In the high-stakes world of healthcare, one malpractice claim can alter the trajectory of a medical professional’s career. But what happens when a physician already has a history of prior paid malpractice claims? According to extensive research, such history is a strong predictor of future claims, raising red flags for insurers, healthcare employers, and medical […]
In the complex world of insurance and healthcare claims, the concept of “zero-paid claims” can feel like a phantom menace. You’ve submitted a claim, received an Explanation of Benefits (EOB) or remittance advice, and to your dismay, the payment is… zero. While a zero payment might seem innocuous, it can, in certain scenarios, be interpreted […]
Errors, delays, and denials can significantly impact a practice’s revenue cycle, leading to financial strain and operational inefficiencies. Artificial Intelligence (AI) offers a powerful solution to streamline and optimize medical billing processes, specifically through AI-powered medical billing solutions. At Allzone MS, we understand the challenges healthcare providers face and are committed to leveraging AI to […]
Description: Modifier 25: Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service. Navigating the Challenges of Modifier 25 in Healthcare Billing Modifier 25 healthcare billing in continues to be a source of frustration for healthcare providers. Health […]
Doctors must consider the implications of altering a patient’s status. The Centers for Medicare & Medicaid Services (CMS) is suggesting novel retrospective and prospective appeal procedures in compliance with a federal district court order from the District of Connecticut. On December 21, the agency unveiled a proposed rule aiming to institute an appeal mechanism for […]
Attendees at AAPC’s AUDITCON, Nov. 3-4, 2022, came loaded with questions about the coding and guideline changes for evaluation and management (E/M) services in CPT® 2023. The conference offered several sessions on the subject, including the ED session, “Changes in 2023: Emergency Department,” presented by AAPC Chief Product Officer. The officer provided a high-level overview […]
COVID-19 continued to affect the industry, which has plowed forward with expanded offerings, digital transformation and other bold moves. It was difficult to predict trend lines for the payer and health insurance industry in 2021, largely because of persistent uncertainties due to the COVID-19 pandemic. Consumer behavior has become more unpredictable, care models and […]
CMS has expanded the prior authorization requirement to two new service categories within hospital outpatient department services. The Centers for Medicare & Medicaid Services (CMS) has expanded the prior authorization requirement for two additional hospital outpatient department (OPD) services. Effective with date of service July 1, 2021, CMS has expanded the prior authorization requirement to […]
Make sure you’re using the latest code files for your Medicare claims. A second quarter update to the HCPCS Level II code set used for reporting products, supplies, and services adds 23 codes. Additionally, six codes are revised and 12 are discontinued, effective April 1, 2021. There are also two codes with changes to Medicare coverage. […]
The Comprehensive Error Rate Testing (CERT) program grew out of the Department of Health and Human Services Office of Inspector General improper payment rate estimates from 1996 through 2002. Due to sample size restrictions, the Centers for Medicare & Medicaid Services (CMS) assumed responsibility because they had access to more granulated data in 2003. The […]