2023-01-30 02:57
Basics of Cardioversion
Cardioversion is a medical procedure by which an abnormally fast heart rate (tachycardia) or other cardiac arrhythmia is converted to a normal rhythm using electricit… Read More
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Latest Update on Medical Billing blog - ICD-10, what physican makes happy?, revenue cycle management, family practice and much more on MedicalBillersandCoders Blog
2023-01-27 14:59
Bilateral Surgeries Billing
Bilateral surgeries are procedures performed on both sides of the body during the same operative session or on the same day. Medicare makes the payment for bilate… Read More
2023-01-25 10:16
On 5th Jan 2023, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), issued guidance that creates an easier path to specia… Read More
2023-01-20 13:01
Basics of Destinations for Ambulance Transportation
Ambulance transport is covered to the nearest appropriate facility to obtain necessary diagnostic and/or therapeutic services such as a CT… Read More
2023-01-17 10:58
To share arthroscopy coding guidelines, we referred National Correct Coding Initiative (NCCI) policy manual. CMS developed the NCCI manual to promote national correct coding of Medicare Part… Read More
2023-01-11 14:14
A physician or supplier often has a lot of doubts when it comes to ambulance transports and ABNs. Most suppliers consider ABNs a way to avoid Medicare ‘medical necessity’ denials… Read More
2023-01-10 05:04
Medical practices sometimes equate improper payments with medical billing fraud. Improper payments could be unintentional where your received payment even after not meeting program requ… Read More
2023-01-09 18:15
Strengthening Affordable Care Act (ACA)
Recently, the Biden-Harris Administration released the 2024 Notice of Benefit and Payment Parameters Proposed Rule that aims to further advance the Ad… Read More
2023-01-06 04:49
A non-physician provider (NPP) is a healthcare provider who is not a physician but who practices in collaboration with or under the supervision of a physician. NPPs may bill payers directly… Read More
2023-01-03 07:49
ICD-10-CM Basics
Selecting accurate diagnosis codes using ICD-10-CM is challenging due to the availability of more than 68,000 codes. In this article, we shared general coding guidelines for… Read More
2022-12-30 07:53
Significance of Patient Experience
There is no question that patient experience is a huge factor when it comes to the success of your practice. In case of negative patient experience, their… Read More
2022-12-29 06:09
Basics of No Surprises Act
The No Surprises Act went into effect on January 1, 2022. This Act is aimed at reducing ‘surprise bills’ to patients in the context of services provide… Read More
2022-12-28 09:46
Billing and coding for cataract co-management can be tricky. It’s important that all parties involved should get accurately reimbursed for their time and expertise. To explain cataract… Read More
2022-12-27 06:28
Medicare Coverage for Ambulance Transportation
Medicare Part B covers emergency ambulance services and, in limited cases, non-emergency ambulance services. Part B covers medically nece… Read More
2022-12-22 14:07
Initial Preventive Physical Examination (IPPE)
The initial preventive physical examination (IPPE) is a preventive visit also known as a ‘Welcome to Medicare Preventive Visit’. Me… Read More
2022-12-21 10:25
Most medical and surgical procedures include pre-procedure, intra-procedure, and post-procedure work. When multiple procedures are performed at the same patient encounter, there is often an… Read More
2022-12-19 15:18
Many times physicians tends to code a regular set of procedure codes without a proper understanding of coding guidelines. It’s always advisable to take the guidance of certified coders… Read More
2022-12-14 13:39
What Is Claim Scrubbing?
