Remaining up-to-date is essential in the healthcare industry, but relying solely on current codes isn’t always the best approach. When auditing, handling appeals, or researching code usage for past encounters, a solid grasp of the descriptors and guidelines applicable during the date of service (DOS) can profoundly impact outcomes. Here’s a concise guide on effectively […]
The constant updates in medical codes and evolving payer regulations, healthcare providers are increasingly turning to external coding audits. This blog post explores the importance of external coding audits, benefits, and how they support the healthcare industry in minimizing compliance risks, improving revenue integrity, and enhancing operational efficiency. 1. What Is an External Coding Audit? […]
For 2024, significant updates will be introduced to ICD-10, CPT, and HCPCS, affecting medical practices, hospitals, and healthcare systems across the country. Medical knowledge, technological advancements, and healthcare practices continue to evolve, so coding systems must keep up. To ensure the accuracy of billing, documentation, and reimbursement, changes are made to the International Classification of […]
In 2024, healthcare providers, medical coders, and revenue cycle management (RCM) professionals need to stay up-to-date on 2024 medical coding updates. Several updates have been made to Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and International Classification of Diseases (ICD-11) by the American Medical Association (AMA), the Centers for Medicare & Medicaid […]
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 […]
Medical coding strategies contribute various benefits, counting cost reduction and control, systematic healthcare management, and increased scalability. Compliance with medical coding qualities also promises patients’ data privacy and security and alleviates the threats of audits. In the current healthcare landscape, keeping up financial solidity has become progressively hard due to the shift from fee-for-service to […]
Industry experts explain the intricacies of the 2021 E/M coding guidelines. During the Evaluation and Management (E/M) Panel general session, an expert panel made up of a physician, coder, auditor, payer, and a representative from the American Medical Association (AMA) answered audience questions regarding the 2021 E/M coding guidelines for office/outpatient visits. The panelists were […]
After three years of policy proposals, the American Medical Association Current Procedural Terminology (CPT) panel responses, and substantial guidance from gastroenterology and other specialty societies, changes to the office/outpatient evaluation and management (E/M) codes became effective as of January 2021. Some aspects of these revisions took effect for telehealth services since spring 2020 for Medicare, […]
Artificial intelligence (AI) is a concept that has moved very quickly from the realm of science fiction into real and practical utility in a number of different industries—including healthcare. One of the most effective applications for AI-powered tools is in the field of revenue cycle management. Sophisticated AI technologies can sift through vast amounts of […]
The importance of Artificial Intelligence (AI) in Medical Coding is often understated and also overstating the same is quite difficult.. to get in-depth with how AI is actually bringing changes in MCA, we must get to the basics of what Medical Billing and Coding really are. Medical Coding Medical coding, if we talk about it […]