Category: Blog

GY modifier

Mastering the GY Modifier: A Guide for Anesthesia Providers

Every code, every modifier, plays a crucial role in ensuring accurate reimbursement for services rendered. For anesthesia providers, understanding and correctly applying modifiers is particularly critical, as their services often involve complex scenarios. Among these, the GY modifier stands out as a powerful, yet often misunderstood, tool for ensuring proper payment for non-covered services. If […]
CPT Code 83036

Ultimate Guide to CPT Code 83036: Accurate HbA1c Test Billing & Coding

Every CPT (Current Procedural Terminology) code represents a specific medical service or procedure, and understanding their nuances is critical for healthcare providers, billers, and even patients. Among these, CPT code 83036 holds significant importance, primarily associated with the Hemoglobin A1c (HbA1c) test. This comprehensive guide will delve deep into CPT code 83036, explaining its purpose, […]

How a Medicare Out-of-Pocket Cap Could Reshape Healthcare

For millions of Americans relying on Medicare, the specter of high out-of-pocket healthcare costs looms large. Unexpected illnesses, chronic conditions, and even routine medical needs can quickly erode savings and create significant financial strain. The idea of a Medicare out-of-pocket spending cap has long been a topic of discussion, promising a shield against catastrophic expenses. […]
Endoscopy billing

Don’t Make These Mistakes When Billing for Endoscopy Services

In the complex world of medical billing, few specialties present as many coding challenges as gastroenterology. Endoscopy billing—covering a wide range of procedures from colonoscopies to upper GI endoscopies—is a cornerstone of diagnostic and therapeutic care. However, the intricate rules governing their billing can be a minefield for healthcare providers and billing professionals. A single […]
Z-Codes in Documenting SDOH

The Pervasive Underutilization of Z-Codes: A Crisis in Healthcare

In the complex world of modern healthcare, a patient’s journey is shaped by more than just their medical diagnosis. Factors like housing stability, access to nutritious food, reliable transportation, and social support networks—collectively known as Social Determinants of Health (SDOH)—are increasingly recognized as powerful drivers of health outcomes. While healthcare systems have the tools to […]
Electronic Claims Management

Electronic Claims Management: Overcoming ERA and PA Challenges

The U.S. healthcare industry continues its digital transformation, with providers and payers embracing electronic transactions to streamline revenue cycle management (RCM) processes. According to the CAQH Index, adoption of electronic claims management transactions—such as eligibility verification, claim submissions, and claim status inquiries—has reached or surpassed 80% for many transaction types. However, significant gaps remain in […]
Outpatient CDI Program

Why Outpatient CDI Programs Are Essential for Accurate HCC Coding and Risk Adjustment

Healthcare is an ever-evolving landscape. In this era of value-based care, accurate documentation and coding are important for financial stability and quality patient care. Hierarchical Condition Categories (HCCs) are crucial for risk adjustment and reimbursement, especially in the outpatient setting. This is where Outpatient CDI programs come into play. They are not just beneficial but […]
AI in Payment Integrity

What AI Can and Can’t Yet Do in Payment Integrity

The landscape of payment integrity, particularly within complex sectors like healthcare and financial services, is constantly evolving. As organizations grapple with escalating costs, intricate regulatory frameworks, and the persistent threat of fraud, waste, and abuse (FWA), Artificial Intelligence (AI) has emerged as a powerful ally. While AI’s capabilities in enhancing payment integrity are undeniably transformative, […]
Medical billing compliance

How Medical Billing Compliance Can Protect Your Medical Practice

In today’s evolving healthcare environment, medical billing compliance is more than just a legal requirement—it’s a strategic safeguard for your medical practice. As regulations tighten and audits become more frequent, staying compliant with medical billing standards helps protect your practice from costly fines, revenue losses, and reputational damage. What Is Medical Billing Compliance? Medical billing […]