Claim scrubbing is a method of reviewing claims before a medical practice submits them to an insurance carrier. Claim scrubbing removes all the errors that might lea… Read More
2022-12-13 12:50
The Centers for Medicare & Medicaid Services (CMS) in its ‘year 2022 annual update to the therapy code’ document introduced 5 newly added ‘sometimes therapy’ code… Read More
2022-12-08 08:23
Patients Love Telehealth
Healthcare providers and patients used to see medical care as something best done in-person. But the COVID-19 pandemic changed everything including a massive transit… Read More
2022-12-06 18:47
Need of Online Presence
In the current era of digitalization where mobile phones are no longer used only for calling, your patients are using every possible online channel to find informatio… Read More
2022-12-05 16:03
Many physicians struggle with fee-for-service payer contract negotiations because asking for higher payments can feel like a pointless effort. Negotiating a successful payer contract is poss… Read More
2022-12-02 18:26
What is Underpayment in Medical Billing?
An underpayment in medical billing refers to a billing situation where practices are expecting higher payments for delivered services while insurance… Read More
2022-12-01 17:47
Timely collection of patient payments is equally important as collecting insurance reimbursements. In the past few years as more and more patients are adopting High Deductible Health Plans (… Read More
2022-11-29 16:00
What is ‘Insurance Only’ Billing?
As the name suggests, in ‘Insurance Only’ billing, healthcare practices accept the amount the insurance company will pay and waive p… Read More
2022-11-28 16:10
Behavioral health billing is quite challenging as various factors affect the billing process. The length of the session, the approach to therapy, and the willingness of the patient to partak… Read More
2022-11-23 07:05
Forming group practice can be incredibly rewarding, from both a business and a financial standpoint. By starting a group practice, you have the opportunity to create a work atmosphere that a… Read More
2022-11-22 16:28
Basics of Healthcare Audits
In the healthcare space, audits play a crucial role in measuring compliance and patient satisfaction. There are two main types of healthcare audits that providers… Read More
2022-11-17 16:44
Need for Active Treatment (AT) Modifier
The Centers for Medicare & Medicaid Services (CMS) developed the Active Treatment (AT) modifier to define the difference between active treatment… Read More
2022-11-14 14:48
It’s Hard to Sell Your Practice
Selling a healthcare practice could be difficult a process. Key challenges in selling your practice include finding the right buyer, wading through lega… Read More
2022-11-09 18:45
Appropriate level of Evaluation and Management (E/M) services are based on Medical Decision Making (MDM) and time for services performed. In our previous article, we has a detailed discussio… Read More
2022-11-07 10:17
CY 2023 Medicare Physician Fee Schedule (MPFS)
The Centers for Medicare and Medicaid Services (CMS) on Nov. 1, 2022, released the final 2023 Medicare Physician Fee Schedule (MPFS), addressin… Read More
2022-11-04 11:02
Challenges of OB GYN Billing
Coding and billing for maternity obstetrical care are quite a bit different from the rest of the medical specialties. Maternity care services typically include a… Read More
2022-11-03 09:56
Defining Critical Care
Under CY 2022 Medicare physician fee schedule final rule, effective from January 1, 2022, critical care services can be billed as split/shared services. Before discuss… Read More
2022-10-27 08:44
Challenges of Running Solo Practice
If you are a solo healthcare provider or own a small medical practice, you might sometime feel the pressure of having to do everything on your own and str… Read More
2022-10-20 15:40
Claim Denials Due to Poor Documentation
Pain management billing is been regulated by various agencies like the federal government, medical boards, state government as well as many other regu… Read More
2022-10-14 12:24
Outsourcing is Need of the Hour
Nowadays, most of the practices feel comfortable passing the burden of billing and coding onto medical billing partners. Billing companies have medical specia… Read More
2022-10-12 11:07
Importance of Proper Documentation in Cardiology Billing
A lot of cardiology claims got denied due to improper and incomplete documentation. It’s really frustrating not to receive insu… Read More
