Tag: Reimbursement

Robust Denial Managament Solutions

6 Action Items for Your Denials Management Plan

Navigating the complexities of denials management can feel overwhelming for revenue cycle leaders seeking effective solutions. Instead of chasing quick fixes, a structured, methodical approach is essential for building a sustainable and impactful denials management strategy. Implementing a Robust Denials Management Solution is key to achieving this, as it provides the necessary framework for a […]
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Top Medical Billing Trends

Medical billing trends in 2025

The medical billing landscape is evolving rapidly, driven by advancements in technology, regulatory updates, and shifting patient expectations. Staying informed about Top Medical Billing Trends is crucial. As we enter 2025, healthcare providers and medical billing companies must stay ahead of the curve to ensure compliance, maximize revenue, and improve patient satisfaction. This newsletter will […]
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HCPCS codes G9037 and G9038

New MCP Model HCPCS Codes G9037 & G9038

Clinicians participating in the Making Care Primary (MCP) model now have access to two new HCPCS Level II codes, HCPCS Codes G9037 and G9038, introduced in fiscal year (FY) 2024. These codes expand the scope of interprofessional consultation services, allowing primary care providers (PCPs) to bill for time spent collaborating with specialists. The MCP Model: […]
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Ophthalmology Billing

Navigating Ophthalmology Billing: Challenges & Best Practices

Ophthalmology, as a specialized field within healthcare, presents unique challenges when it comes to Ophthalmology Billing. From the intricate nature of eye-related procedures to various coding requirements, Ophthalmology Billing is a nuanced process that requires precision and understanding. Healthcare providers in this specialty must navigate complex coding systems, insurance policies, and regulatory requirements to ensure […]
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Chronic Care Management Codes: A Comprehensive Guide

Chronic Care Management Codes: A Comprehensive Guide

Chronic Care Management codes are increasingly being adopted by healthcare providers to address care fragmentation for patients with multiple chronic conditions. However, a recent study published in the American Academy of Family Physicians suggests that while CCM is gaining traction, challenges persist in its implementation and reimbursement. A Growing Trend The study, which analyzed Medicare […]
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Understanding Modifier 25: A Comprehensive Guide

Understanding Modifier 25: A Comprehensive Guide

Often, a seemingly routine preventive visit or minor surgery can take an unexpected turn when a patient mentions a new concern, such as “Oh, by the way…” If a physician provides additional care beyond the originally scheduled service, you may be able to bill for a separate evaluation and management (E/M) service using modifier 25. […]
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CMS Finalizes MPFS with 2.9% Medicare Physician Pay Cuts

CMS Finalizes MPFS with 2.9% Medicare Physician Pay Cuts

The Centers for Medicare & Medicaid Services (CMS) has finalized its 2025 Medicare Physician Fee Schedule, which includes a 2.9% Medicare Physician Pay Cuts to physician payments. This decision, despite opposition from major industry groups, will impact healthcare providers and potentially patient access to care. The rule also includes several positive provisions, such as expanded […]
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2024 ICD-10-CM Code

ICD-10-CM Code Changes: What You Need to Know

The healthcare industry is no stranger to constant updates, especially when it comes to coding and billing. As medical knowledge advances, disease trends change, and the healthcare landscape evolves, the Centers for Medicare & Medicaid Services (CMS) and the National Center for Health Statistics (NCHS) update the 2024 ICD-10-CM Code set every year Healthcare providers, […]
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2024 Medical Coding Updates

2024 Coding Updates: Navigating New CPT, HCPCS, and ICD-11 Changes

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 […]
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Navigating the Shift: Preparing for the ICD-11 Transition in 2024

Navigating the Shift: Preparing for the ICD-11 Transition in 2024

The healthcare industry is on the verge of a significant transformation as we approach 2024: transitioning from ICD-10 to ICD-11. Healthcare providers, payers, and patients alike will all be impacted by this shift, which promises to revolutionize the way medical diagnoses and treatments are documented and reported. Our comprehensive guide explores the intricacies of ICD-11, […]
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