Tag: Healthcare Reimbursement

Prior Authorization Requirements

Physician Discovers Hidden prior authorization Details in CPT Codes

A proposal to track prior authorization using CPT codes was pulled back for revision after a surprising finding. An urologist, advocated for the plan to compensate physicians for time spent on prior authorization requirements. He also hoped it would streamline the process and improve patient care. However, the American Medical Association (AMA) informed urologist that […]
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ICD-10-CM coding

Top 10 ICD-10-CM Coding Errors

Medical ICD-10-CM coding accuracy is crucial for efficient healthcare reimbursement. Even minor errors can lead to claim denials, delays, and lost revenue. Here are the top 10 medical coding mistakes to avoid: Accuracy is Key: 1. Don’t Skip the Details: ICD-10-CM codes often require specific details in the fourth and fifth digits. Using truncated codes […]
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reduce accounts receivable

5 Essential Tips to Reduce Accounts Receivable Turnaround Time

 When your medical practice submits a claim to a payer, the countdown begins until you receive the payment. Ensuring timely payment is crucial for your business, as delays can have costly consequences. Ideally, you should aim to clear accounts receivable within 30 days. To effectively reduce accounts receivable, it’s essential to implement efficient billing processes, […]
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medical-coding-compliance-strategy-to-reimbursement

3 Coding Compliance Strategies to Improve Reimbursement, Quality

The Crucial Role of Medical Coding Compliance in a Value-Based World: Telling the Patient’s Story for Better Billing and Quality Care. Medical Coders: The Unsung Storytellers of Healthcare Medical coders play a critical role in hospitals, but their importance often goes unnoticed. They’re the storytellers behind the scenes, analyzing patient records, selecting billing codes, and […]
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denial management makeover

Denial Management Makeover: Proven Tactics to Reduce Denials

Embrace the Denial Management Makeover and discover how to improve cash flow, streamline billing, and finally conquer denied claims. There are few things worse than denies for any healthcare provider. They disrupt patient care, but they also add to their financial burden. Denied claims mean lost revenue, impacting your cash flow and making it hard […]
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HCPCS Level II Codes

HCPCS Level II July 2024 code update

The HCPCS Level II quarterly update for July 2024 is now available on the Centers for Medicare & Medicaid Services (CMS) website. The update includes: 134 added codes 9 discontinued codes 32 codes with long description changes 3 codes with payment changes New HCPCS Level II Codes Effective July 1, 2024, there is one new […]
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healthcare denied claims impact and appeals

Unlocking the Secrets of Denied Claims: Insights, Solutions, and Strategies

The Prime Minister’s recent voluntary national survey shed light on the Denied claims. The survey, conducted between October and December 2023, found that nearly 15% of all Medicare Advantage, Medicaid, Commercial and Managed Medicaid claims were denied. Between 45% and 60% of rejected cases were overturned, although the expensive appeals process sometimes meant multiple appeals. […]
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Survey: High Initial Claim Denials Impact Healthcare Providers

The Rising Denial Rates in Healthcare Claims Processing Initial Claim Denials: In a new survey conducted by healthcare Company an increased percentage of initial claims are denied by private payers, including pre-approvals for medical claims. Hospitals, health systems, and post-acute care providers may have a difficult time getting paid for medical services. The survey respondents […]
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Preventive-Visits-VS-Office-Visits

Differences: Preventive vs. Office Visits in Medical Coding & Billing

Preventive Services Vs Office Visits: It is important to note that Medicare does not cover preventive services in the same manner as commercial payers. Therefore, it is important to know the patient’s policy and insurance coverage. Table A shows a breakdown of the coverage parameters. Understanding the distinction between Preventive Services Vs Office Visits is […]
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NSA Implementation

Congressional Concerns: Lawmakers Challenge CMS on NSA Implementation

NSA Implementation Shortly before Congress adjourns for 2023; lawmakers sent another in a series of letters to the Centers for Medicare and Medicaid Services (CMS) expressing “serious concerns” about the implementation of the No Surprises Act (NSA). The letter accused CMS of failing to properly implement key portions of the law and suggested that the […]
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