Key Points for Billing and Coding Critical Care Services

Critical care medicine specialists diagnose and treat a wide variety of diseases. A multidisciplinary team approach is needed to care for critically ill patients. Though there are only two codes for critical care services, reporting critical care presents a challenge because of the rules and regulations involved. In fact, Medicare and commercial payers scrutinize the […]

How to use CPT CODE 99214 Correctly?

CPT Code 99214 is commonly used for billing office or outpatient visits involving established patients with moderate to high complexity in medical decision-making. To meet the criteria for this level of Evaluation and Management (E/M) service, proper documentation is critical. It requires a detailed history, detailed examination, and medical decision-making of moderate to high complexity. […]

Estimating Patient Out-of-Pocket Responsibility

According to some sources, patients are now the third-largest payer group in the US behind Medicare and Medicaid. So, now is not the time to let those amounts due slide! One of the best ways to capture those amounts due is by avoiding surprises on the part of the patient by letting them know right […]

Understanding Medicare Non-covered Services

Non-covered services do not require an ABN since the services are never covered under Medicare. While not required, the ABN provides an opportunity to communicate with the patient that Medicare does not cover the service and the patient will be responsible for paying for the service. Pre-emptive communication through a voluntary ABN can prevent negative […]

Compensation for Cognitive Services and Insurance Carriers

A great deal of variation exists in the relationships between the pharmacist and the different types of insurance carriers, including Medicare, Medicaid, third-party payers, and managed care organizations. The Centers for Medicare and Medicaid Services (CMS), which administers Medicare and Medicaid payments for services, and the federal government are usually less flexible in dealing with […]

How to Control Blood Sugar?

Most of the food you eat is broken down into sugar (also called glucose) and released into your bloodstream for use as your body’s main source of energy. Diabetes is a condition in which blood sugar levels are too high. If you have type 1 or type 2 diabetes, it is very important to keep […]

Educate Medicare Patients Using MSN

The Medicare Summary Notice (MSN) is a summary of health care services and items patients have received during the previous three months. MSN is not a bill. This document is intended to help patients remember the physicians, specialties, supplies, and services involved in their care. The contractor that processes claims for Medicare will send the […]

Differentiating Between Medical Necessity and Medical Decision Making

Medical Decision Making specifically refers to the complexity of establishing a diagnosis and/or selecting a management option. Medical necessity refers to the appropriateness of the service provided for a certain condition. Medical necessity determines whether the service will get reimbursed. Problems arise when MDM and medical necessity are used interchangeably, or when practices and payers […]

Alternative Payment Models (APMs)

An Alternative Payment Model (APM) is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population. Types of APMs APMs: Meet the statutory definition of an APM. MIPS eligible clinicians participating in an APM are also subject […]

Preventing Diabetic Complications

Over time, diabetes can affect any part of your body. The good news is that you can prevent or delay many health complications by taking good care of yourself. Keeping your blood sugar within the target range acceptable to you and your doctor will help you to fight complications. Some common Preventing Diabetic Complications problems […]

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