Category: Blog

Value-Based Payment: Prioritizing Patient Health Over Profits

Value-Based Payment: Prioritizing Patient Health Over Profits

Value-Based Payment: Putting Patient Health First: When recommending a medical procedure, should doctors prioritize insurance reimbursements or patient health? The answer hinges on the payment model. In a fee-for-service system, providers are compensated for each individual service, potentially incentivizing excessive care. This model can lead to increased costs and harm patients through unnecessary treatments or medications. […]
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The-Three-Categories-of-CPT-Codes

The Three Categories of CPT Codes

Current procedural terminology meaning: Current Procedural Terminology or CPT codes are developed by the American Medical Association (AMA) to describe a wide range of healthcare services provided by physicians, hospitals, and other healthcare professionals. These codes are utilized to communicate with other physicians, hospitals, and insurers for claims processing. There are three categories of CPT Codes: […]
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Master Retina Injection Coding for Smooth Billing & Reimbursement

Accurate coding is essential for retina practices performing intravitreal injections, especially when handling retina injection coding. While medication and modifier updates occur frequently, understanding these basics ensures proper reimbursement: CPT® Code Consistency: CPT® code 67028 remains constant for administering the medication. HCPCS Level II Code Tracking: Codes for injected drugs (HCPCS Level II) vary and […]
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Top 10 ICD-10-CM Coding Errors

Top 10 ICD-10-CM Coding Errors

Medical ICD-10-CM coding accuracy is crucial for efficient healthcare reimbursement. Even minor errors can lead to claim denials, delays, and lost revenue. Here are the top 10 medical coding mistakes to avoid: Accuracy is Key: 1. Don’t Skip the Details: ICD-10-CM codes often require specific details in the fourth and fifth digits. Using truncated codes […]
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Comprehensive Overview of CMS July 2024 OPPS Update (CR13632)

The CMS Releases July 2024 OPPS Update (reference: CMS Change Request CR13632, MLN Matters number MM13632). Here’s a summary of key changes: New Coverage for COVID-19 Pre-Exposure Prophylaxis: Drug: PEMGARDA (pemivibart) – Code: Q0224 (Note: This code is not reimbursed under OPPS, but at a “reasonable cost”) Administration: Code: M0224 (Covered: Receives separate payment under […]
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Common coding mistakes and how AI is resolving them

How Medical Coding Mistakes Cost You Money

The administrative burden of accurate medical coding is a major contributor to physician burnout—a challenge exacerbated by the COVID-19 pandemic. Studies consistently rank coding-related stress as one of the top concerns for healthcare providers. Medical Coding Mistakes, whether due to oversight or complexity, can have severe financial repercussions for medical practices. Denied claims, reduced reimbursements, […]
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Why Healthcare Providers Need Medical Claim Clearinghouses

Why Healthcare Providers Need Medical Claim Clearinghouses

Medical claim clearinghouses enhance the efficiency of claim submissions for healthcare providers, thereby reducing costs and improving payment accuracy. Each year, healthcare payers and providers exchange billions of claims to finalize patient encounters, a number that continues to rise. As claim volumes increase annually (except for a dip in 2021 due to the COVID-19 pandemic), […]
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Streamline Billing and Boost Revenue with Efficient Payment Posting

Streamline Billing and Boost Revenue with Efficient Payment Posting

While revenue cycle management (RCM) involves many steps, payment posting processes often gets overlooked. Optimizing this process acts as the cornerstone for smoother billing, reducing administrative burdens, and uncovering new revenue streams. By providing a clear view of daily income, accurate payment posting helps practices proactively address errors that could otherwise complicate medical billing and […]
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