Have you ever received a medical bill that left you perplexed, questioning how the expenses added up and left you scratching your head? If that’s the case, you’re certainly not alone. Billing for radiology can be intricate and confusing, involving numerous codes and procedures. Unfortunately, errors in medical billing are all too frequent, resulting in […]
In Congress this week, it wasn’t just pharmacy benefit managers facing scrutiny. The Senate’s Permanent Subcommittee on Investigations directed its attention towards Medicare Advantage (MA) plans, seeking explanations for claims denials. During the hearing, the committee’s chairman highlighted that letters were sent to the three largest MA plans—UnitedHealthcare, Humana, and Aetna—requesting documentation regarding their decision-making […]
Medical coding is an essential aspect of healthcare in that it translates diagnoses, procedures, medical services, and equipment into alphanumeric codes. The processes involved in medical coding is complex, however, so errors can often result in payment delays and significant financial losses. The most common errors leading to delays and lost revenue are tracking down […]
Help physicians and patients understand exactly what it all means. One of the most asked questions coders get from patients at an orthopedic practice is: “Why is there a surgical code on my bill for an office visit?” It’s a valid question coming from a patient who was seen in the clinic, treated for a […]
The number of prior authorization requests continues to increase — despite promises to the contrary by payers — costing physicians time and money. A Medical Group Management Association (MGMA) poll found that 70% of medical groups indicated that prior authorizations increased in the last year. Physicians say that their practices continue to struggle with either […]
Below is a listing of questions and answers regarding some of the nuances of billing Evaluation and Management office visits based on time. The new 2021 E/M coding guidelines for office visits (99202-99205, 99212-99215) allow physicians and qualified health professionals (QHP) to choose whether their documentation and code-selection level for E/M services provided is based […]
Coding must be supported by documentation, but also by the Official Coding Guidelines. While preparing for a clinical validation presentation on acute kidney injury denials, I took inventory of the most common denials and recoveries obtained by payers. It came as no surprise that sepsis, severe malnutrition, and encephalopathy were at the top of the […]
A work group put together by the American Medical Association (AMA) that also represents the AMA’s Current Procedural Terminology (CPT) Editorial Panel and the AMA/Specialty Society RVS Update Committee (RUC) has put together revisions to office and outpatient evaluation management (E&M). These will take effect on January 1, 2021. So how will this affect dermatologists? Well, this […]
Medical billing and coding is an integral component of healthcare. The medical coding outsourcing market alone is projected to reach16.9 billion dollars by 2021. However, coding accuracy is an ongoing challenge. To maximize efficiency and accuracy of the medical coding process, companies are testing the possibilities of Artificial Intelligence (AI) applications. The current problem is […]
The number of conditions a patient has is now going to factor into the risk adjustment score (RAS). In March, I make my annual pilgrimage to Columbus, Ohio to speak at the Ohio Health Information Management Association (OHIMA) conference, and this year, my remarks are titled, “The Hierarchical Condition Categories Model: Risk Adjustment isn’t just […]