2022-10-10 10:51
Medical Billing Challenges for Group Practices
Group practice owners face an unprecedented number of challenges today, from adding or replacing providers; getting rendering providers enrolle… Read More
2022-10-06 12:06
Challenges of Ambulatory Surgical Centre (ASC) Billing
Ambulatory Surgical Centre (ASC) billing and coding are completely different from the rest of medical specialties or the usual physicia… Read More
2022-10-04 12:37
After COVID-19, providers are now ready to provide excellent patient care through direct and virtual modes. Medical billing has always offered unique medical billing challenges prior and pos… Read More
2022-09-29 10:45
In this article, we shared coding guidelines for urology supplies updated for the year 2022. To share these guidelines, we referred CMS document on Local Coverage Determination (LCD) for uro… Read More
2022-09-23 08:43
Basics of Coding for Hypertension Associated with Diabetes
Most coders are still confused about which is the correct code for hypertension associated with diabetes. If you look carefully, hy… Read More
2022-09-19 11:12
Proposed Medicare Payment Cuts
Centers for Medicare and Medicaid Services (CMS) proposed 2022 Medicare Physician Fee Schedule and Quality Payment Program rules and included a 3.75 percent re… Read More
2022-09-15 10:42
Medicare Diabetes Screening Billing
Medicare Part B covers patients with certain diabetes risk factors or diagnosed with pre-diabetes. But note that patients previously diagnosed with diabet… Read More
2022-09-12 14:41
Basics of HIPAA
Medical Billers and Coders (MBC) being a leading medical billing company manages all revenue cycle management activities in HIPAA compliant way. In this article, we shared th… Read More
2022-09-08 15:33
Basics of Preventive Care
Preventive care helps detect or prevent serious diseases and medical problems before they can become major. Annual check-ups, immunizations, and flu shots, as well… Read More
2022-09-07 17:09
Prior to 2021, the time associated with CPT codes 99202-99215 was based specifically on the typical face-to-face time the physician/qualified health care professional (QHP) spent on the day… Read More
2022-09-06 17:13
Surgical Assistants
Practices lose insurance reimbursement by incorrectly billing surgical assistants. In such cases, the major reason for claim denials is to use the wrong modifier/ no… Read More
2022-09-01 12:35
Medicare Part A covers skilled nursing and rehabilitation care in a Skilled Nursing Facility (SNF) under certain conditions for a limited time. Coverage for care in SNFs is measured in &lsqu&hell…Read More
2022-08-25 11:32
Increased Scope of Telemedicine
Telemedicine and telehealth describe the use of telecommunication tools including the Internet, video, and email to exchange information in the context of hea… Read More
2022-08-23 12:50
Basics of Wound Care
Active wound care procedures are performed to remove devitalized and/or necrotic tissue to promote healing. Debridement is the removal of foreign material and/or devital… Read More
2022-08-17 05:32
The burden of Prior Authorization
According to a recent survey from the American Medical Association (AMA), prior authorization creates an administrative burden for healthcare practices, neg… Read More
2022-08-16 15:03
E/M Services Denial Reasons
As per the Centers for Medicare & Medicaid Services (CMS) data, approximately 15 percent of evaluation and management (E/M) services are improperly paid and a… Read More
2022-08-11 07:39
Understanding External Payer Audits
An external payer audit is an examination of a healthcare practice’s finances or processes conducted at the will of payers. These payers are either… Read More
2022-08-08 11:22
Basics of Telehealth Physical Therapy
During the COVID-19 pandemic, the federal government has broadened access to telehealth services including physical therapy. With revised billing guidel… Read More
2022-08-04 12:33
Improper Payment Reasons
Durable Medical Equipment (DME) suppliers of surgical dressings and physicians submit claims for surgical dressings and CMS covers it under the surgical dressings be… Read More
2022-08-03 06:10
Determining Medicare Drug Coverage
While billing for Skilled Nursing Facility (SNF) or for hospital billing, billers always make the mistake of considering the wrong Medicare drug coverage… Read More
2022-08-02 12:43
