Category: Blog

Demystifying Facility Coding

Demystifying Facility Coding

Modifiers 52: Professional fee-for-service guidelines for modifiers do not apply in the clinical setting. Reduced, Failed, Aborted, Aborted… which one? What are the requirements for using modifiers 52, 73 and 74? These questions are common in the coding center world, and  the answers  never seem to be clear. Confusingly mix up the medical code instructions […]
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HIPAA compliance importance: Key Requirements, Consequences, and Tips

It is important to note that the Health Insurance Portability and Accountability Act (HIPAA) Security Rule of 1996 established standards for protecting individuals’ electronic personal health information (PHI). This includes any identifiable health information, such as medical records and histories, medical bills, and lab results, among others. A covered entity, including healthcare providers, health plans, […]
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Survey: High Initial Claim Denials Impact Healthcare Providers

Survey: High Initial Claim Denials Impact Healthcare Providers

The Rising Denial Rates in Healthcare Claims Processing Initial Claim Denials: In a new survey conducted by healthcare Company an increased percentage of initial claims are denied by private payers, including pre-approvals for medical claims. Hospitals, health systems, and post-acute care providers may have a difficult time getting paid for medical services. The survey respondents […]
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Reduce Claims Denial in Your Revenue Cycle

Reduce Claims Denial in Your Revenue Cycle

Claims Denial: Healthcare Leaders report an increase in payer denials, putting increasing pressure on the system’s finances. Going back and forth with denied payers is a long and expensive process, and low reimbursement rates don’t help either. In a new survey conducted by the Healthcare Financial Management Association, CFOs noted a significant increase in denials, […]
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Boost Efficiency & Revenue: 8 Reasons to Outsource RCM Services in 2024

Boost Efficiency & Revenue: 8 Reasons to Outsource RCM Services in 2024

Outsource RCM: Providers who spend too much on RCM staff and processes, or who experience a high rate of claims denials, should consider outsourcing their medical billing requirements. While our experts chase down payments, you can provide the care, receive the funds, and improve your key performance indicators. Outsource RCM makes sense Why Healthcare Providers […]
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Medicare Conversion Factor Increases, But Payments Remain Lower

Medicare Conversion Factor Increases, But Payments Remain Lower

Medicare Conversion factor are up but payouts are still down compared to last year. Healthcare professionals will see a slight upward adjustment to their Medicare payments starting March 9 after President Biden signs the Consolidated Appropriations Act (CAA), 2024.  Really fortunately, although the 2024 CAA increases the conversion factor (CF) finalized for calendar year (CY) […]
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HCPCS Level II Code Updates for April 2024

HCPCS Level II Code Updates for April 2024

The official April 2024 update to the HCPCS Level II code set is now available on the Centers for Medicare & Medicaid Services website.  April update includes: 62 new codes 2 changes to scope and long description 21 obsolete codes 11 changes to long description 1 change to changes miscellaneous changes Below are some  code […]
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Remote patient monitoring: pros and cons

Remote Patient Monitoring (RPM): Transforming Healthcare

Healthcare providers are increasingly recognizing the transformative potential of Remote Patient Monitoring (RPM). This technology offers significant benefits, including improved patient outcomes, reduced healthcare costs, and the ability to deliver personalized, patient-centered care while easing provider workload. This widespread recognition is fueling substantial investment, with the RPM market projected to experience a 3.3% compound annual […]
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AMA Aims to Streamline Prior Authorization Billing with New Codes

AMA Aims to Streamline Prior Authorization Billing with New Codes

New billing codes: Medical experts might consider creating new billing codes for the time doctors and their support staff spends working on prior authorizations. The American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Board meets May 9-11 in Chicago. On the meeting’s agenda are three potential new CPT codes “for reporting services (physician, QHP, […]
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