Category: Medical Coding

Outpatient Medical Billing Process

8 Steps to Clean Up Your Outpatient Medical Billing Process

Is your outpatient medical billing process feeling more like a tangled web than a well-oiled machine? You’re not alone. In the fast-paced world of healthcare, billing errors and inefficiencies can easily creep in, leading to delayed payments, increased denials, and a significant drain on your practice’s resources. The good news? You don’t have to overhaul […]
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medical coding in value-based care

Medical Coding in Value-Based Care: Accuracy for Success

The healthcare landscape is undergoing a significant transformation, shifting from a fee-for-service model to value-based care (VBC). This patient-centric approach emphasizes quality of care, patient outcomes, and cost-effectiveness. For healthcare providers to thrive in this evolving environment, optimizing revenue cycle management is paramount, and at the heart of this lies efficient and accurate medical coding […]
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E/M coding tips

Top E/M Code Tips to Boost Revenue and Mitigate Compliance Risk

This post dives into the top E/M coding tips that will empower your team to accurately capture the level of service provided, optimize revenue, and navigate the intricate landscape of compliance with confidence. 1. Embrace the 2021/2023 E/M Guidelines for Office/Outpatient Visits (99202-99215): The significant changes introduced in 2021 and further refined in 2023 for […]
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Medical Coding Audits for Physicians

Mastering Medical Coding Audits: A Physician’s Guide to Compliance & Revenue Protection

In the intricate ecosystem of healthcare, where patient well-being and financial viability intertwine, accurate medical coding stands as a cornerstone. Physicians, while primarily focused on patient care, bear the ultimate responsibility for the documentation that underpins the billing process. To ensure accuracy and compliance, Medical Coding Audits for Physicians are essential in identifying potential errors […]
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3 Ways to Improve Medical Coding Quality for Accurate Reimbursement

Improve Medical Coding Quality for Accurate Reimbursement

In the complex world of healthcare, accurate medical coding is the linchpin of a healthy revenue cycle. For US-based medical practices, hospitals, and billing companies, efforts to Improve Medical Coding Quality directly translate to timely and accurate reimbursements. Errors in coding can lead to denied claims, compliance issues, and significant financial losses. This blog post […]
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Mechanical Ventilation Coding

Avoiding Overpayments Through Accurate Mechanical Ventilation Coding

 The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently conducted a review of Medicare Severity Diagnosis Related Groups (MS-DRGs) that required more than 96 consecutive hours of mechanical ventilation. The audit focused on compliance with Medicare payment requirements and accurate Mechanical Ventilation Coding and code assignment. A total of […]
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Claim Denial Codes

Claim Denial Codes: Reduce Denials & Boost Healthcare Revenue

Claim denial rates are a significant challenge for healthcare providers, with substantial variations based on payer type, location, and specific insurance companies. To understand these variations, it’s crucial to analyze the specific claim denial codes issued by each payer. While the industry standard for claim denials hovers between 5% and 10%, certain payers, notably those […]
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ICD-10 Pain Coding

Pain Coding ICD-10: G89 Codes & Guidelines | Medical Coding

Continuing our exploration of commonly misunderstood areas in medical coding, today, we focus on pain coding, specifically addressing ICD-10 Pain Coding. Pain is one of the most frequent reasons patients seek medical attention. As published by the National Institutes of Health (NIH), pain is the leading complaint that drives individuals to healthcare providers. Most people […]
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HCPCS G-Codes

AUC Program & HCPCS G-Codes: Ensuring Compliance in Medicare Billing

The Centers for Medicare & Medicaid Services (CMS) initiated the educational and operations testing phase of the Appropriate Use Criteria (AUC) program. During this period, Medicare Administrative Contractors (MACs) began accepting AUC-related modifiers and HCPCS G-Codes on claims for advanced diagnostic imaging services provided to Medicare Part B patients. Understanding AUC Program Requirements Under the […]
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