Recently CMS published Medicare Fee-for-Service (FFS) improper payment date for ambulance services for the 2020 reporting period. For this reporting period, the improper payment rate for amb… Read More
2022-08-01 05:03
Revised Role of Prior Authorization
So far insurance carriers have been using prior authorization as a tool to control spending and promote cost-effective care. But in changing billing scena… Read More
2022-07-29 05:34
Increasing Claim Denials
Recently Kaiser Family Foundation published an analysis on claim denials for various marketplace payers for the year 2020. Under the Affordable Care Act, marketplace… Read More
2022-07-26 05:42
As a practice owner, you might have a team of professional physicians who possess the right qualification and licenses but without properly credentialed providers you invite the risk of losi… Read More
2022-07-25 12:21
Recently on July 7, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces the proposed policy changes for Medicare payments under the Physician F… Read More
2022-07-21 05:32
Medicare Physician Fee Schedule Proposed Rule
Recently on July 7, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces the proposed policy chang… Read More
2022-07-15 07:54
CY 2023 Medicare Physician Fee Schedule Proposed Rule
On 7th July 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comme… Read More
2022-07-11 11:02
Billing Part B Outpatient Therapy Services
Outpatient rehabilitation therapy includes Physical Therapy (PT), Occupational Therapy (OT), and Speech-Language Pathology (SLP) services. Medicare… Read More
2022-07-08 13:16
SNF Advanced Beneficiary Notice of Non-coverage
Medicare requires SNFs to issue the SNFABN to Original Medicare, also called fee-for-service (FFS), beneficiaries prior to providing care that… Read More
2022-07-07 13:20
PCPs are Leaving Money on Table
According to a recent study published in the Annals of Internal Medicine, primary care physicians left a large amount of money on the table for services that… Read More
2022-07-06 12:20
COVID-19 Fraud
The federal government is broadening its multi-agency law enforcement effort to address pandemic-related fraud beyond Paycheck Protection Program (PPP) related cases to encomp… Read More
2022-07-05 12:45
Exclusion of Ground Ambulances from No Surprises Act
The No Surprises Act (NSA) will prohibit most surprise bills, reducing out-of-pocket costs for emergency services and non-emergency servi… Read More
2022-07-01 12:19
The Centers for Medicare & Medicaid Services (CMS) is resuming the Targeted Probe & Educate (TPE) audit, effective September 1, 2021. Based on data analysis of claims payment, CMS wi… Read More
2022-06-29 11:20
Vagus Nerve Stimulation (VNS) is a pulse generator, similar to a pacemaker, that is surgically implanted under the skin of the left chest and an electrical lead (wire) is connected from the… Read More
2022-06-28 09:19
Provider-Based Physician Services
Providers may retain physicians on a full-time or part-time basis in, for example, the fields of pathology, psychiatry, anesthesiology, and radiology, and i… Read More
2022-06-27 09:07
Receiving accurate insurance reimbursement for delivered services is always been a challenge for healthcare providers. Practice owners spend most of the time and energy on doing administrati… Read More
2022-06-23 13:39
Outsourcing your revenue cycle operations to a medical billing company is the right move toward securing the financial stability of your practice. But choosing any medical billing company co… Read More
2022-06-22 13:33
In the Final Medicare Physician Fee Schedule (MPFS) for 2022 issued on November 2, 2021, the Centers for Medicare and Medicaid Services (CMS) added five new CPT codes in the categories of Ch… Read More
2022-06-20 10:19
Understanding False Claims Act
As a healthcare practice, you can typically submit claims to Medicare or Medicaid. Your claims are bills for goods you provide and services you conduct for pat… Read More
2022-06-17 10:10
Physician Self-Referral Law (Stark Law) Basics
The Physician Self-Referral Law, commonly referred to as the Stark law, prohibits physicians from referring patients to receive Designated Heal… Read More
2022-06-16 10:29
A/R Follow-up in Medical Billing
Medical billing is a complicated process that requires special skills in medical billing, coding, denial, and AR management from experienced and well-trained… Read More
2022-06-15 09:58
Basics of ‘No Surprises Act’
