What is an ideal denial percentage? Yes, there will always be some denials

The denial rate represents the percentage of claims denied by payers during a given period and quantifies the effectiveness of your revenue cycle management process. A low denial rate indicates a healthy cash flow. A 5% to 10% denial rate is the industry average; keeping the denial rate below 5% is more desirable. Calculating Denial […]


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Received Payer Request for Medical Records? Keep Calm and Take These Steps

If a letter were to arrive at your organization in an innocuous-appearing envelope, you may be afraid to open it. It’s unsettling for a payer to request medical records for claims that have already been paid. It is becoming more and more common for providers to receive what appear to be innocuous medical records requests […]


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What is MIPS and How it Affects My Practice?

What is MIPS? On November 1, 2018, CMS released revisions to payment policies under the Medicare Part B physician fee schedule for the Quality Payment Program (QPP) for the calendar year 2019. In accordance with one of the most bipartisan and significant legislative changes to Medicare in a generation, the Medicare Access and CHIP Reauthorization […]


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Time-Based Billing for CPT Evaluation and Management

Within the guidelines of the CPT code book, CPT has stated; “When counseling and/or coordination of care dominates (more than 50%) the physician/patient and/or family encounter (face-to-face time in the office or other outpatient setting or floor/unit time in the hospital or nursing facility), then time may be considered the key or controlling factor to […]


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How to Deal with Patient Responsibility?

As patient responsibility balances climb, practice owners are seeking effective methods of collecting outstanding patient balances and ways to collect more payment at the time of service. Estimating patient responsibility prior to claims adjudication is a tricky business. However, practices can absolutely figure out a payment estimation plan that suits their needs and support the […]


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Avoid the Top 10 Modifier Mistakes – Modifier 58

Matching CPT code with an ICD 10 code, this 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. […]


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Identify Coding Pitfalls to Avoid Common Claim Errors

Coding errors accounted for 8.7 percent of improper payments made by Medicare in 2018, which cost over $2.75 billion. To avoid costly denials and potential payback demands, it’s essential to review code guidelines before submitting your claims. MBC helps many practices to pinpoint the coding issues so that there will be no  Common Claim Errors. […]


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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 […]


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