Category: Blog

The Role of External Coding Audits in Healthcare

The Role of External Coding Audits in Healthcare

The constant updates in medical codes and evolving payer regulations, healthcare providers are increasingly turning to external coding audits. This blog post explores the importance of external coding audits, benefits, and how they support the healthcare industry in minimizing compliance risks, improving revenue integrity, and enhancing operational efficiency. 1. What Is an External Coding Audit? […]
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CMS Finalizes MPFS with 2.9% Medicare Physician Pay Cuts

CMS Finalizes MPFS with 2.9% Medicare Physician Pay Cuts

The Centers for Medicare & Medicaid Services (CMS) has finalized its 2025 Medicare Physician Fee Schedule, which includes a 2.9% Medicare Physician Pay Cuts to physician payments. This decision, despite opposition from major industry groups, will impact healthcare providers and potentially patient access to care. The rule also includes several positive provisions, such as expanded […]
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Modifier 26 and Modifier TC for Accurate Healthcare Billing

Modifier 26 and Modifier TC for Accurate Healthcare Billing

In the realm of healthcare billing and coding, modifiers are crucial tools used to provide additional context and specificity to procedure and diagnosis codes. These modifiers help healthcare providers accurately communicate the nature of services rendered to payers. Two commonly used modifiers, Modifiers 26 and Modifier TC, play significant roles in clarifying billing practices and […]
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Optimizing Debridement Coding: Tips for Accurate Claims and Payments

Optimizing Debridement Coding: Tips for Accurate Claims and Payments

The growing U.S. wound care market, fueled by an aging population and rising rates of chronic conditions, presents significant opportunities for healthcare providers. Accurate debridement coding is essential to maximize reimbursement and optimize patient care. Pressure injuries alone affect around 2.5 million Americans each year, leading to more than 60,000 deaths and costing between $9.1 […]
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How to Use Modifiers 59 and X[ESPU] to Maximize Reimbursement

How to Use Modifiers 59 and X[ESPU] to Maximize Reimbursement

When you bill for distinct, separate procedures, it’s crucial to know which modifiers will ensure full payment for each service. Modifier 59, “Distinct Procedural Service,” acts as a universal tool to unbundle procedures that are typically included in a larger procedure or “bundled” together. This modifier signals to the payer that specific circumstances justify separate […]
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Medicare Physician Reimbursement Cuts

Medicare Physician Reimbursement Cuts Threaten Patient Access to Care

With over 67 million Americans—nearly 20% of the population—relying on Medicare, the program plays a crucial role in ensuring access to quality healthcare. Unfortunately, looming Medicare physician reimbursement cuts threaten to undermine this vital service, potentially leading to reduced access to care and compromised patient outcomes Medicare physician reimbursement cuts, such as the proposed 2.8% […]
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funniest ICD-10 codes for Halloween

The Funniest ICD-10 Codes for Halloween 2024

Halloween is a time for fun, frights, and… the funniest ICD-10 codes for Halloween? Yes, you read that right! The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is a complex system used to classify diseases and injuries. While it’s a serious tool for healthcare professionals, some of its codes can be quite amusing, […]
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Growth in the Medical Billing Industry: Trends and Challenges

Growth in the Medical Billing Industry: Trends and Challenges

The medical billing industry, while complex and often mired in regulatory hurdles, is experiencing a period of growth and transformation. A recent survey conducted by healthcare software company, a digital health operating system company, revealed that 65% of medical billing companies hold a positive outlook on the industry’s future. This optimism is fueled by several […]
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You need to know about 99211 CPT code: Guide

Navigating the intricate landscape of medical billing and coding demands a firm grasp of Current Procedural Terminology (CPT) codes. One of the most commonly used yet frequently misunderstood codes is CPT 99211. This low-level evaluation and management (E/M) code is employed for services rendered by healthcare providers, typically in outpatient settings. While it might appear […]
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RCM Outsourcing

Healthcare: The Role of RCM Outsourcing and Technology

The U.S. healthcare industry, marked by its global leadership in spending, faces mounting pressures due to evolving care models, supply chain disruptions, regulations, labor shortages, and rising costs. To navigate these challenges, healthcare leaders are prioritizing quality care delivery while also optimizing administrative operations, including revenue cycle management (RCM). Outsourcing RCM has become a key […]
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