Diagnostic Medical Coding and Reporting Guidelines for Outpatient Services

These coding guidelines for outpatient diagnoses have been approved for use by hospitals/ providers in coding and reporting hospital-based Outpatient Services and provider-based office visits. The terms encounter and visit are often used interchangeably in describing Outpatient Services contacts and, therefore, appear together in these guidelines without distinguishing one from the other. Though the conventions […]

Medicare Advance Beneficiary Notice – 5 Tips for Reimbursement Success

An Advance Beneficiary Notice (ABN) is a waiver of responsibility that is issued to a patient to make sure you receive payment for services and items that are usually covered by Medicare but are not expected to be covered on this occasion. When completed properly, you should be able to recover the cost of the […]

Correct Coding for Pre-operative Clearance

Pre-operative evaluation and testing services may not be covered under Medicare. Primary care physicians are often asked to evaluate a patient prior to surgery at the request of the surgeon. Patients at an advanced age and those with significant medical problems face increased risk for surgical morbidity and mortality, and preoperative evaluation will depend on […]

Avoid the Top 10 Modifier Mistakes – Modifier 79

Matching CPT code with an ICD 10 code, would seem to be a very straightforward process but there are always variations/exceptions to everything. Sometimes, there are related services that the physician is performing, global periods to contend with, etc. Modifiers will clarify extenuating circumstances, which should allow for payment when they otherwise may not. That […]

General Coding Guidelines for Osteoporosis

Osteoporosis is a bone disease that involves abnormal loss of bony tissue resulting in fragile or porous bones. Without appropriate treatment, osteoporosis can worsen. As bones get weaker and thinner, the potential risk for fractures increases. Documentation is very important and physicians must ensure timely medical documentation to ensure appropriate treatment for these patients. Medical […]

Cardiology Billing: Improve Coding and Quality Score

If your in-house Cardiology billing and coding department are facing constant inefficiencies, and dealing with coding backlogs and if you are operating on a shoe-string budget and small staff, chances of a negative impact on your Cardiology facilities bottom line are very high. Keep in mind that seamless medical coding has an ever-increasing impact on […]

Risk Adjusted Hierarchical Condition Category (HCC) Coding

HCC is a payment model created by the Balanced Budget Act of 1997. Implemented by the Center for Medicare and Medicaid Services in 2003, the payment model will identify the individual with chronic illness and assign them to a risk factor score. This risk factor score gives CMS a specific plan out that channelizes the […]

How Will Patient Engagement Affect Your Value-based Reimbursement?

Patient Engagement is an invitation for participation with shared decision-making and to create a take on aspects of communication-channels which will provide the patients the benefit of managing their own health under the care of physicians or with the member of the healthcare team. An activated or engaged patient will provide the healthcare system with […]

Medical Billing: How Training Matters for Coders?

Accurate medical billing is important to achieve sustainable success for your medical practice. When centers lack in training their in-house coders, compliance is threatened. Below mentioned are the facts that you should know: According to several reports, up to 85 percent of medical bills contain coding mistakes resulting in $70 billion in estimated losses. 45 […]

Orthopedic Billing and Coding the Long but Sure Road towards Profit

Orthopedic practices thrive on efficient billing practices that help in streamlining revenue cycle management by cutting out delays and minimizing stress on cash flows. Here is a list of things you need to handle as efficiently as possible to avert claim denial at your orthopedic specialty clinic: Insurance Cover Verification Insurance cover verification is an […]

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Medical Coding