of telehealth coding is crucial for ensuring that services are properly reimbursed. This guide provides essential information and tips for coding telehealth services accurately, helping physicians avoid denials and recoupments. 1. Telephone Services: Use Cases: Suitable for straightforward problems like simple rashes, asymptomatic coughs, and medication refills. Requires a minimum of five […]
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