Category: Blog

The Need for Facility Coding Guidelines

The Need for Facility Coding Guidelines

Facility-specific coding guidelines are key to code hospital visits and encounters consistently. Another role that facility-specific guidelines play is to capture all possible reimbursement that is due to an organization. Every Oct. 1, the MS-DRGs and ICD-10-CM/PCS are updated. In addition to the MS-DRGs, the New Technology Add-On Payments (NTAPs) are updated as well. It […]
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Sequence ICD-10-CM Codes for Proper Payment

Key Concepts for Determining Primary Diagnosis Codes

Accurate diagnosis coding is crucial for medical billing, as it narrates the patient’s healthcare journey. Patients often present with multiple conditions, requiring coders to select and sequence the most specific codes. This sequencing, or code arrangement, is vital for correct billing. This discussion highlights five key terms from the ICD-10-CM Official Guidelines for Coding and […]
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ICD-10 Coding Tips for Influenza

ICD-10 Coding Tips for Influenza

There has been much discussion about COVID-19 this year, but as autumn approaches, thoughts turn towards influenza season. The Advisory Committee on Immunization Policies (ACIP) recently published guidelines for flu vaccination. Their advice is that routine annual vaccination is recommended for everyone 6 months of age and older. The United States vaccines will include updates […]
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New Medical Coding Rules for E M Visits

New Medical Coding Rules for E M Visits

Q: Do the new 2021 coding rules for office visits apply to all payers or just Medicare and Medicaid? Also, are these rules just for office visits, or can we use them for hospital visits, nursing home services, and home visits? A: The changes to the documentation requirements are for codes 99202-99215 only and are […]
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Take a Consumer-Oriented Approach to Your Billing Cycle

Take a Consumer-Oriented Approach to Your Billing Cycle

The Covid-19 pandemic is transforming how physicians practice medicine and bill for it. Physicians who take a consumer-oriented approach to their billing cycle may adapt the best, says John Behn III, MPA, president of Stroudwater Revenue Cycle Solutions and a principal of Stroudwater Associates, a national healthcare consulting firm based in Portland, Maine. “We’ve seen […]
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Nine Tips for Collecting Patient Balances

Nine Tips for Collecting Patient Balances

Practices have been creative during COVID-19 to ensure safe patient access: Telephone visits. Curbside immunizations. Drive-up virus testing. Even checking patients in for their in-office visits while they wait in the car. However, each of these scenarios poses one significant challenge: Collecting copayments and coinsurance. “With COVID-19, you’ve got to find ways to meaningfully engage […]
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Clinicians Serving Socially At-Risk at a Disadvantage Under MIPS

Clinicians Serving Socially At-Risk at a Disadvantage Under MIPS

  Clinicians who served more patients with social risk factors such as low income performed worse in the Merit-Based Incentive Payment System’s inaugural payment year, and therefore, received unfavorable value-based reimbursement, according to a new study. The study recently published in Health Affairs found that out of 510,020 clinicians participating in the Merit-Based Incentive Payment System (MIPS) in […]
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Rules Are Changing_ The Impending Transition to ICD-11

Rules Are Changing: The Impending Transition to ICD-11

The World Health Organization (WHO) updates ICD codes every 10 years to improve clinical use and acknowledge innovations in healthcare. After the tumultuous transition to the 10th revision of the International Classification of Diseases, simply mentioning the phrase “ICD-11” is liable to strike fear in the hearts of revenue cycle professionals and healthcare providers across […]
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AMA Approves 2 New CPT Codes for COVID-19

AMA Approves 2 New CPT Codes for COVID-19

One of the codes, CPT Code 99072, is for reporting additional supplies used to mitigate spread of the virus. The American Medical Association (AMA) announced, Sept. 8, two new Category I CPT® codes to meet the changing needs of the healthcare industry brought about by the COVID-19 public health emergency (PHE). The codes were approved […]
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