The ‘No Surprises Act’ provides patients with protection from surprise medical bills under certain circumstances. The ‘No Surprises… Read More
2022-06-14 11:06
As a healthcare provider, during your residency, you probably are not focused on who pays for your patients’ care. Once you start practicing, it is important to understand who the paye… Read More
2022-05-25 09:59
On 19th May 2022, the American Medical Association (AMA) announced an update to Current Procedural Terminology (CPT®) including new product and administration codes assigned to the Moder… Read More
2022-05-20 13:20
Most providers are delivering telehealth services more often now. Due to lots of advantages, a large population of patients has also adopted to telehealth environment. While delivering teleh… Read More
2022-05-19 08:41
Throughout the COVID-19 pandemic, CMS and government agencies provided flexibilities to health care companies to use popular technology and applications to better engage with their patients… Read More
2022-05-18 09:50
Medicare covers diagnostic and radiology services, but these services must be completed or supervised by a certified radiology physician. Both radiology and other diagnostic health services… Read More
2022-05-17 13:33
Challenges in Securing Reimbursements For any practice owner, submitting error-free claims and securing accurate insurance reimbursements is the most important and at the same time most chal… Read More
2022-05-13 12:58
The A/B Medicare Administrative Contractors (A/B MACs), and Durable Medical Equipment Medicare Administrative Contractors (DME MACs) send to providers, physicians, and suppliers, as a compan… Read More
2022-05-12 15:11
A recent survey of U.S. healthcare organizations highlighted declining reimbursements as a top industry challenge. The COVID-19 pandemic changed payer billing guidelines, and reimbursement p… Read More
2022-05-11 13:44
Electronic Funds Transfer (EFT) allows Medicare to transfer payments directly to the provider’s financial institution. The Medicare EFT Authorization Agreement (CMS-588) is required fo… Read More
2022-05-09 12:52
Most providers face significant challenges when enrolling to receive ERAs (Electronic Remittance Advice) from any Medicare health plan. Some of the challenges include: a wide variety in data… Read More
2022-05-04 15:12
As of January 1, 2020, CMS pays Opioid Treatment Programs (OTPs) through bundled payments for opioid use disorder (OUD) treatment services in an episode of care provided to people with Medic… Read More
2022-05-03 14:30
Basics of Surprise Medical Billing Out-of-network billing, or ‘surprise medical billing,’ occurs when a patient receives a bill for the difference between the out-of-network prov… Read More
2022-05-02 07:35
What is EDI Enrollment? For a provider is trying to enroll with Medicare FFS, they must first establish an Electronic Data Interchange (EDI) agreement with Medicare. EDI is the process of us… Read More
2022-04-26 11:24
Documentation is one of the least favorite parts of Emergency Medical Services (EMS) providers’ job. However, next to patient care, it is one of the most important things. Many EMS pro… Read More
2022-04-22 13:17
Recently Healthcare Financial Management Association (HFMA) conducted a survey on day-to-day challenges faced by small practice owners. This survey revealed that frontline healthcare workers… Read More
2022-04-19 10:43
Unique Medical Billing Operations in the Year 2022 With a considerable number of claims being denied, most medical practices have struggled during the COVID-19 pandemic. Recently, Apollo Hea… Read More
2022-04-18 12:18
During the Public Health Emergency (PHE), The Centers for Medicare & Medicaid Services (CMS) used a combination of emergency waivers, regulations, and sub-regulatory guidance to offer he… Read More
2022-04-15 12:58
On April 11, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update Medicare payment policies and rates for skilled nursing facilities (SNF) fo… Read More
2022-04-14 12:22
Medicare, Medicaid, and private payers had relaxed their billing guidelines and revised reimbursement policies so that physicians can provide better care during the COVID-19 pandemic. A Publ… Read More
2022-04-13 12:31
Most practices are struggling to stay afloat due to shrinking reimbursements and the recent impact of the COVID-19 pandemic. The days of submitting an insurance claim and getting paid within… Read More
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