Tag: Outsourced Medical Billing

medical necessity documentation

Medical Necessity Documentation: A Guide to Reducing Claim Denials

Claim denials are a significant headache for healthcare providers, impacting revenue and administrative efficiency. While denials can stem from various issues, a large majority are rooted in documentation errors, particularly those related to demonstrating medical necessity. Defining Medical Necessity: The American Medical Association (AMA) defines medical necessity as healthcare services or products provided to a […]
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Optimize Your Practice with Expert Chiropractic Billing Services

Optimize Your Practice with Expert Chiropractic Billing Services

Choosing the Right Chiropractic Billing Company The efficient billing practices are crucial for the success of any chiropractic practice. Managing insurance claims, patient payments, and other financial aspects can be time-consuming and complex. That’s where chiropractic billing services come into play. By outsourcing these tasks to experts, chiropractors can focus on providing quality patient care […]
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New Rules Issued for Modifiers 59, XE, XS, XP, and XU

New Rules Issued for Modifiers 59, XE, XS, XP, and XU

The Centers for Medicare & Medicaid Services (CMS) issued a policy change modification to the claims processing logic for Modifier 59 Distinct procedural service (and the optional patient-relationship modifiers XE, XS, XP, and XU) on February 15, 2019. These modifiers are only processed when applied to the Column 2 code in a bundled pair, per Correct Coding Initiative […]
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“Defensive” Undercoding Is Indefensible

“Defensive” Undercoding Is Indefensible

Undercoding, or reporting a lesser service than was performed and documented, is sometimes employed as a defensive strategy to stave off claims denials or audits. But, undercoding can make a provider an outlier, and may create consequential patient care, compliance, and financial liabilities. For example: Undercoding Leaves Money On The Table, Driving Down Provider Reimbursement […]
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Preparing Providers For Value-Based Care

Preparing Providers For Value-Based Care, Consumerism In Healthcare

Technology can transform data into actionable insights for providers needing to meet the demands of value-based care and consumerism in healthcare. Transforming raw data into actionable information is crucial to the financial future of provider organizations, especially as pressure builds on providers to align their care delivery approach with value-based care and consumerism in healthcare. […]
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Federal Policy to End Surprise Billing

Federal Policy to End Surprise Billing: Building on Prior Approaches

Ending surprise medical bills has risen to a national priority with bipartisan political interest. In January, President Donald Trump directed Cabinet officials to find a solution, and multiple congressional bills were proposed in the last Congress with the same goal. Surprise medical bills consist of unanticipated charges from out-of-network clinicians—often when the facility or primary physician is […]
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Coding “Separate Procedures”

Coding “Separate Procedures:” What Coders Need to Know

“Separate procedure” may not mean what you think. Many procedural codes in the CPT® Book are designated as “separate procedures.” However, the common misinterpretation of this is that coders can report such codes as such in every case. Not true. First, you must consider: Were there other procedures performed during the same encounter? Did you consult […]
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Providers Need to Start Talking About Costs

To Increase Patient Satisfaction, Providers Need to Start Talking About Costs: Survey

Even as health systems confront rising healthcare costs and declining margins, they are under pressure to improve the patient experience, retain customer loyalty and collect patient payments. But while two-thirds of patients said cost strongly influences their overall satisfaction with their hospital or physician, nearly 60% of health systems do not discuss costs with patients, […]
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Chronic Condition

Understanding the Correct Use of Chronic Condition Codes

Accurate reporting of chronic and coexisting conditions is an important part of medical coding. When supported by the provider’s documentation and relevant to the encounter, these conditions can help communicate the patient’s overall clinical complexity and the care provided. However, not every chronic condition documented in a patient’s medical record should automatically be reported for […]
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