A domestic medical coding and billing audit is an operation that inspects and estimates the value and dependability of clinical documentation and the overall medical billing process. This technique closely examines health records upheld by the practice and evaluates medical billing data presented to the payers to make sure that the practice picks out, observes, […]
KEY TAKEAWAYS Denials rose to 11% of all claims last year, up nearly 8% from 2021. Revenue cycle leaders should place their focus on clinical validation denials to help ease the overall denials burden. A key defensive strategy for preventing denials is provider education. Revenue cycle leaders need to understand that clinical validation denials are […]
Completing all necessary documentation to describe the individual’s current condition, treatment needs, interventions, and medications must be done with precision. The end of a calendar year and the beginning of a new one can be a busy time for healthcare practices, and this year is shaping up to be no different. In much of the […]
New guidelines remove ambiguity for some diagnosis coding in 2023. The ICD-10-CM Official Guidelines for Coding and Reporting is updated every year, but if you’re not in the habit of reviewing the guidelines at least annually, chances are your diagnosis coding is noncompliant and your claim denial rate is high. In the general session Diagnosis […]
Another study confirms that medical billing costs in the US significantly exceed those in similar countries, but researchers now know why: coding drives up US administrative spending. Complex coding structures in the US are driving up medical billing costs in the US, making it one of the most expensive countries to get paid, according to […]
The cost to appeal is worth the claim reimbursement and modification of payer behavior. As we approach 2022, one of our new year’s resolutions should be to do what’s necessary to decrease denials. We know that payers and external auditors took a break during the pandemic, but now it’s open season for audits and denials. […]
AMA updated the CPT code set to accommodate the new mix-and-match COVID-19 vaccine booster strategy endorsed by the federal government. The update comes on the heels of a decision from the Federal Drug Administration (FDA) to authorize booster doses of Janssen’s COVID-19 vaccine. The federal agency has recommended a booster dose of the vaccine for […]
CDI programs tend to facilitate denials attributable to ingrained reactionary processes perpetuated by the query process. The COVID-19 public health emergency (PHE) has unleashed untoward burden and financial challenges associated with treating and managing acutely ill patients. Costs associated with such patients is overwhelmingly high, with often extended ICU stays in which the patient slowly […]
A healthcare lawyer advises providers to thoroughly document care delivery to prevent medical billing and payment issues likely to arise from the COVID-19 pandemic. Clinical documentation is critical to serving patients with COVID-19, but also avoiding medical billing and payment issues in the months and years following the pandemic, according to healthcare lawyer Delphine O’Rourke. “There’s […]
New series to focus on preparing for the new code set. ICD10monitor and Talk Ten Tuesdays are launching a new series today, which will continue through November, focusing on the need for early preparation for the new ICD-11 code set that most expect will be ready for the U.S. implementation in 2022. “Now, five years after ICD-10 […]